Over the past couple of years, our firm has completed fifteen client engagements that focused on physician alignment strategy. These projects were each tailored to the unique needs of the individual organizations and their diverse markets (in 12 different states).
But, as you might expect, there were common trends. We analyzed the final recommendations, as approved by the fifteen client steering committees, and evaluated the frequency with which particular issues were identified as strategic priorities. These might not all be relevant to your market, but some of them surely are, and we think this analysis provides a good list of issues to consider.
For purposes of this article, we have divided the potential tactics into four categories, based on their frequency: Group One represents core strategies, those most frequently selected as essential to success. Group Two tactics are the second most popular, pursued by most but not all of the organizations. Group Three are those strategies pursued by a handful of our clients. And Group Four are issues included by only one of our clients, and tended to address nagging problems for that client.
Group One: Core Strategies.
One issue was universal among our clients: physician recruitment. It is a major focus because every community faces supply challenges, and the shortage of physicians has most organizations focused on this issue. Tangential to this issue are two others:retention and succession planning. Those two frequently accompanied the focus on recruitment, but it was not universal, depending on the situation in the community.
Two other issues were almost universally identified as priorities: physician employment and promotion of doctors practices. Employment took two forms in these plans. The first was the need to begin to employ more physicians, defining target practices/specialties and defining the acquisition process. The second was the need to develop infrastructure to manage these practices (a model or models, managers, central billing offices, compensation plans, etc.).
Promotion of physicians and their practices was prioritized because it is both a physician relationship issue and a growth strategy. Hospitals often focused on promotion of specialists to other physicians through physician liaisons. They also focused on promotion to the public, with the goal of improving perceptions about the medical community and driving volume to the practices.
Group Two: Frequent Strategies.
Six other issues were identified as priorities by at least a third of the clients. Three of these were heavily focused on growth. Placing physicians in new geographies was a very popular strategy. Primarily, this related to the placement of primary care physicians in underserved growth areas. At times, it also related to the placement of specialists, either full time or in part-time clinics, in areas where the organization perceived an opportunity to grow referrals.
A second category of growth strategy was an outreach strategy, broadly defined. This might include elements previously mentioned, such as the liaison and satellite specialist office, but also might focus on patient intake, CME offerings in tertiary market communities, and special communication back to referring physicians.
The final growth-oriented issue these plans addressed was the development of strategic physician manpower plans around Centers of Excellence. These plans tend to address the capabilities lacking, the numbers lacking, and how to work with the specialists within the center to better serve referring doctors.
IT development and physician leadership development also fall in this category. These issues receive an additional boost and will grow in focus due to the changing environment. The stimulus package telescopes the timetable for EHR adoption and the potential demands of healthcare reform are increasing the focus on physician leadership. For these reasons, we believe these issues have the potential to move to the core strategy level.
The final strategy we frequently see is hospitalists. This strategy is fading somewhat in importance, as it is old news in many facilities. But in many organizations it is a required strategy to deal with issues such as ER call.
Group Three: Occasional Strategies.
Two to four times in fifteen engagements, these issues have arisen. But all need to be considered as the plan is develop, and some (such as co-management) are growing in importance.
Though relatively mundane, they can be strategically important. This list includes medical office building development, recruiting infrastructure, and employed practice consolidation to facilitate practice efficiency.
Two issues related to economic integration, co-management and joint ventures, fall into this group. As noted, co-management is getting more consideration in our most recent projects, while JVs are getting less, due to regulatory limits.
Two of the issues in this group relate to physician culture. Several hospitals have chosen to focus on the social dynamic of the medical staff. The objective of such a strategy is often to facilitate social relationships that have diminished with the advent of hospitalists. The second cultural strategy has to do with governance of employed groups, and specifically how to keep the physicians engaged. This is obviously a priority for organizations that have employed physicians but are not achieving the value they desire from these relationships.
The final issue in this group is Rural Health Clinics and/or Federally Qualified Health Centers. Hospitals, at times, see this as integral to their physician alignment efforts for three reasons: First, the favorable reimbursement can facilitate physician recruitment. Second, the model can also help address the needs of an under served population. Third, it can improve the payer mix for the rest of the medical community.
Group Four: One-Time Strategies.
Three issues surfaced in our alignment plans at one organization alone. These were the development of new residencies, intensivist program development, and compensation for medical directorships within the hospital. Of these, we believe that residency training has the potential to increase in importance, driven by the physician shortage and the changes in residency funding included in some of the reform efforts.
This laundry list of potential strategies should be useful as you address physician alignment. We also know that it is not all-inclusive. For example, in planning sessions we have considered strategies such as merger with a multi-specialty group and allowing the hospital to be acquired by such a group. While the strategy was not pursued, the discussions lead to valuable insights and new considerations.