Co-management agreements are growing in popularity as health care shifts to outcomes-based reimbursement models.  Physicians and hospitals contract with one another in quality-oriented pay-for-performance arrangements, in which physicians oversee and manage service lines (most commonly orthopedics, oncology, and cardiology). The overarching goal of these agreements is quality improvement, which benefits all parties involved -- especially the patient.  The hospital benefits financially in part from reducing costs and physicians receive a base ...

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A big challenge facing academic medical centers is how to maintain a focus on patient care in an artificially divided environment.  Most academic medical centers developed in a system with abundant resources, cost-based reimbursement and a traditional academic departmental structure.  This led to individual departments growing as microsystems formed around particular specialties. The untoward effect of this is that the different silos within the system tend to operate with their own ...

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More and more hospitals are realizing that the 30 to 50 percent of waste occurring within their organizations is not only real, but a tremendous opportunity.  This is good news for both our patients and our health care system.  The bad news is that many hospital executives believe that this waste is largely limited to processes like materials management, ER wait times and operating room first-starts. The next step in our ...

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For many years, I taught a sizable chunk of our local medical school’s second-year pathology course.  I was always energized by the students’ enthusiasm and desire to learn more about medicine.  On the other hand, I remembered feeling their same frustrations regarding the lack of fundamental practice skills included in today’s medical school curriculum. In fact, at our university, a group of students started a business in medicine interest group, where ...

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Last year, hospitals and health systems underwent 98 consolidations, a 51 percent increase from 2010.  Many of these mergers and acquisitions arose in response to declining government reimbursement and the Affordable Care Act.  Smaller hospitals are having increasing difficulties maintaining a margin and many face high debt burdens, bankruptcy or even closure. But is consolidation the clear-cut answer? Here are 4 reasons bigger actually may not be better for all hospitals: 1. Disparate ...

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My husband and I both like to run.  I run about 3 miles once or twice a week -- if the weather’s not too bad, and if I don’t have something else going on.  Keith, on the other hand, runs half marathons.  He goes for long runs on the weekend for 3 to 4 hours at a time, and shorter runs during the week.  He runs in the heat, rain ...

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We’re ready to work on cost savings, just not for patients. There is a tremendous amount of culture change needed to move from fee-for-service to value-based health care.  One of the paradigm shifts is for hospitals to embrace the strategy of cost reduction as opposed to the traditional focus on top-line revenue.  In a system that focuses on value rather than volume, increasing the amount of hospital resources a patient consumes ...

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Over the past 5 to 10 years, hospitals and physician offices have been in a mad dash to implement electronic health records (EHRs) in order to meet governmental regulatory requirements.  Now that most projects are either complete or well on their way, what are we doing with all of the data that EHRs promised to generate? From my experience as a physician at a large academic medical center with one of ...

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As a physician, I enjoy listening to non-physicians tell me how to motivate doctors.  I don’t mean this in a totally snarky way (well, maybe just a little).  These conversations often highlight the chasm that exists between physicians and administration. What’s the most common motivator people throw out there? Money.  Certainly everyone wants to make more money, I don’t refute that.  What I take issue with is the notion that the ...

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I read an article recently that implied the practice of hospitals acquiring physician groups encouraged “clinical integration and multidisciplinary team-based health care.” I guess that would depend on your definition of clinical integration. The American Hospital Association has a particularly cogent one, which is: “[A practice] needed to facilitate the coordination of patient care across conditions, providers, settings, and time in order to achieve care that is safe, timely, effective, efficient, equitable, ...

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Many hospitals rely on bond funding for their expansion and the purchase of new equipment.  Revenue that is created by the hospital is then used to pay back the bondholders.  The risk to bondholders is that they are generally paid after the hospital pays its operational expenses.  Therefore, if the hospital is less profitable than expected (or not profitable at all), bondholders assume the financial risk. Hospitals have historically been rated ...

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When I started medical school, a wise professor likened the amount of new information I was about to learn to trying to drink water from a fire hose.  It didn’t take long until I understood exactly what he meant.  After sitting through the seemingly endless hours of lecture, lab and small group sessions required in the first two years of medical school, my head was spinning from information overload.  The ...

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