1. Bridge the gap between surgeons and hospital executives with shared revenue opportunities. Hospital executives and independent spine surgeons have traditionally been on opposite sides of the spectrum when it comes to managing the spine hospital service line. However, more surgeons and hospitals are taking advantage of the opportunity to come together around a mutually beneficial goal — providing great patient care — while also sharing in savings and revenue generation.
"We have to recognize that one of the primary motivators for both hospitals and surgeons is revenue," says Scott Gibbs, MD, founder of Brain and NeuroSpine Clinic of Missouri and director of the Southeast Missouri Hospital's Brain and Spine Center, both in Cape Girardeau. "I think revenue opportunities are very important and we have to inspire others to work toward a mutually common goal. Surgeons need to take the lead with hospitals and craft a vision that is mutually beneficial for the hospital and the surgeon."
These partnerships could come in the form of co-management arrangement of spine service lines, collaboration to construct a comprehensive orthopedic or spine "center of excellence," or a joint venture surgery center, among other arrangements. "The surgeons and the hospitals have to create a vision that is big enough to include both parties," he says. The future may bring additional challenges and opportunities for surgeons and hospitals to partner and share revenue gains, especially in accountable care organizations.
2. Form the foundation of your relationship around value created. Orthopedic surgeons must demonstrate the value they bring to the table as partners with hospital executives. This value can come in the form of clinical expertise, operational efficiency or positive reputation, and should become the foundation of your relationship.
"We as men and women need to become men and women of value to our patients and create relationships with the hospital that drives value," says Dr. Gibbs. "I think value is created through creative collaboration with the hospital. As the Irish playwright George Bernard Shaw said, 'Life isn't about finding yourself; it's about creating yourself.' We have to continue to create ourselves as spine surgeons."
Heightening your value as a surgeon often means continuing your education, learning new surgical techniques and participating in research to advance the field. It also means using new technology and adapting to changes in spine care delivery.
"We have to grow and learn new procedures and stay abreast of new technologies," says Dr. Gibbs. "There are a lot of surgeons who don't seem to make as much effort as they need to in staying abreast of new technologies and techniques. If they do that, they will be at the head of the pack. Leadership is about leading, not working from behind."
3. Appoint a contact representative to manage communications. Individual orthopedic surgeons need to focus on their medical practice, which means they don't need to be involved in every correspondence about the partnership between their group and the hospital. Larger groups often appoint a physician or practice administrator to coordinate with the hospital's administration.
"To have someone who can be managing the process in terms of communications is going to be important," says Randy Shulkin, a consultant with Culbert Healthcare Solutions. "Having a representative of the physicians there who is visible is important to keeping these relationships on track." While communications might funnel through one person, that person can also bring in other physicians for meetings or other correspondence when necessary.
4. Approach meetings as partners. "Don't approach the hospital as the enemy from which you need to get as much money as possible, but as a partner," says Rick Wilfong of Rick Wilfong Consulting.
Orthopedic surgeons and hospital executives must have a secure space and trusting relationship so they can talk candidly about what works and what doesn't. "This relationship is important and people have to have a venue where they can trust each other and be frank with each other," says George Rappard, MD, founder and director of the Los Angeles Brain and Spine Institute at Hollywood Presbyterian Medical Center in Los Angeles.
During these meetings, it's important to look at solutions for increasing efficiencies and lowering expenses. You can help the hospital by considering the use of a cheaper devices or implants, working with the hospital to renegotiate current contracts for a better price and being conscious of your payor mix.
5. Set mutually beneficial goals. Strategic alignments between hospitals and orthopedic surgeons are based on agreement of appropriate metrics, goals for future accomplishment and acknowledgement of the baseline data. Financial terms of the agreement should also be clearly stated upfront.
Sanjay Jatana, MD, founder of Denver Spine, is part of a co-management agreement with one of the hospitals in his area. The physicians who work within the orthopedic specialty at the hospital created a company to form an operating agreement with the hospital. Inclusion in the company is based on credentialing and a quality of care set up by the physician group.
"The concept is that a company is created by a bunch of physicians working at the hospital and the prime function of the company is to improve quality and efficiency of care for that institution," he says. Benchmarks in 18-20 categories are set for several different components to improve the efficiency of the surgical process, decrease readmission rates and length of stay and minimize the cost of implants. Once the benchmarks are set, surgeons must meet the benchmarks 100 percent in each category to receive extra compensation.
"The idea is that it's not gainsharing, it's more of a co-management agreement that has nothing to do with the volume of surgery being conducted at the facility," says Dr. Jatana. "It's designed more toward quality and efficiency." Under these agreements, physicians aren't putting in time that isn't reimbursed and are able to use the hospital's database to monitor patients."
6. Maintain a good relationship with hospital staff. You should make sure you have a good reputation at the hospital, which means fostering a good relationship with the nursing staff, anesthesiologists and other OR professionals. "Developing a good relationship with all these people means there will be a positive messages getting back to the administration," says Mr. Shulkin. "The administrators will hear not only are you a good physician technically, but also from a personality perspective, you are a good person to work with. Then you will be at the forefront of their radar."
7. Keeping the agreement open. If you enter into an exclusive partnership or agreement with a hospital, you’ll need to honor that commitment. Instead, choosing alignment might be a smarter option because surgeons can still work with other area hospitals.
OrthoIndy physicians successfully maintain an alignment with St. Vincent Health in Indianapolis for a strategic partnership between the two groups. The partnership allows OrthoIndy physicians to maintain autonomy but still partner with the hospital to navigate the healthcare world more efficiently.
Even though OrthoIndy physicians have partnered with St. Vincent, they can still see patients at other hospitals, which is important for maintaining positive relationships in the community. The partnership is that it allows OrthoIndy to grow in different markets and work with other facilities in relationships the group has valued over the years.
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7 Tips for Solid Orthopedic Group Partnerships With Hospitals FeaturedWritten by Laura Miller | February 14, 2013
Here are seven tips for a solid partnership between orthopedic groups and hospitals.
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