"Developing our primary care base is really our overall strategy," says Leaver. "We felt we were more of a hospital-centric organization and needed a more integrated delivery of care, to be physician- and patient-centered. We won't be able to have physician buy-in to the [ACO] model unless we create physician leaders now." More than 30 graduates currently are being considered for leadership positions in the organization, he says.
As Barry P. Ronan, president and CEO of the 275-bed Western Maryland Health System in Cumberland, examines the current physician landscape and the needs of his facility, he says the organization works to maintain a balance among hospitalists, specialists, and subspecialists. "As more and more attending physicians give up their hospital inpatient privileges to focus on their office practices exclusively, we add additional hospitalists or nurse practitioners," Ronan says. "We also continue to recruit specialists and subspecialists in the community in order to complement our existing physicians and to support our extensive program requirements."
Hospitals must always look at costs when they are recruiting individuals for teams. It is estimated that a physician search can cost as much as $50,000. Another $20,000 may be spent on signing bonuses and other incentives. But the right physician is worth the recruiting investment, bringing in potentially millions of dollars for a hospital depending on the specialty—and adding that "perfect fit" so essential to a hospital's goals.
When assembling a physician team, Christine Griger, MD, president of the Affinity Medical Group, part of the three-hospital Affinity Health System based in Menasha, Wis., says her group is exploring different ways to improve physician relationships within the larger health system, especially as it forms teams for medical home care.
"We have people knocking on our door to get in," Griger says of physicians seeking the security of hospital employment within the Affinity Health System. "There are physicians who have been independent and in smaller groups, wanting that security and stability of a healthcare system. But we need them to function not just as a physician, but as a businessperson, too," she says. Affinity Medical Group includes 265 physicians and advanced practice providers and 26 clinics in northeastern Wisconsin.
With Affinity's unified medical staff, any member of the medical group can serve as a department chair or head of quality. Still, as Affinity executives examined its governance structure, it sought more physicians in leadership roles, says Griger.
"We need more physician leadership in operational issues, for quality and patient satisfaction and productivity," she says. "We are developing a title of a regional VP for physicians, who will be involved in physician leadership primarily in an administrative way," she says.
The health system enlisted "all types of team development and collaboration" across the sites as it initiated case-management changes and improvements in staff to stay on track with patient-engagement protocols, Griger says.
Colavita of the Sanger Heart & Vascular Institute says his health system chooses team members who are responsible not only for various aspects of care, but also for documentation of specific metrics for procedures during a patient's stay—and sometimes even after a patient is discharged. A Carolinas HealthCare System quality committee reviews the patient data to improve patient outcomes, Colavita says.
The Sanger Heart & Vascular Institute stepped up its team concept in recent years after a large cardiology practice joined it. Regional and subspecialty medical directors are charged with overseeing operations divided into various aspects of care, such as cardiovascular surgery, Colavita says. Each physician group can be empowered with clinical decision-making and hire doctors. "We actually have a ‘delegation of authority' document," he explains. "This document defines who can recommend and/or approve a decision. The doctors can decide to hire another physician; the executive committee may decide to open another office."
The institute's executive committee is composed of members from the CHS administration, Sanger Heart & Vascular Institute, and Carolinas Physician Network. The officials are the SHVI president; the chair of the department of cardiovascular and thoracic surgery; the regional medical director; three CHS executive vice presidents; a CHS hospital president; the SHVI executive director; the CHS chief medical director; the Carolinas Physician Network senior vice president; and the Sanger metro (subspecialty) committee chair.
"What's necessary is a common culture, and an understanding where different physician groups are coming from," Colavita adds. "Each physician has a stake in this. There is nothing to be said about arguing with each other, but working together and doing a better job."