Cooperative physician teams were important for developing the hospital's heart failure clinic, Ronan says. At least 50 patients were enrolled in the clinic, with many referrals by hospitalists and providers in the hospital's observation unit. Multidisciplinary teams "identified several medication mismatches from discharge instructions and have intervened to make appropriate adjustments in medications," he says. Patients also have been screened for sleep apnea and referred for sleep studies, or to nephrology and home care when appropriate.
The hospital has increased its collaboration with "primary care physicians, and our focus is on disease management by setting personal goals," Ronan says. "We also help to achieve the goals through formalized individual and group teaching with collaboration with dieticians and pharmacy staff."
Hospital leadership consistently talks with primary care physicians about the potential of the heart failure clinic. "The chief medical officer is assisting by ‘talking up' the heart failure clinic to medical staff," Ronan says. "He is emphasizing that enrolling patients in the clinic will free some of their office time that is spent managing complex patients."
Developing a culture
When putting together a physician team, hospital leaders have to determine not only where the pieces of the puzzle fit, but also how to change the culture of the organization to conform with the new puzzle's shape. Nearly all medical systems employ medical directorship teams to evaluate quality and patient safety in their organizations. Others are broadening the roles of physician staff to further evaluate hospital needs, whether it's hiring a new administrator or defining what service lines to add for anticipated patient needs.
Hospital leaders who are forming and reforming physician teams examine their patient demographics to determine the demand for certain specialties—such as cardiologists, oncologists, and orthopedic surgeons, whether employed or independent—as well as the needs for its primary care base.
Developing a primary care base
As health systems consider accountable care organizations, development of teams with primary care at their base is crucial for a hospital, says Jim Stone, who is president of the Medicus Firm, a physician recruitment company with offices in Atlanta and Dallas, and serves as president-elect of the board of directors for the National Association of Physician Recruiters.
"I think with the concept of the ACOs on the horizon, and basically getting into a capitation type environment, the key component for a health system will be to manage care for that patient population," says Stone. "To do that, you need to control physician behavior, and you can't do that without having the influence of a primary care physician quarterbacking" overall patient care, he adds.
But hospitals must rely on a population foundation to develop their physician teams, and that rests with demographics, says Griger. When a hospital system balances deciding whether to get hospitalists or subspecialists in the most cost-effective manner, much of it is related to demographics, which must be evaluated closely.
"We have hospitalists, intensivists, invasive cardiologists, and cardiac surgeons here because there is a need and there is the population to support those services," she says. "We don't have a cardiac transplant service because there aren't enough patients here who need that service, either to support it economically or to maintain the level of technical expertise needed to do that kind of work."
Most hospitals are reporting an increasing need for psychiatrists and neurologists, accounting for 15%–20% of placements, according to Stone. Primary care placements remain the highest percentage of all—34%—with surgical specialties next at 20%.