Bridging the Physician-Management Chasm

Philip Betbeze, for HealthLeaders Media , April 15, 2013
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"It means multiple different things for us. We can't just do one thing, because we're in a private practice environment," he says. "We've made some investments in physician leadership initially around quality. It's clear to me that's where you integrate physicians into the financials."

But do you look for someone from the outside who has an MBA, for example?

 "That would not be a replacement for someone who has the respect of the group he's dealing with. Having the right person is equal to or more important than having a specific degree," Kronenberg says.

His senior medical quality officer helps make the translation by routinely speaking about quality with the physicians, but is careful to quantify ROI from following protocols, for example.

"There's so much opportunity to reduce costs around quality," he says. What does it mean if you have one less central line infection, for example? "Cost avoidance of $40,000 or more and at the same time getting a better quality outcome for that patient," he rattles off quickly. "We have lots of those opportunities. When you get to utilization, sometimes it's just a matter of changing people's practice patterns."

Kronenberg is careful to point out that in Crouse's predominant DRG-based fee-for-service reimbursement stream, the less it costs to take care of the patient in the hospital environment, and the more the savings accrue to you.

But such savings would still be shared in an ACO-like environment, he notes, making at least informal ROI training for physicians a must, especially for the individual physicians who have the most clinical credibility.

Crouse's most recent example of this training, stemming from an acquisition of a 15-physician internal medicine practice, has taken on a family vibe.

Some 40% of Crouse's employees are cared for by that practice, making such focus on quality and cost particularly important to the hospital. Kronenberg says the managing partner has been undergoing training in understanding balance sheets, the impact of cost reduction, and the basics of managing population health.

"I've taken their managing partner aside and told him, 'You have to learn about these things and you have to engage the other physicians in your group in getting to understand what this means,' " Kronenberg says. "He happens to be my son."

Philip Betbeze is senior leadership editor with HealthLeaders Media. He can be reached at

Reprint HLR0413-5

This article appears in the April 2013 issue of HealthLeaders magazine.

Philip Betbeze is senior leadership editor with HealthLeaders Media.
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