The ultimate goal of physician acquisitions is enhanced coordination of care and integration across the care continuum. The sad reality is that most providers currently share very little clinical information with each other. Diagnostic and/or therapeutic information from one location or encounter is often unavailable to others who treat the patient at another location. In developing a physician network, the coordination of care is too often deferred until “later” because physicians and management are not comfortable with how to proceed.
First, it should be recognized that clinical integration is different than economic integration. Clinical integration requires different operational activities and decision-making approaches than those of typical hospital systems. It should start with the integration and coordination of key services lines or programs. While integration often begins with primarily inpatient-focused services, the concept should be extended into ambulatory care and include a broad spectrum of providers and facilities. In spite of how difficult it is, a transformation from traditional isolated care delivery models to coordinated care models is required if the hospital is to remain successful. This transformation cannot be done exclusively by healthcare administrators. Most importantly, the skills required focus on:
- Making clinical decisions.
- Evaluating evidence-based medicine protocols.
- Communicating clinical standards and expectations.
- Evaluating provider performance.
Leadership must come from physicians who are supported by clinical coordinators. Phase 3 therefore requires the addition of a different type of manager, as physicians and nurses become central to decision making. Administrators and financial managers will serve in supporting roles to ensure that clinical decisions are sustainable. When structuring leadership for clinical coordination initiatives, the balance of administrative and medical perspectives is an important goal. There are many ways to structure a leadership team that includes physicians, nurses, and lay administrators, but we have found that a “dyad” management structure, which pairs a physician leader with a senior administrator, can be an effective option for managing clinical coordination.
With the growing importance of clinical coordination throughout the hospital industry, it is not surprising that qualified physicians and care coordinators are in short supply, but these are the professionals needed to make any sustainable progress in reducing costs and improving quality in this phase. The search for physicians and nurses who will provide the needed clinical coordination leadership should begin very early in the integration process, whether those physicians and nurses are homegrown or recruited from the outside.
Our next post will focus on the final phase of physician integration: Physician Partnership.
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