Features by William D. Petasnick, Kenneth Cohn, MD, Leonard H. Friedman, PhD, and Thomas R. Allyn, MD

EDITORIAL

Cooperation and collaboration between hospitals and physicians are key to achieving improvements in the quality of medical care delivery and outcomes. As each of the authors in this issue of Frontiers notes, old medical staff models are not adequate for today’s challenges and demands. New and creative approaches to the hospital-physician relationship are needed. Each of the authors discusses different approaches to this challenge, and as they do so a common theme runs through their words: alignment of incentives between hospitals and their doctors and strong communicative teamwork throughout organizations are needed. Structures that incorporate these two key ingredients will not only succeed, they will put the patient at the center of attention.

This issue of Frontiers brings together experts from executive offices to medical offices to academe to share insights and perspectives gleaned from years on the front lines of practice and experience. The lead authors have addressed models for the physician-hospital relationship and the three physician commentators add further depth and breadth to the discussion.

Feature author William D. Petasnick succinctly outlines the challenges that physicians and hospitals face as including “declining reimbursement levels, increasing competition, rising consumer expectations, and transparency pressures against a backdrop of increasing demands for greater efficiencies and cost-effectiveness.” He challenges us to recognize that “the time has come to commit to creating a new clinical enterprise that is built around physicians and hospitals that are strategically aligned and are committed to working together.” Commentator Dr. Scott Larson brings another perspective to bear on the importance of the enterprise model when he comments, “The axiom that hospitals don’t practice medicine, physicians do, must be rewritten to say that the practice of medicine requires a team of providers led by physicians and it continues inside and outside of the hospital.”

Dr. Kenneth Cohn and his colleagues also express this sentiment in their feature article in relationship to the cultural shift that is needed. They remark that “healthcare leaders need to discern the handwriting on the wall … and to embrace cultural change as an opportunity rather than a threat.” Put another way, commentator Dr. Michael Perry calls for trust building by “making joint and aligned decisions [that] will eventually decide the success of these programs. In the end the patient will be the one who benefits.”

Payment systems have historically not only failed to support collaboration between hospitals and doctors, they have discouraged it. As Petasnick regrets, “Unfortunately, regulatory and environmental barriers to collaboration and to sharing financial benefits from performance and quality improvements have created incentives for physicians to look for other venues that are better able to reward these behaviors.” Countering this phenomenon, commentator Dr. William Fera observes that “If hospital and physician pay-for-performance programs can grow together … and feed into one another rather than run on separate, parallel tracks, hospitals and physicians will have incentives to accomplish common goals.” Perry, drawing on his experience as a physician CEO, aligns with Fera on this point. He comments that “Systems can offer incentives to physicians that meet quality goals by legally sharing pay-for-performance rewards. Sharing rewards can go a long way to unite goals and strategies.…With pay for performance knocking on our doors, we must find ways to align physicians and hospital goals.”