Physician-hospital alignment is important to improving the U.S. healthcare system. In this essay, we will go over the concept of the integrated physician model, clinical integration, the workings and controversies of accountable care organizations (ACOs), and the pros and cons for physicians that work under hospital-owned group practices.
The integrated physician model is best described as a group of physicians and hospitals coming together to form a partnership to help aid in the improvement of quality patient care, (Harrison, 2016). The concept of the integrated physician model is to have physicians and other administrative roles cooperate on multiple different ventures in order to accomplish a goal. A goal may be difficult to accomplish by one hospital or organization, but if a group is able to get together and effectively communicate and work towards the goal it may result in a more positive outcome. An example of an integrated physician model would be a primary care clinic, oncology clinic, independent medical group, and private oncologist practice working together to improve cancer related treatment protocols.
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Having physicians be a part of the planning process is important because they get to see firsthand how procedures and daily operations are performed. When physicians from different organizations communicate it’s easier to achieve a more cohesive treatment plan for a patient because the medical history can be more readily accessible. The integrated physician model is designed to allow various physicians to accomplish and meet goals for the patients and their practice.
There are multiple definitions for clinical integration. The American Medical Association (AMA) describes at is a way to coordinate patient care across multiple different outlets to achieve safe, timely, and efficient patient-focused results. The Affordable Care Act (ACA) describes clinical integration as coordination of care across settings to increase positive outcomes in areas such as expanding coverage, boosting quality care, promotion of innovation, and cost control, (Athena Health, n. d.). Both definitions encompass improvement of the coordination of care for patients through provider communication.
Clinical integration is very important into day’s healthcare system due to the variety of specialties that exist today. It’s especially important for patients with chronic conditions who receive care at multiple different facilities. Clinical integration is a continuous process of alignment across the care continuum that supports the triple aim of health care: improving quality of care, reducing or controlling the cost of care, and improving access to care and the overall patient experience, (Athena Health, n. d.). Clinical integration has an overall goal of improving the consistency of quality care for patients.
Affordable Care Organizations (ACOs) are groups of doctors and hospitals who come together voluntarily to give coordinated high-quality care to their Medicare Patients. They share both a financial and medical responsibility to keep their patients healthy, (ACOs, 2016). They can be financially compensated for accomplishing this goal. The groups receive the compensation by effectively coordinating the care of Medicare patients. This provides incentives to doctors to reduce costs of medical services and weed out duplicate processes.
There are controversies surrounding ACOs. ACO’s allow multiple providers to look into a patient chart. This adds an increased risk for HIPAA and PII breaches. Capitation is a possibility within ACOs. Patient’s that require chronic care may be high cost. Under an ACO these patients may be placed under a ceiling for payments that can be provided, leading to lesser care due to potential financial ruin, (ACOs, 2016). Total implementation may be very cost heavy depending on whether or not the organization already has an electronic medical record (EMR) in place. Setting one up may play a heavy financial burden on the organization.
Hospital acquisition of medical group practices began in the 1990s as healthcare organizations crated integrated delivery systems, (Harrison, 2016). Hospital-owned group practices refers to the acquisition of medical practices by a hospital. This is becoming more frequent in the U.S. due to the advantages that come along with being associate with a network of hospitals. In 2015, 63 percent of physicians said they were employed by hospital-owned medical groups and less than 32 percent were in private practice, (Harrison, 2016).
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A major advantage for physicians within a hospital-owned group practice is that they do not have to pay out of pocket for any special equipment that needs to be replaced because the hospital is generally responsible for it. When a physician is employed through a hospital their compensation includes their salary, bonuses, and contributions for profit-sharing. Physicians have more access to specialty care for their patients allowing for more optimized patient care experiences.
One disadvantage may be that a physician under a hospital-owned group practice is required to abide by rules of the facility that employees them. This means that they are unable to make certain decisions on their own due to possibility breaking hospital policy. In a private practice, physicians are, for the most part, able to make their own decisions without having to worry about interference from a high entity. Another disadvantage is that although having multiple providers can be a benefit, it can also cause issues. Too many providers dealing with one patient can cause conflict. One physician in the chain of care may disagree with another and may attempt to treat the patient their own way.
As the health care industry evolves, it seems integration is becoming more prevalent. Integration will continue to be improved upon as time goes on. As Healthcare administrators it will be important for us to maintain a knowledge of all aspects of this venture. Understanding topics such as the integrated physician model, and clinic integration will be key in the success of our careers.
- AHA. (2012). A Guide to Physician Integration Models for Sustainable Success. Retrieved from URL: https://www.aha.org/system/files/hpoe/Reports-HPOE/guide_to_physician_integration_models_for_sustainable_success.pdf
- Harrison, J. P. (2016). Essentials of Strategic Planning in Healthcare. [Purdue University Global Bookshelf]. Retrieved from https://purdueuniversityglobal.vitalsource.com/#/books/9781567937916/
- Athena Health (n.d.). What is Clinical Integration? Retrieved from URL: https://www.athenahealth.com/knowledge-hub/clinical-integration/what-is-clinicalintegration
- (2016, June 7). ACOs – Pros, Cons & Challenges of Accountable Care. Retrieved from https://eligible.com/community/pros-cons-accountable-care-acos/
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