Hospitals may have to cede power to get docs in ACOs

Hospitals may have to fork over more power, but not necessarily higher pay, to get physicians to participate in accountable care organizations and other cooperative initiatives. That's the upshot of a report on how hospital and physician relationships are evolving under healthcare reform, released today by PriceWaterhouseCoopers' Health Research Institute.

A full 45 percent of physicians say they would want more money if they went to work for a hospital--an average of 2.4 percent. But a total of 55 percent said they either wouldn't expect a pay hike (38 percent), or that they'd take a pay cut (17 percent).

In an interesting quid pro quo, more than 60 percent of physicians say they'd accept performance-based compensation as part of the deal. They say they'd want half of their pay to be salary, but that hospital employers could base the rest on quality metrics like productivity, patient satisfaction and cost of care.

Hospitals may be able to implement more standardized care protocols, too. Doctors indicated they'd be willing to accept national care guidelines, clinical protocols and other changes to their traditional practice patterns.

Hospitals will have to cede some control as they bring physicians on board with ACOs and other integrated care models. Nearly all of the study's respondents (between 93 percent and 97 percent) say physicians will need to serve as hospital executives, on boards of directors and in other leadership positions.

One unexpected bonus of better physician/hospital alignment: Nursing and support staff are happier and more productive, researchers note. In traditional arrangements, nurses and administrative staff work for the hospital, but have to respond to physician needs, making for an uncomfortable relationship, according to officials at Huntsville (Texas) Memorial Hospital, one of the case-study facilities profiled in the report. When physicians and hospitals are more closely integrated, "there is unbelievable camaraderie between the nursing staff, physicians and executives," says Larry Boyle, Huntsville's co-management director.

To learn more:
- read the PwC report