Long-held hard feelings undermine physician-hospital relationships


You know, you look at the history of relationships between hospitals and physicians, and you begin to think that hospitals are from Mars and medical practices are from Venus--or maybe from Cleveland, I don't know. The point is, for two industries you would think have fair number of interests in common, they don't get along very well.

That, at least, is the conclusion I've drawn from my recent attendance at this year's Medical Group Management Association meeting. One of the highlights of the meeting--for me at least--was my attendance at a session in which several consultants and health system administrators spoke freely about their philosophies on aligning with physician groups.

A few things they made clear were that:

* They generally prefer to hook up with small, new primary care practices whenever possible, as they're not confident established groups are going to play ball with them.

* They're ready to admit that medical groups shouldn't be forced to carry a share of the hospital's overhead, but instead, that groups brought into the hospital should be treated like assets that drive business.

* While all accepted that new in-house groups bring ancillary services revenue to the table, there's still no industry-wide standard for how such revenue should be accounted for in judging a medical group's performance.

These attitudes may not win administrators an A+ from doctors (especially the first), but it seems like the administrators are moving in the right direction. Admitting that the currently standard practice of allocating health system G&A to medical groups (then castigating them for losing money) might not be such a good idea is progress, after all.

Still, conversations in the hall at the show, and comments on the related story posted on FierceHealthcare.com, make it clear that there's still a huge cultural gap in place. Check out the (perhaps understandable) bitterness in this one poster's comments:

"Hospital CEOs think they know best, but community groups with long standing ties in a community have seen practice models (PPOs, etc) pushed by hospitals come, and then usually go at great expense and frustration. Furthermore, most old hands have vivid memories of ignorant CEOs trying to come in and push their vision of medicine down their throats. Hospitals should stick to running hospitals and get out of the hiring physicians. It eventually blows up in their faces, especially in smaller communities."

This points to a reality that is difficult to escape, no matter how enlightened health systems become, and no matter how intelligently the hospital makes its case. Health systems and hospitals have been struggling to form a more viable integrated relationship for decades, and each unsuccessful round has scarred both sides. While the problems that take place may be due to a wide variety of factors (including health plan strategies, which weren't even mentioned at the conference session) hard feelings seem mostly to have focused on the face doctors and CEOs looked at at the bargaining table.

So, readers, what do you think? Have you run into a model for physician-hospital integration that can help put some of these hard feelings aside and help both sides enjoy the fruits of their labor? I'd love to hear from you. - Anne

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