CARLSBAD, CALIF. — Hospitals are standing on a "burning platform," and physicians just might be the ones to throw them a lifesaver.
That was the message delivered this week by Alice Gosfield — a health law expert and former chair of the board of directors of the National Committee for Quality Assurance — at the Siemens Health Executives Forum. Some two-thirds of hospitals got "dinged" by the new payment penality for readmissions. Hospital leaders need to better engage physicians on clinical integration if they want to survive in the new health care environment.
"Hospitals are standing, on Medicare alone, on a burning platform. They have the value-based hospital payment, which is not going to pay them for a whole bunch of things that they've been paid for before," she said, adding, "We have been paying for rework, redos, readmissions and re all kinds of stuff, particularly avoidable complications that have not been avoided, and that is where most of our health care dollars are being spent at the moment."
Gosfield was "thunderstruck" by language in the Affordable Care Act — which includes 483 uses of the word quality, 146 of effective or effectiveness, and 115 of value or value-based. If hospitals want to speak that same language and succeed in this new era, they must engage physicians around quality and value. Doctors are the portal to the health care system. When they're engaged, it translates to enhanced results, a better culture, and true inter-disciplinary collaboration in a system. On the flipside, disengaged MDs can actually thwart your efforts to deliver value-based care, Gosfield said.
Of course, employment of physicians doesn't automatically translate to clinical integration. Hospitals that are truly integrated foster clinical collaboration and interpendence among staff, and they track data to help figure out how to improve. Gosfield offered this handy tool to help gauge the level of integration at your hospital.
It's also critical for docs to have systems in place that help them to make decisions. It's easy to say that a physician is controlling or arrogant, but theirs is a profession where lives are put on the line, Gosfield said. It's hard to let go if you've harmed or killed someone in your career because of an innocent mistake or imperfect information, made on the fly, in the course of treating a patient.
"It alters them forever," she said. "This is such a horrifying vulnerability for them that the way they respond to it is by trying to control everything in their environment so that that problem doesn't happen again. This is really important for patient safety efforts and clinical integration. We need to create systems that support physicians in making their decisions in an optimal way, with the best information and safety redundancies, so that they can let go of what that's all about. Very much what non-physicians experience as the arrogance of physicians is exactly the opposite."
As for what sorts of payment models support such clinical integration, Gosfield is a supporter of the use of bundled payment, and specifically the Prometheus Payment model, of which she was the first chair of the board, which rewards providers for coordination and efficient care.
"How do you win in a system that's based on science? You win by picking the right partners from whom to take referrals, to whom you give referrals, and you are acutely aware of how you are delivering care over time," she said. "There has to be data that gives you information, and the goal of the thing is clinical collaboration. I think that kind of a bundled payment model can really support clinical integration."