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Collaborative Hospital-Physician Relationships: Moving Beyond Control

In a previous post, I mentioned that the January 1, 2012 deadline for Accountable Care Organization (ACO) Medicare applications is rapidly approaching.

In a recent Advisory E-Alert, entitled the Hospital-Government Complex, Mark Weiss, warned physicians:

The fact is, the ACO is simply a model for hospital control of physician practices, cloaked in the respectability of quality of care. Tied to the focus given to the notion of paying for quality of care as opposed to simply the volume of care, pundits suggested that organizations linking hospitals, physicians and other providers can be used to contract together, take risk based in part on achieving quality (however quality is defined), and distribute the income.

The reality is that there is only one acronym at play here: PCN — Power, Control and Naiveté. Issues of power and control underscore all levels of healthcare. As to the “N” for naiveté, it’s yours that they are counting on.

 An ACO is about power and control over physician services rendered and, importantly, power and control over physicians’ incomes. ACOs are the intended funnel of payor funds – they serve as a mechanism to distribute those funds and, as such, invoke the Golden Rule: He who has the gold makes the rules.

 As a physician, if you think that it’s difficult to negotiate with third party payors or to obtain stipend support from the hospital to shore up declining reimbursement, think what it will be like when there is one real payor in town, the hospital-controlled ACO.

In Surgeon Frustration, I mentioned that we are no longer viewed as captains because we lack process skills in communication, win-win negotiation, and conflict resolution that are necessary for leadership.  However, the lessons that guide me through these uncertain times come from my inadvertent fellowship in oncology, when I received chemotherapy for lymphoma and learned the mope-cope-hope strategy for dealing with helplessness. 

I paradoxically derived strength from admitting that I did not have control and focused on what I could influence, especially my attitude toward helplessness.  I quoted Paul Tsongas’ book Heading Home about his battle with lymphoma:

Now the matter of belief is central to me and gives me a truer sense of direction.  These changes are a precious gift.  My illness gave them to me. I treasure them.

President Reagan told advisors who brought him bad news, “You have shown me the manure. Now find me the pony.”

I think that we need to look for the gift of these times: an opportunity to improve healthcare delivery, so that we can improve clinical outcomes and cut costs at the same time.  Every one of us who cares for patients can play a role by doing things right the first time and being mindful of what we are doing for patients in the present moment.

At Sentara Health, the acronym SAFE stands for:

• Stop
• Assess
• Focus
• Evaluate

It seems counterintuitive, when we have so many tasks to accomplish, to stop first, but we have precedents.  Before operations, we take time out to verify that we are performing the correct procedure on the correct patient on the correct side.  At most hospitals, we pause to obtain a sponge and instrument count before closing.

Control means different things to different people.  For most physicians I know, control of their time is far more important than control of material assets, like property, plant, and equipment.

The Copernican model of putting patients and families at the center of our universe says nothing about control except that we try to control what we do to patients to cause no harm.  I believe that caring physicians will play a central role and that successful ACOs will coordinate care, optimize outcomes, and limit readmissions regardless of who is in control.

What do you think?

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

© 2010, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

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