Long before the recent round of national healthcare reform legislation was proposed, many hospitals and physicians were already scrambling to better align for mutual financial benefit and to grow 临床 programs through a number of vehicles, 包括更积极的bet8娱乐安排, 子公司的合资企业, 最近, 管理模式与医院医师就业. 随着《bet8娱乐》(PPACA)的通过, 这种活动已经加剧. Under pressure to manage costs and share risk through models such as the accountable care organization (ACO), community hospitals/systems and physician practices are repositioning for the post-reform era. Noticeably quiet amid all the activity has been the academic medical center (AMC). 资产管理公司是否认为自己为改革做好了准备? Are they procrastinating in the face of unique organizational, political, and economic challenges? 这篇文章, 两部分系列的第一部分, previews one dimension of the AMC that will require redesign in most institutions under healthcare reform – the organizational relationship between the teaching hospital, 教员团体实习(FGP), 以及其他相关实践.
Reform-Ready?
被共同的使命所束缚, teaching hospitals and their affiliated practices have long represented a highly collaborative and, 在很多情况下, 集成模型. 这些实体已经证明了合作的能力, 共享资源, 并通过bet8网站备用主导的组织结构提供护理. 这, coupled with a diverse mix of services across the care continuum and collectively large-scale infrastructure, leaves AMCs ideally positioned to manage costs and demonstrate quality within the framework of an ACO-like model … right? 许多资产管理公司欣然承认事实并非如此. 在AMC客户中, we have found a correlation between reform readiness and two factors: the level of integration within the FGP (pictured on the X-axis in the above graphic) and the extent to which the teaching hospital and FGP are under a common ownership structure or directly share financial risk (shown on the Y-axis above). The graphic illustrates the intersection between these two elements and the action steps required based on the current state of the organization. The AMC categories can be further consolidated into two groups: the fully 集成模型, 学术方面呢?, 临床, and research functions report to one person and one board and the split model, 学术方面呢? and 临床/health system are managed by multiple individuals and governing boards.1 特别是, among the latter group and in cases where the teaching hospital and FGP are separate, there is a tremendous opportunity to advance from a predominantly contracted relationship to a more contemporary structure that is conducive to an ACO-like model. 与规划规模和许多核心组件已经连接, this path should be shorter for most AMCs than it is for nonacademic systems and community practices.
新经济将推动重新设计
在医疗保险实施后不久, universities/AMCs established FGPs at a remarkable rate to more effectively manage newfound resources. 支付改革即将到来, 加上其他相关的力, 会再次引发AMC内部重新设计的深刻趋势吗, 即FGP和教学医院的重组. 就像他们的非学术同龄人一样, teaching hospitals will seek maximum alignment with physicians as they compete and assume increased financial risk from 纳税人. 事实上, many teaching hospitals with open medical staffs have already moved aggressively to directly employ community physicians at an unanticipated pace. 同时, teaching hospitals are demanding more tangible value from their agreements with affiliated physician organizations, 包括FGPs. The anticipated decline in hospital contract income compounded with reduced professional fees will cause FGPs to seek a more formal partnership with teaching hospitals where financial risk is directly shared. AMCs that overcome the political and cultural barriers inherent in pursuing more integrated 临床 enterprise models will be better positioned to sustain their tripartite mission. 这 is contrary to the belief that keeping the AMC component entities separate provides more protection of the academic mission.
There has been a growing trend in pediatrics over the past 5 to 7 years to integrate specialists with children’s hospitals. 这 movement illustrates the mutual benefit of aligning physicians with an inpatient enterprise focused on the same population and may be a preview of what is to come for many AMCs at a 临床 enterprise level. Two of the constructs used to achieve this alignment are introduced in the graphic below. 为特定机构选择的模式, 及其变体, will ultimately depend on the balance of control among the AMC’s component entities and the aggregate financial opportunity. 这两种模式都允许大学/SOM保留学术使命, 在一个对临床生产力需求强烈的时代, while giving the hospital more control over the physician 临床 enterprise through a more meaningful governance structure. 作为一个整体, the AMC will be positioned to implement an ACO-like model while maintaining balance between the university/SOM and hospital.
外卖
AMCs have long been pioneers in innovation and leaders in contemporary care delivery models. 随着经济/支付模式发生重大变化, AMCs should further fuse the relationship and degree of integration between the teaching hospital and affiliated physician organizations. 毕竟, 而临床企业在程序上不是最重要的, 它仍然是绝大多数资产管理公司的经济引擎. 2011年初, 请参阅本系列的第二部分, 哪个将侧重于战略, 编程, and financial benefits of migrating to an integrated multispecialty FGP and how this is likely a prerequisite for greater alignment with hospitals and, 反过来, 纳税人, 在后改革时代.
脚注
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本文就在何处、如何进行提供了建议 & why to apply basic yet rigorous process improvement methodologies to create efficiencies & 减少周期时间,这可能导致成本节约.
出版于2010年12月14日