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Today's Most Relevant Issues Facing Medical Staff Relations

November 1, 2017

medical-staff-relations.jpgI had the privilege last week of moderating a panel discussion at a regional American College of Healthcare Executives meeting. The panel discussion topic was “Medical Staff Relations.”

Obviously, this is a pretty broad topic so we focused the discussion on what the panel – and the audience – see as today’s most relevant issues. The panel included the VPMA of one of the region’s top hospitals. She is the person in charge of physician credentialing and performance for one of the region’s largest providers of urgent care services and she recruits for and focuses on development of a team of 1,300 providers.

We started with a quick recap of the history of the independent medical staff:

  • The Joint Commission independent medical staff model worked reasonably well from the 60’s through the 70’s as much of a physician’s practice focused on the hospital and the hospital needed physicians to provide services and generate fees in a fee-for-service world.

  • As we got into the 80’s, managed care and prospective payment systems strained the relationship as hospitals looked to control costs and standardize care.

  • In the 90’s and early 2000’s, some specialties shifted to an outpatient setting and some physicians started to compete directly with the hospital for business and revenue. Accordingly, much of the dialogue was about how to manage the hospital-medical staff relationship in light of these changes. How do you delegate important hospital functions to an independent medical staff when the goals of those very physicians might conflict with those of the hospital?

  • Today, the discussions are different. Between the growth of physician employment models and accountable care organizations, many (but not all) of these conflicts have been removed. In theory, these two models align the goals of the hospital and the physicians.

The panel and audience concluded that there are three primary issues they are dealing with on a daily basis:

  1. Why is it such a struggle to engage medical staff in system initiatives?

  2. We are asking more of physicians – the expectations have changed but have we positioned them for success?

  3. We are asking physicians to lead, but have we prepared them to lead effectively?

Noteworthy points made by the panel and the audience:

  • As far as physician frustrations, Electronic Health Records (EHR) remain at the top of the list. While these tools provide powerful data that helps to better manage populations of patients, they still reduce provider efficiency. Current EHR systems are not meeting the needs of providers. The group encouraged organizations to push their EHR vendors to meet their needs as it’s the only way these tools will evolve.

  • Medical schools and residency programs need to do a better job of preparing physicians to succeed - beyond clinical skills. They need practical, practice-based information during their training.

  • The entire system is caught between a fee-for-service and RVU-based world and the concept of value-based care. Most providers are trying to meet RVU-based goals but being asked to adapt to a value-based system.

  • Physicians will only be engaged in quality and cost-based initiatives if they are receiving data that is actionable and if the hospital understands what motivates each physician. This means doing work to understand your physicians and what drives them.
    Related: Leverage Seven Top Motivators to Improve Physician Engagement

  • MACRA is a step in the right direction but many providers are still concerned that it provides the wrong incentives. Many are concerned that saying no to patients, even when it’s the right thing to do, will punish the provider under these programs.

  • EVERY organization needs to be implementing program to identify and develop physician leaders. Leaving this process to chance is no longer an option.
    Related: Three Keys to Developing Physician Leaders

  • The physician MBA may or may not be a useful strategy. Leadership requires more than an MBA. Physicians need practical, on-going training and mentoring, formal and informal.

  • Communication is critical, and from the physician’s point of view, it needs to be “bi-directional.” Often administrators believe they are doing a good job communicating when all they are really doing is providing information on decisions already made by the hospital. This is not the same as engaging physicians in a discussion ABOUT decisions to be made. That being said, a first step is just creating more effective, streamlined models of communication, leveraging technology where possible.
    Related: Successful Culture Strategies from Healthcare Thought Leaders

What does all of this mean? We’ve created an important, valuable, and highly paid physician workforce. In most cases, though, we’ve not built the infrastructure to prepare that workforce for their new challenges and expectations. Administrators need to take on this challenge – partner with physicians and position them for success.

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Bryan Warren Bryan Warren is the President of J3 Personica, a consulting, assessment, training, and coaching firm, and a guest blogger for PSI. Bryan is an expert in progressive talent strategies, with a particular focus on leader and physician selection and development.