Medical Staff Integration: Transactions and Transformation

 Content: Conceptualizing New Models of Care Based on Traditional Structures Physician-Hospital Organization (PHO) Independent Provider Association (IPA) Contracting Unit/Messenger Model Management Services Organization (MSO) Group Practice without Walls (GPWW) Group Practice Captive Physician Group Other Models and Combinations of Models Summary Issues   Does Anyone Know the Definition of Integration? How Will We Know If We Are Integrated? Maybe, We Already Are! Integration Is Not a Place, It Is a Process Integration and the Challenges of Income Determination Summary Issues   Does What We Have Now Actually Work? How Did We Get Here? How Do We Get Where We Need to Be? What Is Different This Time? What Is the Same? Same Players, Traditional Structures, New Tools Summary Issues   Ignoring Fundamentals Will Produce Unwanted Results Different Practices, Different Relationships, Different Approaches Academic Practices Retail-Oriented Practices Concierge Practices and Aesthetic-Oriented Practices Hospital-Based and Codependent Practices Physicians in Different Disciplines Have Differing Needs Summary Issues   Where Are We Headed and What Will Get Us There? Case Management and Care Management-The New Paradigm Existing State, Near-Term Future State Final Note-What Is a Doula? Summary Issues   The Basic PHO (Joint Governance) or IPA (Independence) Summary Issues   The MSO (Services) The Basic MSO Approach MSO Development Functional Operations Financial Operations Goals of the MSO/Vendor Group Operational Responsibilities of the MSO/Vendor Group What Does the MSO Not Do? Summary Issues   Co-Management Programs (Partnership) Getting There Is (More Than) Half the Battle An Orthopedic Co-Management Model Development Process Summary Issues   Contracts and Subcontracts (Managing Relationships) Example: A Hospital-Based Physician Arrangement (Hospitalists) Hospitalist Group Contract Points/Coverage Terms Measurement of Hospitalist Productivity and Quality and Value Job Description-Hospitalist (Internal Medicine) Qualifications Relationships Description of Hospitalist/Internal Medicine Service Objectives Responsibilities of Hospitalist/Internal Medicine Physicians Example: RFI/RFP Scope of Work for a Hospital-Based Group (ED) Emergency Department Provider Items/General Services Emergency Department Provider Items/Recruitment and Orientation Emergency Department Provider Items/Financial Services Emergency Department Provider Items/Compliance Example: Evaluation of a Contracted Group's Performance Summary Issues  Sponsored Practices and Hired Practitioners (Employment) Simple, But Many Moving Parts To Every Project, a Process Structure-Pick One Transactions and Transaction Elements Special Circumstances-Normalizing Practice Numbers Special Circumstances-Asset vs. Stock Purchase Special Circumstances-Leasing Practices Special Circumstances-Fractional Purchase Special Circumstances-Related Parties Special Circumstances-Underwater Practice Summary Issues  Align the Correct Solution Supported by Effective Communications The Team Must Have a Shared Set of Principles and Core Values Choose a Structure That Fits the Situation Physicians Involved in the Care Process Must Have a Meaningful Role in Governance Physicians Must Be Allowed to Pursue Treatment Options in Line with Quality and Service Standards Summary Issues  Recognize the Different Parties to the Transaction The Result of the Transaction Can Often Mean More Than the Transaction Itself It Is Important to Understand Differing Perspectives Are There Any Universal Truths? Transition Is More Than a Corporate Function-It Is a Cultural Reprogramming The Future of Independent Hospitals and Private Practice Is Limited Summary Issues  Address Issues of Colleagues, Culture, and Politics Physicians and Providers in Alternative Organizations-the IPA and PHO Revisited Medical Staff Issues and Trends-The Structure of the New Medical Staff What Defines a Good Plan? Summary Issues  Discern between Patient Management and Practice Management What Is the Commitment Level to a Different Level and Style of Governance? Operational Management Is Not Governance-Managers Manage and Doctors Govern Why the Resulting Product Is Often Less Than the Sum of the Parts Summary Issues  Separate the Transactional Issues from the Transitional Process Practice Transition Does Not Follow a Recipe It Is Not ''Business as Usual'' Providers The Staff The Revenue Stream Infrastructure Summary Issues  Establish Fundamental Standards and Link These Standards to Definitive Policies Was the Practice Well Managed Beforehand? Quality vs. Quantity and the Bottom Line Managers Must Have Defined Roles and Responsibilities Is There a Clear Set of Achievable Metrics for the Practice? Are the Metrics Aligned with Management and Provider Compensation Models? Patient Service Process Measures and Patient and Consumer Satisfaction Metrics Can (Should) Change over Time What about Financial Measures? Summary Issues  Align the Compensation with the Programming The Hospital/Health System as Paymaster Some Basic Regulatory (and Commonsense) Constraints One Model, Many Factors Call Compensation and Confusion Putting It All Together Summary Issues  Developing a Core Set of Strategic Issues Visions and Hallucinations Succession Planning Structure? Financial Issues, Systems Level Specific and Special Opportunities Issues Listing-One Approach Summary Issues  Is There a Clear Value Proposition? Summary Issues  Build an Organization That Can Learn and Transform Itself Summary Issues  To Understand Success, Study Failure The Group in Crisis Developing an Emergency Turnaround Strategy The Group Approaching Crisis Summary Issues  Appendix: Samples and Examples  Glossary  Index