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Economics and Technologyare Driving Closer Hospital and Physician Relationships  By David Henriksen Senior Vice President/General Manager Physician Practice Solutions McKesson Provider Technologies Physician Alignment More Critical than Ever The relationship between physicians and hospitals has waxed and waned over the decades, but those bonds are rapidly growing stronger. Physician alignment is now a critical issue for hospitals of all sizes and locations. Quite simply, the economics of healthcare and a changing political environment are bringing them together as never before. This new strategy of alignment has produced three distinct trends that promise to change the face of healthcare across the country. To create good referral relationships, hospitals are:  Employing a greater number of physicians Helping employed and independent physicians convert toelectronic health records (EHR) Connecting community physicians with online servicesDriving the Physician Business A decade ago, many hospitals started acquiring physician practices at a rapid pace, only to realize they were unprofitable in many cases. Losses prompted hospitals to pull back from direct employment, but over the past three years that trend has gained new strength. Consider these numbers on physician employment: 8% growth in hospital-employed physicians over the past 3 years 150,000 out of 620,000 U.S. physicians are hospital-employed While there are several reasons for this shift, those most often cited are a change in hospitals' perceived value of physician practices and an emerging emphasis on quality of life among doctors. The Hospital View: Increasingly, hospitals and health systems see employment as a means to secure referral revenue for surgery, radiology, laboratory testing and other procedures. These referrals and other ancillary revenue streams from employed physicians far outweigh the marginal benefits of owning a practice. The Physician View: Physicians are also viewing hospital employment more positively as they see reimbursement declining and labor costs increasing. In addition, many physicians have become increasingly dissatisfied with a practice model that takes a heavy toll on their personal and family life. Employment offers the benefits of greater business and professional support coupled with more predictable income and work demands. Employment also gives physicians access to another significant benefit of affiliation with a large organization — information technology (IT) such as electronic health records (EHRs) and practice management systems that can improve patient safety and create greater clinical and financial efficiencies. Helping Practices Convert to EHRs A health system's ability to roll out ambulatory electronic health records solutions brings us to the second leading trend in physician alignment — helping doctors automate the care delivery process. That process has been given a powerful boost by the American Recovery and Reinvestment Act, which includes legislation designed to promote the use of healthcare IT by all providers. McKesson has responded to the legislation with its Achieve HIT program. Achieve HIT is designed to help providers optimize and accelerate their efforts to improve care delivery as they put plans in place to achieve meaningful use and qualify for these new incentives. American healthcare has long lagged behind other industrial nations in using IT to improve patient care and efficiency. With more money and other incentives on the table, physician offices with EHRs will grow dramatically. If these systems are to achieve their full use and potential, health systems must do their part in making the transition a reality. As physicians make IT decisions, many will turn to the health system for guidance about selecting systems that are interoperable with the hospital system. Many will be receptive to the idea of a hospital becoming their EHR champion. Thanks to Stark law exceptions and anti-kickback safe harbors, hospitals and other entities can donate health IT to physicians. Many health systems have developed successful programs offering technical services such as hosting, support and implementation, and even training. Connecting Practices with Online Services Another option to promote a referral relationship, especially with smaller practices that may not have an EHR, is to provide connectivity services that include: Patient results shared from the hospital Inpatient EHR to the practiceEHR, and optionally to the patient's personal health record E-prescribing to pharmacies Provider-to-patient communications and the opportunityfor reimbursable webVisits® Provider-to-provider secure messaging for collaboration and referralsThese connectivity services are attractive to physicians because they provide important benefits that improve patient care and streamline operations. They also create a foundation of data that makes the transition to a fully functional EHR more seamless. Joining Forces to Create a Connected Community While these efforts come at a time when hospitals themselves are facing tight budgets, this three-pronged approach (employ, provide EHR, connect) is a particularly effective strategy for hospitals in areas with strong competition. Reaching out to physicians with EHRs and connectivity tools to help automate their practices may give a hospital the edge in attracting those physicians and their referrals. Just as medicine is practiced most effectively when professionals and healthcare organizations work together as a team, so the path to healthcare automation is best traveled together. David Henriksen is Senior Vice President and General Manager of McKesson's Physician Practice Solutions and has more than eight years of experience in physician office and medical imaging solutions. For McKesson, he oversees McKesson's practice management and electronic health record solutions for physician practices. Henriksen is currently on the Board of Directors of the Technology Association of Georgia Healthcare Society.
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