Praise for Partners in Health"The combination of visionary leadership, knowledge, and superb timing makes this book a winner. Health care is evolving toward collaboration and integration, and this book is essential reading for anyone wishing to change the relationships between hospitals and physicians."—Donald W. Fisher, PhD, president and CEO, the American Medical Group Association"This book is a must-read for anyone committed to a high-performance health system. It spells out the practical steps that will move us toward an accessible, coordinated, patient-centered system of care. Its recommendations for payment and regulatory reform underscore the urgency of comprehensive health reform if the current misaligned incentives are to be changed to support those on the frontlines in providing the best care with prudent stewardship of resources."—Karen Davis, PhD, president, The Commonwealth Fund"Closer physician-hospital integration would lead to higher quality care at lower cost. Partners in Health is a masterful guide to past integration efforts, current models of success, and thoughtful recommendations for future progress." —Victor R. Fuchs, PhD, Henry J. Kaiser Jr. Professor Emeritus, Stanford University"The working relationship of hospitals and physicians must be restructured for the United States to achieve more efficient, accountable care. But addressing our urgent challenges can't wait for all hospitals and physicians to join highly structured systems. Thankfully, the authors offer steps that all the major stakeholders can take today to spur new models and start the flywheel of trust spinning at new speeds." —Richard Umbdenstock, president and CEO of the American Hospital Association"Transitioning U.S. health care from fragmentation to integration, in the context of a more rational payment system, is sure to be a long and tortuous journey. Partners in Health is a kind of Fodor's Guide to the voyage. No one committed to health reform should travel without it." —Susan Dentzer, editor-in-chief, Health Affairs
Author(s): Kaiser Permanente Institute for Health Policy
Edition: 1
Year: 2010
Language: English
Pages: 269
Partners in Health: How Physicians and Hospitals Can Be Accountable Together......Page 5
CONTENTS......Page 7
FIGURES AND TABLES......Page 9
ACKNOWLEDGMENTS......Page 11
THE EDITORS......Page 15
THE CONTRIBUTORS......Page 17
FOREWORD......Page 21
Introduction......Page 27
Delivery System Reform Proposals......Page 30
Physician-Hospital Integration as Central to Delivery System Reform......Page 36
About This Book......Page 37
Notes......Page 41
Introduction......Page 44
Historical Development of Physician-Hospital Relationships......Page 45
The Hospital’s Growing Responsibility for Clinical Risk and Cost......Page 63
Conclusion......Page 66
Notes......Page 67
Introduction......Page 72
Challenges in Hospital-Physician Relationships......Page 75
Accountable Care Organizations (ACOs)......Page 78
Four ACO Models......Page 79
Promoting Hospital-Physician Collaboration......Page 83
Addressing the Redesign Imperatives......Page 87
A Supporting Framework for Developing ACOs......Page 89
Notes......Page 93
Introduction......Page 98
Evolution of Payment Methods and the Hospital-Physician Relationship......Page 99
Moving Toward New Incentives......Page 105
Conclusion......Page 114
Notes......Page 116
Operational Value of Physician-Hospital Integration......Page 119
Operational Barriers to Improved Integration......Page 125
Operational Changes to Encourage Integration......Page 130
Case Study: Saint Joseph Mercy Hospital......Page 132
Conclusion......Page 134
Notes......Page 135
Introduction......Page 136
Antitrust......Page 138
Fraud and Abuse......Page 145
Tax Exemption......Page 152
State Laws......Page 155
Conclusion......Page 162
Notes......Page 164
Introduction......Page 167
Historical Development of Modern Hospital Governance......Page 168
Medical Staff Governance......Page 173
Additional Challenges to Governance and Alignment......Page 175
The Board of the Future: Moving Beyond Oversight to Collaborative Leadership......Page 179
Conclusion......Page 184
Notes......Page 187
Commentaries......Page 189
Introduction......Page 195
Key Differences Between Hospital and Physician Cultures......Page 196
Simple Rules for Engagement......Page 200
Case Study: Middlesex Hospital......Page 203
Conclusion......Page 206
Notes......Page 209
Public Safety Net Hospitals and Clinics—A Training Model of Care......Page 211
Current Models of Physician Staffing in Public Hospitals and Health Systems......Page 213
Examples of Tighter Physician-Hospital Integration in Safety Net Institutions......Page 216
What Can We Learn from Public Safety Net Hospitals and Clinics?......Page 220
Implications for Non-Safety Net Institutions......Page 221
Notes......Page 222
Introduction......Page 224
Organization and Management of AMCs......Page 225
Financial Challenges for AMCs......Page 226
Unique Role of the Medical School......Page 227
Advantages and Challenges to Collaboration in AMCs......Page 228
Case Study: Vanderbilt University Medical Center......Page 229
Conclusion......Page 238
Commentary......Page 239
CHAPTER ELEVEN: WHAT NEEDS TO HAPPEN NEXT?......Page 242
Physicians......Page 243
Existing Multispecialty Group Practices......Page 247
Hospitals......Page 250
Payers, Plans, Employers, and Government as Payer......Page 252
Government as Lawmaker and Regulator......Page 255
Patients, Patient Advocates, and the Media......Page 257
Conclusion......Page 258
Notes......Page 259
INDEX......Page 261
