By Daniel J. Marino
What is your reaction to the concept of clinical integration? If you are like most physicians I talk to, you are interested in the idea but wary of the many uncertainties that surround it. You may also have some reservations about getting involved with the local hospital. If you become clinically integrated, will you be able to maintain control of your own practice?
One thing is clear: Doing nothing is not an option. Unsustainable health care cost trends are creating pressure that is simply not going away. All payers are pushing to reduce costs, and there is broad and deep agreement that greater coordination of care is the solution. Physicians who stick to the clinical models developed under fee-for-service reimbursement are going to suffer from steady fee schedule reductions.
The good news is that family physicians who are interested in exploring collaborative care models have several options. One possibility is the patient-centered medical home. Developing a medical home model in your practice will allow you to put greater focus on coordinating patient care. Improving patient management will enable you to negotiate value-based reimbursement with payers. One disadvantage of the medical home model is that it limits the scope of care coordination to the factors that are under your control as a primary care provider.
The other option is clinical integration with a hospital. On the patient care side, clinical integration offers unprecedented opportunities to coordinate care as patients move between primary care, specialty medicine, hospital, and long-term care settings. On the contracting side, clinical integration opens up new possibilities for securing better reimbursement for better patient quality outcomes. Given the cost control pressures that are driving the industry today, clinical integration may offer family physicians the best chance of surviving financially in the years ahead.
Of course, the big question for physicians is where does this leave practice autonomy? One answer is to look at clinical integration from the point of view of leadership.
Who will be in charge of hospital-physician clinical collaborations? Based on discussions with hospital CEOs from across the country, I can tell you that without exception hospitals are looking to physicians for strong leadership on clinical integration programs. There is widespread recognition that the only stakeholders who can effectively guide coordinated care are physicians. Physicians are being asked to take part in decision-making at every level, lead on the development of quality metrics, and help guide implementation at the unit level.
And practice autonomy can remain strong. Hospitals are acquiring physician practices in many markets as part of their integration strategy, but clinical integration can develop outside of hospital employment. Information technology and shared governance structures are carving out a viable niche for physicians who want to collaborate with hospitals while still remaining independent.
What many physicians find most exciting is that they see clinical integration as an opportunity to practice medicine as they were trained to. Under fee-for-service reimbursement, physicians are underpaid for the cognitive work that defines the best medical practice—the time- and cost-intensive work required to diagnose and manage difficult cases and maintain patient wellness. Clinical integration gives physicians the opportunity to focus their skills on outcomes. Physicians will be able to work at both the population level and the patient level to prevent the complications of chronic disease, keep patients out of the hospital, and optimize patient health.
Interested in moving forward? To prepare your practice for clinical integration, the key is to focus on technology. If you have not already done so, make the transition to an electronic medical record and work to meet the government’s meaningful use requirements. Then begin tracking clinical outcomes on chronic diseases within your practice. Diabetes and coronary artery disease are common starting points.
As you begin to get technology and quality tracking in order, you can also explore opportunities to collaborate. In most communities, clinical integration initiatives are still in the early planning phase. Structures, goals, and incentives are still uncertain—but that’s good. Family physicians who get involved now have a real opportunity to shape how clinical integration will develop in their community for years to come.
Daniel J. Marino is the president and CEO of Health Directions, a national health care consulting firm with offices in Chicago, Ill., and Austin, Texas.