Hospital-Physician Alignment Model Essay

PHYSICIAN/ HOSPITALS ALIGNMENT MODELS

Introduction-

“Hospital-physician alignment” can be described as the close relationship in which a hospital and physicians works in a cooperative way to achieve patient-centered goals and economical outcomes.

History and evolution of alignment models

In the United States health care system with increasing patient expectations towards better outcome coupled with a need to improve financial and clinical outcomes which force health systems and hospitals to relate with physicians. New health care reforms stress mainly to improve efficiency, effectiveness, and quality of providing health care, by which physicians and hospitals are motivated to form new alignment models. (17)

Evolution of alignment models-

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o The 1990s- Hospitals builds an integrated network and brought primary care practices to feed the hospitals. Hospital organization purchases most efficient practices by multiples of revenue or consolidating better rent. They assure three to five years’ salary guarantee to physicians. Managed care with the focus on capitation type of payment system ensues which creates huge losses to hospitals due to large hospital losses on the physician employment arrangements. In addition Physician productivity also decrease due to little involvement in decision making, few work incentives and the little voice in practice operations. With increasing losses and pressure from medical boards, hospitals dismantle their group’s aims at employing physicians and restore inpatient services.

Graphical depiction of varying degrees of physician-hospital alignment with their respective levels of integration are shown below (2).

During 2012 in the United States about one-third of reimbursements are made through bundled payments.

The Center for Medicare and Medicaid Innovation developed (BPCI) Bundled Payments for Care Improvement initiative which has four service delivery models to reduce expenditures under (CHIP) Children’s Health Insurance Program or Medicare, Medicaid while enhancing the quality of care for beneficiaries.

Under BPCI, patient can choose any of four models and they are developed on the bases of selected drug-related groups or hospital stay or post-acute care or readmissions

Formal integration between hospital and physician is not required but coordination is required and a hospital may wind up taking more risk.

Main advantages with bundled payments are improved coordination of care with potentially improves outcomes and provides additional advantages to both providers and patients through removing inefficiency and no longer needed patient-care protocols.

Another advantage is it provides transparency for consumers in terms of publishing costs and outcomes