Frontiers of Health Services Management - Summer 2013 - (Page 7)

nity to create a sustainable care integration model that, once further defined, would serve as a model of clinical integration for other physician specialties. Developing a positive new culture and integrating a physician-driven entity with hospitals can easily disrupt “the way we’ve always done it.” care must be taken to ensure a newly created culture is not a counterculture that disrupts the old and new businesses to the extent that neither is successful. once conflict is resolved internally, the value produced through innovative integration models will transform the current, unsustainable healthcare model and help shift providers to curve B, where patients and other stakeholders experience greater value. Innovations That Create Value three areas in which Piedmont Heart is already creating incremental value are its center-of-excellence organizational structure, clinical pathways development, and Patient first program. Adopting the Center-of-Excellence Model Piedmont Heart’s first major innovation was a patient-centric center-of-excellence (coe) design. rather than organize by functional departments, like a traditional hospital organizational structure, Piedmont Heart physicians organized themselves along a continuum of patient care by disease state or condition. Piedmont Heart’s six coes, shown as vertical bars in exhibit 1, are arrhythmia, advanced Heart failure, coronary therapeutics, general and Preventive cardiology, Structural and valvular Heart Disease, and vascular. Because of the matrix relationships inherent in exhibit 1, Piedmont Heart has input Michele M. Molden, FACHE; Charles L. Brown III; and Bryan E. Griffith • 7 f e a t u r e uncomfortable years, the partnership between the hospitals and physicians, and often between physician and physician, grew. Piedmont Heart assumed responsibility for strategic and some operational cv decision making from PHc hospitals, including care processes, service rationalization, capital allocation, and physician recruitment. While decision-making responsibility shifted, income statement accountability between the hospitals and Piedmont Heart did not always correspond, resulting in a disconnect between revenue generation and the expenses necessary to drive that revenue. this is a critical issue to resolve in the integration process. if the expenses required to operate the physician group are kept separate from the revenues they drive in the hospitals, there is a tendency to characterize these expenses as “losses.” instead, the expense to employ the physicians and manage the enterprise should be viewed as an investment and, when aggregated with the corresponding revenue, can result in greater benefit for the whole than was possible before integration. Unless the expenses and the revenues are calculated together, the organization may not recognize the true value of the integrated enterprise. this lack of recognition leads physicians to feel that their contributions are not valued and others to incorrectly view the integrated organization as a financial burden. PHc’s acceptance of Piedmont Heart’s role has increased as the system itself has focused more on integration and “systemness.” Many stakeholders, who did not see it before, now view the development of Piedmont Heart as a best practice for system service line development. for PHc, forming Piedmont Heart was an opportu-

Table of Contents for the Digital Edition of Frontiers of Health Services Management - Summer 2013

Frontiers of Health Services Management - Summer 2013
Contents
Editorial
At the Heart of Integration: Aligning Physicians and Administrators to Create New Value
Volume to Value
Physician-Led Models of Accountability and Value: Observations on Payment Policy and Culture
Collaboration Across Clinical Silos
Breaking Down Clinical Silos in Healthcare

Frontiers of Health Services Management - Summer 2013