Journal of Healthcare Management - May/June 2014 - (Page 203)

p H ys I c Ian c lI nI cal a l IgnMent addition, it is important to address expectations surrounding the established goals and metrics: determining how often to review roles and responsibilities, gauging the successful maturation of the relationship, and measuring deliverables to ensure that goals are met. Furthermore, metrics around quality must be agreed on, must be meaningful to both parties, and must focus on excellent patient care. Quality goals should be evidence based and seen as essential to improving quality and lowering costs. As a first step in defining benchmarks for our alignment agreement, we conducted a thorough review of our opportunities as a hospital system. We obtained baseline metrics for the agreedon quality goals and determined what data to collect in order to track the group's performance. Of equal importance, we explored the degree of experience that our physicians had with performance metrics and ascertained their desire to learn more about quality improvement. Choosing metrics, including prevention and management of chronic diseases and patient satisfaction with care, that appealed to the physician group was a major consideration. The traditional metrics of the Physician Quality Reporting System (CMS, 2011), Healthcare Effectiveness Data and Information Set (HEDIS) (NCQA, 2011), and the Centers for Medicare & Medicaid Services Core Measures were included as part of the selected metrics; however, these alone were not sufficient. Our hospital also strived to raise the quality bar by developing specialty-specific quality initiatives and identifying other quality and I ntegrat Ion metrics needed to ultimately improve outcomes, lower costs, and transform care delivery in our hospital system. Legal Oversight Hospital-physician alignment strategies are highly complex and, as such, require careful scrutiny to be sure they comply with the Stark and anti-kickback statutes (HHS, 1991, 2004) and do not violate antitrust or tax exemption regulations. Legal counsel must have an understanding of and experience in healthcare law as well as the skills and passion for developing solutions and models to facilitate a healthy hospital-physician dialogue. The legal team should be involved in early discussions, communicate to all participants the legal requirements affecting the proposed alignment strategy, and quickly identify and resolve issues on any elements of the proposed agreement that may not comply with applicable laws. Clay and Bruton (2012) name several indicators to evaluate when exploring affiliation. Building on their key points, we identified the most critical issues to consider when laying the groundwork for our clinical alignment and integration agreements. Generally, we have found that the agreement is not acceptable to one or both parties (and therefore not entered into) unless the following key issues have been addressed. Structure. The structure of the clinical alignment and integration can take several forms: (1) direct contract between the hospital and one or more physicians or physician groups, (2) lease of the physicians and offices, or (3) formation of a joint venture 203

Table of Contents for the Digital Edition of Journal of Healthcare Management - May/June 2014

Journal of Healthcare Management - May/June 2014
Contents
Interview With Christopher D. Van Gorder, FACHE, President and CEO of Scripps Health
Successful Strategic Planning for a Reformed Delivery System
You, Inc.
Assessing the Feasibility of a Virtual Tumor Board Program: A Case Study
Physician Clinical Alignment and Integration: A Community–Academic Hospital Approach
Employer-Based Coverage and Medical Travel Options: Lessons for Healthcare Managers
Composite Model for Profiling Physicians Across Domains of Care

Journal of Healthcare Management - May/June 2014