121
Chapter 13
Address Issues of
Colleagues, Culture,
and Politics
A practice is part of the whole organized approach to the emerging marketplace,
and the physician is part of the practice. But the entire enterprise has to exist as a
part of something that can actually contract with managed care organizations and
with things that are in place, being developed and being conceived under organiza-
tions that will use tools like accountable care organizations (ACOs) and insurance
exchanges. ese are taking forms that are not unlike the subcapitated contracts
that most institutions played with in decades past. What is the same seems obvious;
what is different is that the physicians are mostly “in-house,” and there are better
management systems in the provider environment.
Physicians and Providers in Alternative
Organizations—the IPA and PHO Revisited
No matter what it is called, not every physician may be in the “hired model” or
fully integrated. Some may still maintain independence, and some may work with
other organizations that are not only not collaborative, but competing. Few health
systems will have the capital and the energy to fully integrate the entire spectrum
of services necessary to serve an ACO population or a managed care cohort of
some kind.
122Medical Staff Integration
e organizations may still need to have a business model that includes some
kind of physician organization. If it does, it needs to do it carefully and under
a plan that has some basic guidelines outlining what it is supposed to do and
how its members are to be involved and incorporated within the services design.
Although the following points are generic, they should be a starting point for
discussion in any planning process that includes a variety of doctors in a range
of contracted models. e managed care companies are organized, ACOs are
organized, and the doctors who contract with them need some kind of orga-
nization. If they cannot all be in one group and under one billing number and
management structure, maybe they need to be in an organization that emulates
that model.
Some goals for an initial planning session might include:
To utilize group behavior and collaboration to assure a high quality of patient
service as measured by national outcome standards and customer satisfaction
To assist all members in achieving contract standards that are prevalent in
the local market area in a form that reflects a fee schedule and remuneration
program that is competitive externally and recognizes internal membership
contributions
To operate an efficient and businesslike service that brings top management
talent to directly support efficient and effective medical professionals and
practices
To impact the system in a manner that will allow a true partnership between
doctors, patients, providers, and payers in order to foster a true understanding
of the value of health, instead of merely the cost of health services
To use the independent provider association (IPA) (physician-hospital orga-
nization (PHO) or management services organization (MSO)) group power
and the synergy between independent physicians, contracted practices, man-
agement, capital, and the critical mass of patients to produce a working model
that will have significant market impact and a healthy bottom line
To develop an entity that will be able to coordinate the activities of its mem-
ber physicians with the supportive efforts of the health care system in coop-
eration with its array of contracted and employed physicians and its ancillary
support units
To develop an entity that will have the required breadth and depth to
accept responsibility for populations under a variety of scenarios and con-
tracting methodologies
To develop a structure that will foster the input of physicians into the govern-
ing process of the joint venture and which will command the respect of man-
aged care programs, partner institutions, and subscribing physicians
To develop systems and support mechanisms to allow member physicians
and related entities to participate in competitive contracting initiatives,

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