Bethesda, MD — Deteriorating relations between hospitals and physicians are imperiling a wide range of health care objectives, researchers from the Center for Studying Health System Change (HSC) report in a Health Affairs Web Exclusive published today.
One consequence of the unraveling hospital-physician relationship is a "medical arms race," as services once performed only in hospitals migrate to physician-owned specialty hospitals, free-standing ambulatory surgery centers, and physicians´ offices. But the estrangement between hospitals and physicians is also impeding the adoption of information technology (IT), the implementation of pay-for-performance programs, and care for the uninsured.
As one hospital executive told HSC researchers: "Doctors used to feel that in return for having the hospital as a place to care for their patients and earn income, they should contribute to the hospital, taking ED call, participating on committees, improving quality. Now they say to the hospital, screw you. . . . Many don´t even come to the hospital any more."
The HSC paper is one of the lead articles in a six-article Health Affairs package on the interaction between physicians and hospitals. Two other lead articles offer different approaches to aligning incentives for physicians and hospitals more closely. Dartmouth Medical School professor Elliott Fisher and coauthors propose making "extended hospital medical staffs" accountable for quality and cost. Gail Wilensky, the John M. Olin Senior Fellow at Project HOPE, and coauthors advocate the use of comprehensive gain-sharing arrangements, where hospitals and physicians share savings generated by more efficient care delivery, as a way to transition to a future of integrated delivery systems.
In addition to the three lead articles, package also includes shorter Perspectives by Mayo Clinic president and CEO Denis Cortese and Mayo chief administrative officer Robert Smoldt; Health Futures Inc. president Jeff Goldsmith; and VHA vice president of research Ken Smithson and VHA executive vice president and chief operating officer Stuart Baker.