1. Bill Byron, administrator, Treasure Coast Center for Surgery in Stuart, Fla.:
Primary care physicians are the lifeline for direct admissions and referrals to surgeons, medical specialists and other key admitting doctors at hospitals. In competitive markets it is critical for hospitals to align the interests of their primary care base in order to be reasonably confident that patient volume will follow. Physician practice ownership is a critical element to this success and allows the physician participants to benefit from well-organized management systems, economies of scale inherent in a group practice and greater voice in directing the development of hospital based systems to improve their patient care. The pursuit of a competitive financial package for participating primary care physicians and appropriate voice in the development of a governance structure should promote a successful dynamic for long term success between the doctors and health system leadership.
The base of the hospital patient structure is its foundation of primary care physicians. Appropriate numbers, high quality training and incentives to improve quality of care are all important elements to the success of a hospital based group. The health system leadership must be willing to develop the physician specific management skills necessary to support this endeavor. The leadership needs of the physician practice are different from those of a larger hospital organization and require a degree of autonomous flexibility to interface with the hospital. The most important elements to the successful hospital based physician practice are productive oversight of cash flow, contract management, information systems, coding education, and personnel talent development. With these pieces in place the physician and hospital are likely to enjoy a successful practice development.
I have seen a well-run hospital-based primary care group increase the admissions at the hospital by more than 25 percent over a three-year period. The hospital needs the primary care commitment, and the primary care doctors can benefit from the management depth of a group practice and the resources of the hospital. The only remaining element is the involvement of the specialists who will receive referrals from the primary care group. Early involvement of the non-participating physicians should emphasize the value added to be created by the formation of a hospital based primary care group and the inherent value to the hospital and its medical staff at-large. With this accomplished, all parties will benefit from this initiative.
2. James Seymour, CASC, administrator, Coral Gables Surgery Center in Miami, Fla.:
With the latest in quality of care issues about histories and physicals from JCAHO and AAAHC, the relationship between the surgeon, the ASC and the PCP have become more important than ever. The quality of an H&P can mean the difference between a case getting done versus a cancellation.
At our surgery center, we have helped our surgeons identify PCPs that provide good and bad H&Ps. We attempt to educate the surgeon’s office which PCPs are providing good quality H&Ps. After that, it is the responsibility of the surgeon to discuss the issue with the PCP.
We also provide the surgeons office with a copy of a blank H&P that has been approved by our medical director and anesthesia department. This blank H&P is given to the patient when they leave the surgeons office and it is the ASC’s hope that the PCP will complete our H&P, thus minimizing the possibility of the patient being canceled.
3. Kathy LeJeune, Business Office Manager of Surgicare of Lake Charles, La.:
In my opinion, forming a relationship with the surgeon within the community is essential to the success of an ASC. An important fact to remember is that the surgeon and the family have a choice of facilities.
Surgicare has worked diligently with the surgeons and their staff in order to provide continuity of care, personalize service, efficient turn around time, and patient and family care with the focus being on customer care.
An ASC is simply a structure standing alone. The foundation and support system is formed from within by building relationships with the surgeon and staff, trending out comes in order to set goals and compare to national standards, focus on continued improvements, addressing the needs of the surgeon and staff, having dedicated staff and management committed to the success of the surgery center. Goal and team focus is essential.
My personal views regarding physician ownership by a hospital are mixed. I feel that steerage becomes an issue and patient choice becomes limited.
4. Craig J. Bakken, CMPE, CEO of Rocky Mtn. Gastroenterology Associates in Lakewood, Col.:
I understand the motivation by hospitals to do this and think this issue should be of great concern to many specialists and policy makers as well. In certain metropolitan communities this has led to a significant decline in the number of "independent" specialty medical groups and their surgery centers. There is no price or quality competition left except between equally expensive hospital-owned alternatives. Specialists, BEWARE. Your referral base of independent primary care physicians may be slowly drying up and the next step is to use the hospital "or else."
