Tuesday, March 20, 2007

It's about the Physician

Who has patients.....doctors or hospitals?

Somewhere along the way to the informed healthcare consumer and all that hospital advertising about how good they are, the newest piece of technology and the latest greatest renovation as well as how much we care about you as a person (or your spirit, whatever that means), we have may have forgotten about the role of the doctor.... and that is not a good thing.....

Hospitals and health systems talk about "their patients". Healthcare organizations troll for consumers and employers through a variety of marketing techniques. Some have even entered into agreements with insurance companies under capitation arrangements for "covered lives" where they are paid a certain dollar amount per month per life to provide complete care. (After learning that it's not as easy as it sounds and losing millions of dollars, most hospitals and health systems have exited the insurance business. Good move.)

Physician referral programs, RN staffed call centers, community health and wellness programs, service lines in cardiology, neurology, orthopaedics and others, quarterly magazines and newsletter mailings, advertisements and public relations aimed at creating that awareness, usually center around the hospital, clinic or health system. Sometimes, just sometimes, it does center around the primary care doctor, specialist or physician group. Those hospitals and systems that do center their efforts around the doc get it.

Its about the physician......

A contrary view no doubt. But think about this for a minute. When to go to the clinic or hospital and you need a test what do you need? A doctors order. You can't walk into the Emergency Room at any healthcare facility and just go... "My shoulder hurts, give me an MRI". You need a doctors order. Want an aspirin to treat a headache in a healthcare setting, you need a doctors order. Want an antibiotic for an infection filled at your local pharmacy (unless you live in Mexico), you need a doctors order. If the hospital wants to bill for inpatient or outpatient services, managed care aside, they need the doc to put the patient in the bed or send them to the outpatient clinic. No order, no physician involvement, no bill. No bill, no revenue. It all starts and ends with the physician.

But to hear healthcare providers tell it, I belong to them. I don't belong to anyone, but have a relationship with my physician whom I trust and will go where she directs me. It does still happen to be that way for most people. Informed consumers exist and lots of available data is there for all of us to see, but the exception to the rule is the consumer who at the end of the day, will disagree about where their personal physician will send them for care.

What can hospitals learn from this....

Its about a partnership. That partnership is a three way- you, me and my doc. Stop spending so much time figuring out joint ventures, employment options and all the rest. Yes, I do admit some of it needs to be done, any organization worth its salt will look at service enhancements. That is the natural evolution of a business. But focus on the doc. Each year dozens of seminars, books and articles appear about improving medical staff relations, partnering with physicians, strategies for working together and on and on and on. Maybe its about time we learned from that and began to practice it more.

It means putting egos aside and listening. Doesn't mean you are going to do everything the physician wants, but if you listen very closely you might find some simple ways to help the physician practice medicine more efficiently, improve their satisfaction and at the end of the day increase admissions and procedures.

Want a sure fire way to improve admissions, focus some of your improvement efforts on making it easier for the physician to practice medicine in your institution. When the nurse pages the attending physician, make sure they are there when the doctor calls back. If a physicians wants a faxed copy of their ER report, send it. If the doctors office calls Admissions, have caller ID available so the admission representative can ID the doc and respond appropriately. And improve your patient satisfaction. Patients complain to their doctor about your service and care. Docs don't want to hear it. Physicians will send their patient to those facilities where it is easier to practice medicine, where they have their needs meet and their patients are satisfied.

Don't believe me. Take a look at market share data of any provider over time. Seeing only a one or two point market share swing among competing facilities? Guess what, it is not through any great marketing, its about the docs moving patients around to different facilities.

The healthcare organization that can improve physician satisfaction and make it easier for them to practice medicine in the halls of the hospital will gain admissions and outpatient business, which in turn will generate revenue, which, well you get the idea.

I admit it is not so simple with competing medical staff, the movement of services and procedures to different settings and other providers raiding medical staffs. But at the end of the day, if you can understand that it is about the doc, you will be better, the physician will be happier and patients will hold you in a new light.

Not that much different from billing the 1960s is it?

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