Anatomy of an Acquisition Alternative: Leasing the Practice.

The default position of many healthcare systems seeking physician alignment is to acquire the practice and employ the physicians, but there is another approach that poses far less firancial risk to both parties and is far easier to undo if necessary: leasing the practice. The group stays as it is, but renders services for which the hospital receives the reimbursement and commits to paying the group a fixed amount for a stable quantum of work. Additional alignment features can be added, including medical directorships, comanagement, quality bonuses, and more. Potential problem areas include post-termination restrictive covenants and dispute resolution. Planning in advance for both fair market value disputes and addition of new practitioners is useful.

Using patient safety organizations to further clinical integration.

This article addresses why in the current context of driving toward improved value, physician groups ought to consider developing a patient safety evaluation system and reporting to a patient safety organization. The fundamental challenge to physicians to succeed in the future is to clinically integrate within their own practices, standardizing to the evidence base, and measuring their performance. In addition, it is increasingly clear that the physician office practice is a source of patient safety issues. The Patient Safety and Quality Improvement Act provides two powerful protections for data that will support and bolster clinical integration and patient safety. The protections and how to deploy them are presented.

Clinical integration and the CFO.

Healthcare CFOs should consider five strategies for promoting clinical integration: Seize the opportunity to work with physicians in demanding credible payment models from payers. Collaborate with physicians in redesigning compensation models and processes of care. Establish financial relationships with physicians who are not employed by the hospital or health system. Develop data-sharing relationships with referral sources. Become actively involved in creating an articulated, transparent approach to capacity control.

Informed consent to the ties that bind: clinical integration.

If you're already aboard or about to board the physician/hospital integration train, take a moment to ask some critical questions and consider the consequences.

Improving quality through physician engagement.

Quality care is built on a foundation of physician engagement.

How to listen to your lawyer.

As regulations become more complex and tensions increase between conservative legal guidance and the move to more transparency, the issue of when and how to listen to your lawyer deserves the board's focused attention.

Finding common cause in quality: confronting the physician engagement challenge.

Although it's difficult to achieve, physicians can be engaged and supportive of quality improvement efforts, if the activity is presented and managed effectively.

Avoiding quality fraud.

What constitutes "quality fraud"? Learn about the board's responsibilities and liability, as well as how to protect your organization from CMS and the DOJ.

Physician investment in startup device companies: debunking the myths.

Physician entrepreneurship is on the rise; and investment by physicians in startup device companies is one manifestation of it. At the same time, there is increasing concern about potential conflicts of interest in physician business interests, given their fiduciary responsibility to their patients. There are multiple forms such investment can take. The Stark and anti-kickback statutes are relevant to investment in companies that do business with the federal programs. Many physicians are confused about the distinctions between these two statutes and their different requirements. This article elucidates these distinctions, describes a continuum of safety associated with such investment, and offers some practical tips for those considering or involved in such arrangements.

Sharing the quality agenda with physicians.

Hospitals cannot hope to improve quality without physician engagement--and the board's role in working to build and sustain a shared agenda with its medical leadership and staff is paramount.

PROMETHEUS payment: better for patients, better for physicians.

Although pay for performance is a positive development in the history of quality improvement in this country, it is generally accepted that most pay-for-performance programs do not offer a sustainable business model. PROMETHEUS Payment is a new approach to provider payment that is predicated on paying for the resources to be brought to bear to treat a patient for a condition in accordance with good clinical practice guidelines. It is explicitly designed to reduce the administrative burden on physicians in favor of improved care coordination and collaboration among providers without requiring them to financially integrate or take insurance risk.