Model anticipates changes related to health reform
CATHOLIC HEALTH INITIATIVES
Mercy Medical Center of Des Moines, Iowa, has reorganized its leadership structure to better align physicians with administrators and to ensure physicians are integrally involved in planning and decision making. Facility leaders said the change prepares Mercy for the reformed health care landscape.
Under the new structure put in place Feb. 1, Mercy has created seven, two-member teams, each with a newly named physician leader and an administrator. Mercy has both employed and affiliated physicians in its network, and all physicians will report up through one of the seven physician leaders, according to Robyn Wilkinson, senior vice president of human resources for Mercy.
The physician-administrator dyads will together make all major decisions for their practice area (there are seven practice areas, see box for list), including decisions about operations, coordination with other practice areas, care quality improvement, physician engagement and budgeting. The physician and administrator have equal status in the dyad relationship, said Wilkinson.
"We're integrating physicians into decision making up front, not after we've made changes and it's too late," said Wilkinson. "Physicians will now be involved in all organizational decisions."
The new structure establishes a direct management reporting relationship for all physicians including community physicians and employed physicians. All reporting relationships lead up to the seven physician leaders, who in turn report to a chief physician officer.
Wilkinson said Mercy made the change in response to a challenge from its board a year and a half ago, that Mercy leaders better prepare the facility for changes happening under health care reform. Policies enacted under reform are challenging health care providers to better coordinate services across a continuum of care and to organize as accountable care organizations, with all caregivers aligned, explained Wilkinson. Mercy has set up a legal structure and filed a related letter of intent to form an accountable care organization. The facility plans to file an application for its accountable care organization with the Centers for Medicare & Medicaid Services by the end of this month. If that is approved, Mercy will have a functioning accountable care organization on July 1.
"The key is coordination," Wilkinson said. "You need physician buy-in in designing" the accountable care organizations. She noted the hope is that the silo mentality that was predominant before will be replaced with collaboration. Wilkinson said that medical service silos emerged because medical specialties long were treated as independent service lines rather than as interdependent services. While referrals would occur between practitioners, there was no "hardwired," formal relationships between them. "We need to foster the relationships between physicians and their work rather than continue functioning so independently," she added.
The seven physician leaders will have monthly meetings as a group on their own; as will their administrator partners. And, once a month, the entire 14-person group will meet.
David Vellinga, Mercy president and chief executive, noted, "With the ever-evolving landscape of health care reform, we believe physician engagement and leadership are key to success" and that this model will help achieve that.
Each physician-administrator dyad will be held accountable for achieving certain performance goals set out on a Mercy scorecard.
Wilkinson said Mercy solicited applicants for the physician lead roles from within its physician ranks, which includes both employed physicians and community doctors with admitting privileges. The physician leader positions representing primary care and the hospital are full-time; the remaining five are part-time. The physicians serving in the role part-time will continue their practices.
Wilkinson acknowledged there will be a learning curve as the physician leaders learn more about making operational decisions and as the administrators learn more about the physicians' perspective. And, there will be culture change as physicians who may be used to working independently begin to work more as team members.
But it will be essential for all of them to function well as teams. "These are the leaders who will be helping to orchestrate any moves we make that fall under the accountable care organization model," she said.
Focus areas of the dyads