Other-Than-Economic Models for Physician-Health System Partnerships

Beginning of article

In the last physician issues column, economically grounded models of physician-hospital partnerships were discussed. In this column we will present models that, while grounded in economic realities, pursue initiatives with other goals for the relationship. We will also describe evaluation criteria that should be used to develop and assess the effectiveness of the partnership models.

As discussed in previous columns, one of the failures of physician-hospital partnerships has been relationships characterized as "all or nothing" or "all or minimally integrated," such as the practice acquisition and employment model or independence. A second common reason for failure is the inability of partnerships to meet expectations. From the physician perspective, affiliations with hospitals often fail because demonstrated economic benefit or improved practice viability--explicit goals of most established partnership models--is not achieved. From the health system perspective, inordinate sums of money have been spent to achieve only marginal improvement in relationships with the medical staff. Also, the execution of partnership models rarely results in improved competitive position relative to other health systems or payers. In other words, physician-health systems partnerships in many markets are a zero sum game because no net change in physician relationships or health system competitive position is achieved.

Therefore, before any model is implemented, whether the model …