9 Points for Orthopedic and Spine Surgeons on Forming Positive Relationships With Hospitals

Laura Dyrda -   Print  |
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If you want to become part of the overall continuum of care in your community, forming a partnership or aligning with a hospital may be in your future, if it hasn't occurred already. Here, orthopedic and spine surgeons and industry professionals discuss what it takes to form a positive relationship with hospital executives.

1. Become a part of a larger group for leverage.
If you are a single physician or part of a small physician group, consider partnering or merging with a larger group to gain increased access to relationships with hospitals. "If you're a significant enough presence in the community and you have a skill set the hospital needs, it makes sense for you to get together," says Steve Fiore, CEO for Orthopedic Specialty Group, PC, in Fairfield, Conn. "It's often hard for small practices to have that leverage." Large groups in the community can be seen as competition for the hospital, and hospitals often are more motivated to work with those groups as partners instead of adversaries.

2. Know what is possible out of hospital agreements. When selecting a hospital for an exclusive partnership, orthopedic surgeons and practices want to understand the financial and practice benefits they might realize from the exclusive relationship. Hospitals are limited in the ways they can compensate private practice surgeons. Sometimes a leadership or administrative role is available, but this is not always the case. "In considering which hospital to go to, surgeons want the administration to make a meaningful investment in the relationship," says George Rappard, MD, founder and director of the Los Angeles Brain and Spine Institute at Hollywood Presbyterian Medical Center in Los Angeles. "There are a variety of ways a hospital can work with physicians including developing facilities, equipment and staff to make the surgeons work in the hospital go more smoothly while providing excellent care to the patient. There may also be options for call coverage if the hospital is a trauma facility." It is important to note that hospitals and physicians should be careful to ensure any compensation relationships do not exceed fair market value.

Hospitals and physician groups might also enter into recruiting agreements. Under these agreements, hospitals provide a guaranteed salary to the new physician brought into the group.

3. Appoint a contact representative to manage communications.
Individual orthopedic surgeons need to focus on their medical practice, which means they don't need to be involved in every correspondence about the partnership between their group and the hospital. Larger groups often appoint a physician or practice administrator to coordinate with the hospital's administration. "To have someone who can be managing the process in terms of communications is going to be important," says Randy Shulkin, a consultant with Culbert Healthcare Solutions. "Having a representative of the physicians there who is visible is important to keeping these relationships on track." While communications might funnel through one person, that person can also bring in other physicians for meetings or other correspondence when necessary.

4. Approach the hospital as your customer.
Orthopedic surgeons are accustomed to hospitals looking at them for support, says Rick Wilfong of Rick Wilfong Consulting, but surgeons need to start looking at hospitals as customers as well. "Too often with physicians, it's more about 'what can you do to help me earn money,' and it needs to be 'here is what I can offer you'," he says. "Surgeons need to be able to talk to hospital executives about what type of cases they have, case volume and their payor mix. It shows the hospital that these surgeons are taking the partnership seriously." Hospital executives will be interested in knowing your practice metrics, such as cost for doing each procedure, recidivism rate and other quality indicators before entering into a committed partnership with you or your practice.

5. Steer clear of adversarial comments. Partnerships between orthopedic surgeons and hospitals should be friendly, even in times of stressful negotiations. "Adversarial comments never help," says Neel Anand, MD, director of orthopedic spine surgery for the Spine Center at Cedars-Sinai Medical Center in Los Angeles. "There's no point in being adversarial with the hospital executives. At the end of the day, it has to be a compromise where you try to help each other understand what you are doing." One-on-one conversations instead of e-mails can help foster an open relationship that can work well for both parties.

6. Don't try to change the system over night. Hospitals are racked with bureaucracy, and even the most optimistic orthopedic surgeons aren't going to immediately change the system through an alignment or joint venture. "A lot of surgeons believe you can implement changes quickly and hospitals should do something differently beginning tomorrow. The surgeon has to know the system and work through it," says Dr. Anand. Throughout these meetings and negotiations, it is particularly important that orthopedic surgeons help administrators understand their point-of-view through the lens of financial gain because most administrators don't have a medical background and may not understand medical implications driving a decision.

7. Foster a good relationship with medical staff. Respecting the entire medical staff is essential to forming a good relationship with hospital executives, especially if you are new to the team. Current medical staff is often concerned about competition for patients or operating room time, and you have to make sure you step in line with community values and seniority. "The most important thing is to be able to influence the medical staff so the administration's support for you is mirrored by the medical staff's support," says Dr. Rappard. "A hospital can form an agreement for a directorship, recruit the new surgeon, market the surgeon and if the medical staff is against him, his ability to succeed is going to be limited by his ability to suffer."

8. Be faithful with exclusive relationships.
Trust is important in any relationship, including those between orthopedic surgeons and hospital administrators. "A hospital cannot maintain its sense of integrity with a physician if they have an agreement one day and then recruit the surgeon's competition the next," says Dr. Rappard. "On the same token, the physician's integrity could suffer if they have two agreements with different facilities. There's nothing wrong with competition, but when you try to foster a special relationship, there has to be a sense of exclusivity."

9. Consider bringing in a third party. An impartial third party can bridge the gap between orthopedic surgeons and hospitals. In the event of an existing adversarial relationship, the third party can help the other two peaceably collaborate. The third party can smooth out technical differences between the hospital and orthopedists, such as cross pollinating the two billing process. The use of electronic medical records between the groups can also cause problems. Orthopedic Specialty Group and their hospital partner use two different electronic medical record systems, which are incompatible with each other. Culbert Healthcare Solutions helps bring the two together. "They come from a background with expertise in both systems," says Mr. Fiore. "Those of us in the practice management world have to recognize we don't have all the answers. Our job is to find the subject matter experts who can make the collaboration happen."

Read other coverage on orthopedic surgeon relationships with hospitals:

- 6 Different Methods for Orthopedic Surgeon-Hospital Alignment

- Physician Hospital Contracting — A Compliance Approach: 11 Key Concepts

- 5 Steps to Develop a Co-Management Arrangement for a Hospital Service Line

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