Working With Hospitals: 6 Tips for Orthopedic Surgeons Who Aren't Employed

Written by Laura Dyrda | July 05, 2011 | Print  |
Here are six tips for orthopedic surgeons to work with hospitals without employment.

1. Fast-track lines of communication between the two entities. Communication between hospitals and the orthopedic groups with physicians who have hospital privileges is very important to sustain a successful relationship, especially if the two entities are working on a collaboration. It can be difficult to make sure everyone is on the same page because of busy schedules on both sides. Indianapolis' OrthoIndy and St. Vincent Health jointly employ a team member to report to the CEO of OrthoIndy's Indiana Orthopaedic Hospital (IOH) and the Chief Nursing Officer and Chief Operating Officer at St. Vincent Indianapolis Hospital. "When this person goes in and says here are places we can improve, she talks to both hospitals and together we all determine what the plan of action is going to be to resolve an issue," says John Martin, CEO of OrthoIndy. "It has to be a collaborative approach. We spend a fair amount of time making sure everyone on both sides of the fence knows what our role is in the program. When you are first trying to get these types of partnerships achieved, that's the hardest part. After you get a little traction and people understand how it works, issues resolve over time."

2. Agree on financial sharing or separation upfront. Marin General Hospital (MGH) in Greenbrae, Calif., began a new collaboration with the University of California, San Francisco Department of Neurosurgery and the orthopedic spine surgeons at the Mt. Tam Spine Center, led by Robert Byers, MD, and Brian Su, MD. Under the terms of a recent agreement, the hospital and the Mt. Tam Spine Center physicians remain financially separate and do not share income. "The hospital provides the bulk of the marketing budget for the Spine & Brain Institute, which includes advertising in newspapers and magazines as well as promoting to other physicians through literature and symposiums," says Dr. Su. "We've been meeting with the marketing team at Marin General Hospital. They see that if we can treat more of the local elective spine and brain surgery cases in our area, it will be a good thing for the community."

When a patient calls for a physician referral through the Spine & Brain Institute, physicians are assigned to them on a rotating basis (unless the patient specifically asks for one surgeon over another). "There's equity in assigning patients that way," says Tarun Arora, MD, a UCSF neurosurgeon who is involved in the Institute. "Marin General Hospital doesn't favor one physician or physician group over another.”

If patients need rehabilitation services associated with the Mt. Tam Spine Center, MGH does not receive compensation for the services.

3. Maintain a good relationship with hospital staff.
You should make sure you have a good reputation at the hospital, which means fostering a good relationship with the nursing staff, anesthesiologists and other OR professionals. "Developing a good relationship with all these people means there will be a positive messages getting back to the administration," says Randy Shulkin, MBA, FACMPE, principal consultant with Culbert Healthcare Solutions. "The administrators will hear not only are you a good physician technically, but also from a personality perspective, you are a good person to work with. Then you will be at the forefront of their radar." Having a good reputation at the hospital makes extending a collaboration easier in the future.

4. 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 Neel Anand, MD, director of orthopedic spine surgery for the Spine Center at Cedars-Sinai Medical Center in Los Angeles. 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.

5. Approach strategic meetings as partners. "Don't approach the hospital as the enemy from which you need to get as much money as possible, but as a partner," says Rick Wilfong of Rick Wilfong Consulting.

Orthopedic surgeons and hospital executives must have a secure space and trusting relationship so they can talk candidly about what works and what doesn't. "This relationship is important and people have to have a venue where they can trust each other and be frank with each other," says George Rappard, MD, founder and director of the Los Angeles Brain and Spine Institute at Hollywood Presbyterian Medical Center in Los Angeles. During these meetings, it's important to look at solutions for increasing efficiencies and lowering expenses. You can help the hospital by considering the use of a cheaper devices or implants, working with the hospital to renegotiate current contracts for a better price and being conscious of your payor mix.

6. Decide whether the agreement is exclusive or not, and stay true to it. 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 George Rappard, MD, founder and director of the Los Angeles Brain and Spine Institute at Hollywood Presbyterian Medical Center in Los Angeles. "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."

However, there may be some benefits to keeping the agreement open. Even though OrthoIndy physicians have partnered with St. Vincent, they can still see patients at other hospitals, which is important for maintaining positive relationships in the community. "The beauty of this partnership is that it allows us to grow in different markets," says Mr. Martin. "It's an arrangement that has continued to allow us to work with other facilities in relationships that we have valued over the years."

Related Articles on Orthopedic Surgeons:
6 Different Methods for Orthopedic Surgeon-Hospital Alignment

9 Points for Orthopedic and Spine Surgeons to Form a Positive Relationship With Hospitals

6 Steps for Orthopedic Surgeons to Maintain a Positive Relationship With Hospitals

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