Observation Deck – The Shape of Things to Come

Imagine a Little League baseball season during which no parents volunteer to coach, or a condo association of which no one agrees to be president. Now imagine a hospital where no doctors participate in the medical staff organization. That’s the direction in which things are heading, according to a new study from VHA (see related article in this month’s issue, pp. 30-32).

In non-profit, community hospitals, a kind of contract exists, says Ken Smithson, M.D., VP of research for VHA. The contract states that the hospital allows physicians to use its facilities and resources for free. In return, the doctors provide certain services, such as participating in the medical staff organization, taking emergency room calls, attending committee meetings, and providing advice on various issues, such as infection control or medical records. In short, while administration assumes responsibility for many of the “hotel” functions associated with running a hospital, physicians maintain the clinical oversight. That’s the way it must be, according to the Joint Commission on Accreditation of Healthcare Organizations. But what happens when the physicians are reluctant to hold up their ends of the bargain?

“In the past, the hospital could go to a committee chairman and say, “We need some physicians to help us with this issue,’ and physicians would donate their time,” says Smithson. “But today, physicians don’t have the luxury of donating their time without it having a material impact on their income. So, more and more, they are resisting cooperating with the hospital.”

More alarming is the fact that, just as in a failing marriage, there’s not as much animosity as there is apathy. Smithson says a number of physicians simply aren’t showing up at the hospital that much anymore. They send acute patients to the emergency room, where hospital-employed intensivists care for them; or they care for patients at some kind of ambulatory facility, perhaps one where they have an ownership interest. Hospital administrators end up with what Smithson calls the “empty clubhouse” syndrome: With fewer doctors to rely on, administration keeps going to the same well, forcing a smaller group of doctors to take on increasingly heavy burdens.

Many doctors who take an interest in their hospital’s medical staff organizations do so only because they perceive it in much the same way a worker perceives his union, that is, an organization to which they can air their grievances.

Astoundingly, hospitals and doctors are finding less in common with each other these days. I say “astoundingly” because both are, after all, in the patient care business. While administrators stay up at night worrying about regulatory issues, staffing shortages and the cost of implementing new IT solutions, doctors are on a different wavelength, says Smithson. They’re worried about their own (dwindling) income.

Given this state of affairs, who would be surprised if IDN contracting professionals were to find it more difficult to enlist the support of high-level physicians and surgeons in product standardization activities? After all, standardization takes time and work. Without the passion and commitment of the hospital’s highest profile clinicians, there’s little chance of success.

Yet, while doctors might indeed be ceding control over functions they used to hold onto tightly, in no way will they cede oversight of patient care to administration. And if history is any guide, physicians will continue to view the supplies they use (particularly things like implants) as an integral component of patient care.

So the contracting staff is faced with double trouble: a medical staff that doesn’t have time to get involved in initiatives such as standardization, but still holds dear to its heart the right to select sensitive medical products for use on patients.

If ever there was a time for professionalism, leadership and good, old-fashioned salesmanship on the part of contracting professionals, it is right now.

About the Author

Mark Thill
Mark Thill is the Editor of The Journal of Healthcare Contracting and has been reporting on healthcare supply chain issues since 1985. He is a graduate of Dominican University in River Forest, Ill., and he received a master's degree in journalism from Northwestern University in Evanston, Ill.
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