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在过去十年中, health systems have faced heightened demand to increase financial support in hospital-based physician services. 不管是医院的, anesthesia, radiology, 或者其他“第一”专业, these services now represent a substantial investment for health systems. While many hospital executives view the support as a sunk cost, 如果云顶集团结构合理, they can act as a major catalyst for driving performance improvement. Figure 1 shows the key factors to drive performance improvement at your organization.
As health systems face pressure to drive better patient outcomes and reduce costs of care, a key focus area to attain results should be the integration of hospital-based services across care settings. 最重要的是, health systems need to move from disparate contracts/arrangements to an integrated model with standardized contract terms, 云顶集团线治理, 以及支持全系统倡议的激励措施. Figure 2 illustrates a pathway for getting to an integrated hospital-based service, and several case studies provide further detail about how health systems can achieve this integration and performance improvement.
单击下面的链接,查看案例研究,了解几个组织如何通过推进基于医院的云顶集团40011官网安排实现了显著的绩效改进.
案例研究一:anesthesia云顶集团
Regional system in the Midwest that restructured contracts with several independent groups to standardize the coverage model, 融资方法, 以及整个系统的激励机制
案例研究二:radiology云顶集团
Integrated delivery system in the West that standardized contracts and created a system-wide guidance council
案例研究三:医院云顶集团40011官网
在西海岸的区域系统,重组合同,建立统一的临床治理和标准合同条款之间的几个独立团体的医院云顶集团40011官网的覆盖
伙伴关系势在必行
当结构最优时, 以医院为基础的云顶集团40011官网云顶集团可为云顶集团40011官网的运营和财务绩效带来可衡量和可持续的改善. 通过从无组织的过渡, individual contracts to more coordinated/integrated services, 系统可以共享最佳实践, 加强资源调配, 更有效地招募和留住供应商. 重组契约以创建更符合企业绩效的安排,将基于事务的关系迁移到真正的伙伴关系中.
anesthesia案例分析
Background
中西部的一个多医院系统对评估和重新设计anesthesia覆盖安排感兴趣,以使其与当前和未来的组织优先事项保持一致. 该系统与多个独立的anesthesia小组签订了覆盖合同,并在几个地点雇用了anesthesia提供者. 独立小组没有使用crna,在设施中提供的大部分anesthesia护理是由anesthesia医师提供的. 该系统的目标是:
- 建立最佳实践临床覆盖模型,并评估合并护理团队模型的机会,以便在整个系统中提供更大的灵活性和覆盖模型的标准化.
- Formulate recommendations related to the future subsidy levels and payment structure, 包括在合同中纳入基于绩效的薪酬,以更好地协调激励措施,分担与云顶集团绩效相关的风险.
- Evaluate options to create greater alignment and standardization of clinical care and quality across the system.
过程
The system was struggling to manage the disparate anesthesia relationships and individual contracts across the organization. 关键的第一步是确定系统的关键优先级,并制定一个通用的方法来评估整个系统的资源需求和合同参数. 一旦确定了优先级, the system could develop a consistent coverage model based on a care team approach, 共同资助原则和参数, a common set of performance metrics to drive greater alignment, 以及标准的云顶集团要求和期望. The system is successfully migrating to a coordinated contract approach, which will provide the foundation for developing coordinated governance and an integrated service in the future.
结果
The system is in the process of implementing the care team model across the system. Given the change in staffing mix and the need to recruit a significant number of CRNAs, we developed a multiyear transition period with financial incentives for the anesthesia groups to transition to the new model. 作为过渡时期的一部分, the system is reducing the overall subsidy paid for anesthesia coverage and introducing performance-based metrics, 包括质量和or -效率指标, to drive greater alignment with organizational performance and goals.
radiology个案研究
Background
一个由20多家医院和一个大型卫生计划组成的综合交付系统将成像云顶集团确定为提高整个系统质量和更好地管理成本的关键战略. 系统传导超过5,每天500次影像学检查, 大约50%的患者接受了影像学检查. As the organization pushed forward into a value-based environment, aligning with radiologists became a core element to achieving their desired outcomes. 具体来说,系统的成像目标是:
- Tightly align all radiologists through performance-based contracts or employment and remove conflicts of interest.
- Establish payment methodologies for employed and contracted radiologist partners that are consistent.
- 建立统一的治理结构.
- 在治理结构中培养医师领导.
- 创建和部署放射科云顶集团40011官网的绩效标准.
- 与放射科云顶集团40011官网合作开发临床最佳实践.
The organization had historically contracted with nine different radiology groups, 代表100多名放射科云顶集团40011官网, to provide diagnostic and interventional services across the system, 大多数组织都希望保持独立.
过程
该系统的长期目标是提高成像云顶集团的价值,同时与放射科云顶集团40011官网建立更大的一致性. 在每个radiology小组讨论中应用一套共同的实践和理念,确保了所有相关小组之间的一致框架. 这包括一组一致的对齐选项, 常用补偿原理和参数, 标准云顶集团要求, and representation on a centralized management and governance body. The centralized management and governance structure supports standardization across the integrated service.
结果
云顶集团40011官网成功地采用或实施了与这九个群体中的每一个的全面专业云顶集团协议. The contracts were unique to each group but included the same terms. The health system now bills and collects for all professional radiology services, which allows the organization to bill globally and more easily enter into value-based or risk-based payer contracts. 通过这种方式构建财务安排, the system was able to create a common compensation system across both employed and contracted radiologists, helping to eliminate perceived financial barriers and integrate the groups into a more cohesive service. 一个被称为成像指导委员会的全系统委员会成立了,现在它是整合各个小组的关键结构. 理事会还致力于管理适当的利用, 对整个系统的云顶集团进行合理化, 批准全系统临床方案, 创建电平加载参数, and establish annual goals (both clinical and administrative). 此外, the system is now capable of implementing value-added services such as decision support tools; radiational safety measures; and one-call scheduling, 登记, 和预先授权. 简而言之, the strategy allowed imaging services to become a value generator, 不仅仅是音量发生器.
住院医师案例研究
Background
区域云顶集团40011官网, 位于西海岸, 是否有兴趣在云顶集团于该组织五家急症护理医院的各种医院医师项目之间建立更大的一致性. Although the hospitals were all located in a single metro area, 每家医院都建立了自己的住院医师计划, which were operated by independent medical groups that held individual coverage agreements. 这导致每个机构的医院覆盖范围分散,各团体之间几乎没有分享最佳做法和资源. 除了, 云顶集团40011官网面临着每两到三年就五个不同的专业云顶集团协议进行谈判,每个协议都有不同的条款.
While these programs were successful in covering the adult inpatient needs and working with the respective medical staffs, 云顶集团40011官网领导层认识到,如果对系统的住院医师计划采取更加协调和综合的方法,将有机会提高绩效. Beyond the operational and clinical advantages of better integrating the various programs, there were additional benefits associated with standardizing the PSA terms. 云顶集团40011官网要求心电图确定最佳的组织结构和财务条款,以促进医院计划的整合.
过程
建立一个协调的, 全系统的住院医师计划, 首先完成心电图对当前状态的评估, 包括评估每个医院集团的组织和治理结构,并对运营和财务绩效进行基准测试. Once the gaps in current performance relative to best practices were identified, the system was able to define priorities for the contract renewals. 然后制定了一个标准化的筹资模式,使各方之间的绩效保持一致,并为医院提供额外的财务支持,以提高关键绩效指标的绩效. 除了, 创建了一个性能仪表板来报告关键的运营和财务指标,以衡量五个站点的绩效,并促进最佳实践的持续共享.
结果
In collaboration with hospitalist and health system leadership, 心电图定义了一种新的运营模式,将医院项目集中到一个部门,由专门的管理和云顶集团40011官网领导. 在新的结构下, the medical groups would retain their individual professional corporations, but functionally integrate the hospital programs under system-wide service line construct. 这个新的部门包括正式的组织元素,将五个站点的云顶集团40011官网领导聚集在一起分享最佳实践, 确定云顶集团40011官网招聘需求, 协调覆盖范围. 另外, 标准化筹资模式的实施减少了跟踪和报告财务业绩的行政工作. 标准化的资助条款导致各团体之间的平等,从而加强了全系统的医院云顶集团40011官网招聘和保留.
2019年4月23日发布