by Dr. Kenneth H. Cohn

In Hospital Competition: The Unusual Suspects, Tony Chen wrote that in addition to physicians, other areas of competition--such as insurance companies, pharmaceutical manufacturers, drug stores, wellness providers, and hotel--are broadening competition for healthcare dollars.

In the comment section, Ron Whiting wrote, "A complete alignment of interests particularly between hospitals and physicians is required to effect real change in hospital care." As a practicing surgeon, I remain mystified over the operational definition of "complete alignment"; in Collaborative Mentality, I wrote about mindset differences between physicians and hospital leaders.

Nevertheless, my cluelessness about how to achieve the state of complete alignment will not stop me from pointing out a few ways that we can collaborate better to improve financial and clinical outcomes for our communities:

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1) A hospital in Northern Virginia provided a care manager for a few hours each weekend to expedite discharges, especially on patients for whom other physicians provided weekend or holiday coverage; within months, the hospital reversed losses on Medicare patients by decreasing a patient's length of stay, despite the cost the care manager's time. A neurosurgeon commented, "She had all the forms and prescriptions ready for my signature. It was a no-brainer to see those patients first."

2) A hospital in Northwestern Pennsylvania utilized an internist with an interest in palliative care to encourage all physicians who admitted patients to the ICU to obtain a palliative care consult on admission; the Chief Medical Officer exclaimed, "We cut our ICU patients who were DNR [do not resuscitate] to zero, saving money and staff morale!" (Note: They used a step-down unit for ventilated patients for whom there was little likelihood of survival)

3) At a hospital on the Connecticut coast, general surgeons came to consensus on packs for laparoscopic general surgery, saving money on unused items, especially disposables.

4) In one of my blog posts on Collaborative Culture, I showcased the results of physicians in Connecticut and Maine who used healthy competition to decrease costs and improve clinical outcomes in the cardiac catheterization laboratory and among diabetic patients.

Financial collaboration does not need to involve ransom payments from hospitals to specialists. I discuss in my ACHE seminar, Practical Strategies for Engaging Physicians, a hospital in Southern California whose orthopedic surgeons saved the hospital over $ 4 million by consolidating implant vendors from eight to two. In return, they asked for a new fracture operating room table and imaging system, totaling $365,000.

As I described in my first book, Better Communication for Better Care, hospital leaders can be proactive in describing to practicing physicians what they can offer, such as:

• Participation advantages in the purchase of rapidly obsolescing expensive technology.

• Market power to obtain bundled payment from payers.

• Experience with regulatory agencies.

• The multiplier effect of dollars that stay in the community rather than going to out-of-town vendors.

In Rethinking Hospital Care, Nick Jacobs compared healthcare to the newspaper industry, saying that both need a "change-or-die overhaul." He asked provocatively, "How do we remain relevant?"

To me, we remain relevant by remaining focused on the needs of patients and families to maintain wellness first and sick care as necessary. I truly believe that collaboration is the only low-hanging fruit that the current recession has not taken from us. I remain passionate about the value of our learning to work more interdependently because, as outlined above, I have seen financial and clinical outcomes improve throughout the U.S. when healthcare professionals focus on talking with rather than at one another.

What do you think?

• Currently, do we have a healthcare system in which the parts function interdependently?

• Can we make a business and clinical case for change?

• If healthcare is ultimately local, on what successes can we build?

As always, I welcome your input.

Ken is a practicing general surgeon/MBA who divides his time between providing general surgical coverage and speaking, writing, teaching, and consulting on physician-hospital relations. Learn more about what he does by visiting his blog here.