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4 fixes that will boost your bottom line

January 16th, 2013

by Kenneth H. Cohn

Happy New Year. Sometimes, the fuss in Washington causes temporary amnesia that healthcare, like politics, has a local focus. So this post contains the first four tips on ways to engage physicians where you work to improve clinical and financial outcomes and create a more satisfying practice environment:

1. Convene a panel of your top physicians to look at how improved collaboration can reduce expenses.

A surgeon once confessed to me, "I may ignore others' opinions, but I definitely listen to physicians who refer patients to me or to whom I refer patients for preoperative clearance and postoperative management."


Take, for example, a CEO at a Rocky Mountain tertiary care facility who asked the Medical Advisory Panel at his hospital for advice on how to cut supply costs. The panel worked together and with an interdisciplinary supply cost reduction group to achieve more than $500,000 in ongoing supply cost savings in the purchase and utilization of orthopedic implants, heart valves, radioisotopes, and anesthetic and cardiovascular medications.

While this task force may not seem novel, it represented the first time that physicians and administrators at this hospital had worked together to achieve sustainable, long-term results and represented a cultural change.

("Making hospital-physician collaboration work." Healthcare Financial Management. 2005. 59(10):102-108).

2. Boost revenues by facilitating discussion between physicians who work at the same hospital or healthcare system regarding referrals.

Most referrals derive from years-decades of collegial interactions and are difficult to change, even with data. To anticipate the coming bundled reimbursement for episodes of care, put physicians in a room together with a trained facilitator who speaks their language and has earned their respect. People say different things to people in person than they do outside the room.

3. Obtain a palliative care consultation for every patient admitted to the intensive care unit and on all patients for whom ICU transfer is likely.

Being proactive puts patients and families with caring professionals who can assure families that their loved ones will not suffer, and limits the cost of futile, do-everything care.

4. Improve communication between physicians and healthcare administrators by developing a compact.

As I described in "Collaborative Compact", a compact is a social contract that clarifies mutual expectations and helps both groups come to a shared vision that will improve care for their community. The compact for Wisconsin's Wheaton Franciscan Medical Group provides an operational definition of expectations regarding mutual respect, integrity, development, excellence and stewardship.

Other examples of compacts available include Gundersen-Lutheran Health System and Virginia Mason Medical Center.

Trying to achieve complete alignment between physicians' and hospital administrators' goals is unrealistic because physicians and administrators have substantial differences in background, training and outlook. Because most physicians' lives revolve around the immediacy of direct patient care, they respond to different pressures than hospital administrators, whose responsibilities may demand a more consensus-oriented, organization focused approach.

(Gaining hospital administrators' attention: Ways to improve physician-hospital management dialogue. Surgery. 2005; 137:132-140).

Working harder is not a viable economic solution for either group. However, effective dialogue is in hospital leaders' and physicians' self-interest because improved communication increases predictability, which can help both parties work more productively to build transparency and trust.

Ken is a practicing general surgeon/MBA and CEO of, who divides his time between providing general surgical coverage and working with organizations that want to engage physicians to improve clinical and financial performance.


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