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在过去十年中, 云顶集团40011官网面临着增加以医院为基础的云顶集团40011官网云顶集团的财政支持的日益增长的需求. 不管是医院的, anesthesia, radiology, 或者其他“第一”专业, 这些云顶集团现在是云顶集团40011官网的一项重大投资. 尽管许多医院高管将这种支持视为沉没成本, 如果云顶集团结构合理, 它们可以作为驱动性能改进的主要催化剂. 图1显示了在您的组织中驱动性能改进的关键因素.
云顶集团40011官网面临着改善患者治疗效果和降低医疗成本的压力, 取得成果的一个关键重点领域应该是在各个护理环境中整合基于医院的云顶集团. 最重要的是, 云顶集团40011官网需要从不同的合同/安排转向具有标准化合同条款的综合模式, 云顶集团线治理, 以及支持全系统倡议的激励措施. 图2说明了获得基于医院的综合云顶集团的途径, 一些案例研究提供了云顶集团40011官网如何实现这种整合和绩效改进的进一步细节.
Click on the links below to review case studies on how several organizations have achieved significant performance improvement by advancing their hospital-based physician arrangements.
案例研究一:anesthesia云顶集团
中西部地区的系统,重组了与几个独立团体的合同,以规范覆盖模式, 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
西方的综合交付系统使合同标准化并建立了一个系统范围的指导委员会
案例研究三:医院云顶集团40011官网
Regional system on the West Coast that restructured contracts to create unified clinical governance and standard contract terms among several independent groups for hospitalist coverage
伙伴关系势在必行
当结构最优时, hospital-based physician services lead measurable and sustainable improvements to a health system’s operational and financial performance. 通过从无组织的过渡, 单个契约到更加协调/集成的云顶集团, 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. Restructuring contracts to create arrangements that better align with enterprise performance migrates the transaction-based relationship to a true partnership.
anesthesia案例分析
Background
A multihospital system in the Midwest was interested in evaluating and redesigning its anesthesia coverage arrangements to align them with current and future organizational priorities. The system contracted with multiple independent anesthesia groups for coverage and employed anesthesia providers at several sites. The independent groups did not employ CRNAs and the majority of anesthesia care provided at the facilities was by anesthesiologists. 该系统的目标是:
- Establish best practice clinical coverage models and evaluate opportunities to incorporate a care team model to provide greater flexibility and standardization of the coverage model across the system.
- 就未来的补贴水平和支付结构提出建议, including the incorporation of performance-based payments in the contract to better align incentives and share risk associated with the performance of the services.
- 评估各种选择,使整个系统的临床护理和质量更加一致和标准化.
过程
该系统正在努力管理整个组织中不同的anesthesia关系和个人合同. A critical first step was identifying key priorities for the system and developing a common methodology for evaluating resource requirements and contract parameters across the system. 一旦确定了优先级, 该系统可以建立一个基于护理团队方法的一致的覆盖模型, 共同资助原则和参数, 一组通用的性能指标,以推动更大的一致性, 以及标准的云顶集团要求和期望. 系统成功地迁移到协调契约方法, 哪些将为未来发展协调治理和集成云顶集团提供基础.
结果
该系统正在整个系统中实施护理团队模型. 考虑到人员结构的变化以及招募大量crna的需要, 我们制定了一个多年的过渡期,为anesthesia组提供经济激励,以过渡到新的模式. 作为过渡时期的一部分, 该系统正在减少为anesthesia覆盖支付的总体补贴,并引入基于绩效的指标, 包括质量和or -效率指标, 推动与组织绩效和目标的更大一致性.
radiology个案研究
Background
An integrated delivery system with over 20 hospitals and a large health plan identified imaging services as a key strategy for improving quality and better managing costs across the system. 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. 随着组织推进到以价值为基础的环境, 与放射科云顶集团40011官网保持一致成为实现他们期望结果的核心要素. 具体来说,系统的成像目标是:
- 通过基于绩效的合同或雇佣,使所有放射科云顶集团40011官网紧密结合,并消除利益冲突.
- 为受雇和签约放射科医师合作伙伴建立一致的支付方法.
- 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.
该组织历来与九个不同的radiology小组签订了合同, 代表100多名放射科云顶集团40011官网, 在整个系统内提供诊断和介入云顶集团, 大多数组织都希望保持独立.
过程
The system’s long-term goals were to enhance the value of imaging services while also creating greater alignment with radiologists. Applying a common set of practices and philosophies to each of the radiology group discussions ensured a consistent framework across all aligned groups. 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, 以及集中管理和治理机构的代表权. 集中管理和治理结构支持跨集成云顶集团的标准化.
结果
The health system successfully employed or implemented a comprehensive professional services agreement with each of the nine groups. 这些合同对每个团体来说都是独一无二的,但包括了相同的条款. 云顶集团40011官网现在为所有专业radiology云顶集团收费, 这使得组织能够在全球范围内计费,并且更容易签订基于价值或基于风险的付款人合同. 通过这种方式构建财务安排, 该系统能够在雇佣和签约放射科云顶集团40011官网之间建立一个共同的补偿系统, 帮助消除感知到的财务障碍,并将这些团体整合到一个更有凝聚力的云顶集团中. A system wide committee known as the Imaging Guidance 委员会 was created and now serves as a critical structure for integrating the various groups. 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, 制定年度目标(包括临床目标和行政目标). 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, 这一策略使成像云顶集团成为一个价值创造者, 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, was interested in creating greater alignment between the various hospitalist programs that served the organization’s five acute care hospitals. 尽管这些医院都位于一个都会区, 每家医院都建立了自己的住院医师计划, 哪些是由持有个人保险协议的独立医疗集团运营的. This resulted in a decentralized approach to hospital coverage at each facility with little to no sharing of best practices and resources among the groups. 除了, the health system faced negotiating five distinct professional services agreements every two to three years that each had different terms.
虽然这些方案成功地满足了成年住院病人的需求,并与各自的医务人员合作, health system leadership recognized the opportunities to elevate performance if a more coordinated and integrated approach to the system’s hospitalist program was attained. 超越操作和临床的优势,更好地整合各种方案, 标准化PSA条款还有其他好处. The health system asked 心电图 to define the optimal organizational structure and financial terms to facilitate the integration of the hospitalist programs.
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, including evaluating the organization and governance structure for each hospitalist group and benchmarking operational and financial performance. 一旦确定了当前绩效与最佳实践之间的差距, 该系统能够确定合同续订的优先次序. A standardized funding model was then developed that aligned performance among the parties and offered the hospitalists additional financial support for improved performance in key performance metrics. 除了, a performance dashboard was created to report key operational and financial metrics to measure performance across the five sites and facilitate ongoing sharing of best practices.
结果
与医院云顶集团40011官网和云顶集团40011官网领导合作, 心电图 defined a new operating model that centralized the hospitalist programs into a single division with dedicated management and physician leadership. 在新的结构下, 医疗集团将保留他们各自的专业公司, 而是在全系统云顶集团线构建下功能整合医院项目. This new division included formal organizational elements that brought the physician leadership across the five sites together to share best practices, 确定云顶集团40011官网招聘需求, 协调覆盖范围. 另外, the implementation of the standardized funding model resulted in less administrative work tracking and reporting financial performance. The standardized funding terms resulted in parity among the groups that enhanced the system-wide recruiting and retention of hospitalists.
2019年4月23日发布