Are Employed Physicians Fully Integrated?

While both physicians and administrators agree the integrated physician model has potential to succeed, there is sharp disagreement over whether or not employed physicians are fully integrated into their hospital or health system.

A survey from the American College of Physicians Executives (ACPE) found that integrated physician models are favorable both for healthcare leaders and physicians. The 20-question survey was sent to nearly 10,000 ACPE members and completed by 617.

The trend toward physician employment and value-based payment is reminiscent of the 1990s, when hospitals reacted to the increased demands of managed care. This time around, Peter Angood, MD, FRCS(C), FACS, FCCM, president and chief executive officer of ACPE, believes it’s a good sign.

“This is a strong and important trend that is really essential for healthcare to become more successful in delivering what the public actually wants,” he said in a statement. “The ultimate goal is higher quality, safer care that’s more efficient, more personalized, and is really consumer-focused.”

Benefits of today’s physician integration model as cited by the participants include improved communication, greater transparency, better physician job satisfaction, and a more patient-centered focus.

The participants, all ACPE members, were asked to rate their own satisfaction and estimate administrators’ feelings. The survey found that 80% of the participants either agreed or strongly agreed that the employed physicians within their healthcare organization were satisfied with the current integration model. Likewise, 85% agreed or strongly agreed that administrators were also satisfied.

Responses were split nearly evenly in 2 categories. The survey results showed 53% said employed physicians were fully integrated into their hospital or health systems with 47% disagreeing. Those surveyed were also split over whether their organization offered an incentive plan to encourage and reward physicians for being engaged in practice performance initiatives: just 51% said yes.

Physicians were also asked what was stopping them from becoming more actively engaged. The anonymous responses ranged from “the employed physicians are not empowered,” meaning the physicians are micromanaged through emails without being offered a seat at the table, to “employed does not mean culturally aligned,” meaning there were unclear expectations for all parties.

Challenges to the integrated model included lack of financial incentives, difficulty blending employed and non-employed physicians, reconciling geographical differences, and breaking down silos between administrators and those who practice medicine.

Still, most survey participants agreed that there was strong potential for the integrated model. They cited core elements that needed to be improved upon, such as appropriate IT support, aligned incentives, and strong physician leadership.

In a separate but similar study, researchers shed light on whether Accountable Care Organizations proposed by the Affordable Care Act would reduce costs and improve quality of care through integration and coordination of services in a Midwest community.

Investigators concluded that different medical groups serving local communities will experience different costs. The data confirmed that high-performing medical groups in each category (32 not-for-profit primary care and specialty Integrated Delivery Systems, at least one owned hospital, and 20 medium-sized, physician-owned primary care practices) exist; however, researchers also unexpectedly learned they are often out-performed by small physician-owned practices.