A Review and Survey of Neurosurgeon–Hospital Relationships: Evolution and Options

Abstract

As healthcare delivery shifts from fee-for-service, episodic care to pay for performance and population health, both hospitals and physicians are looking for new forms of integration. A number of regulations and restrictions govern physician relationships with hospitals. In this paper, we review the legal basis for such relationships and the options available. We also survey neurosurgeons and hospital executives to gain their perspective on the current situation and likely future. Two series of structured interviews were conducted with 10 neurosurgeons who work in a range of situations in diverse markets, and with Memorial Hermann Healthcare System senior executive leadership. Their responses form the basis for the subsequent discussion. Neurosurgeons can be independent, join a confederation such as an Independent Physician Association or another type of "clinically integrated" network, or be employed by a hospital, medical school, or physician group. With varying levels of integration comes the strength of size, management expertise, negotiating leverage, economies of scale, and possibly financial advantages, but with impact on autonomy and independence. Constructive alignment can lead to a win-win situation for both the individual physician and the organization, but options vary widely due to heterogeneous local conditions. This paper reviews possible relationships, moving along a spectrum from no financial integration to full integration. Concepts such as physician leasing, professional service agreements, "clinical integration," and employment are presented. This paper offers a practical reference that might be useful to a new graduate, independent neurosurgeon considering integration, or employed physicians considering alternatives.

Practice Consolidation in Otolaryngology: The Decline of the Single‐Provider Practice

“…Recent changes to the health care system at the federal level have affected the relationship between hospitals and physicians across the country with a shift in the focus from pay for performance to population health. 1 - 3 The Patient Protection and Affordability Act and the Children’s Health Insurance Program have placed an emphasis on increasing quality of care while reducing health care costs. 4 These policies constrain the health markets, which govern the behavior of physician practices, with some variation at the state level due to differences in local legislation.…”

Physician leadership and hospital ranking: Expanding the role of neurosurgeons

“…They are often the first to advance quality initiatives and can be leaders in helping organizations adapt to the changing healthcare environment. [ 28 ] Therefore, having neurosurgeons as hospital leaders will provide high-quality and efficient care and support for education and research. In Canada, The Montreal Neurological Institute (The Neuro) was founded and headed by renowned neurosurgeon Dr. Wilder Penfield, in 1934.…”

A Direct Experience in a New Accountable Care Organization: Results, Challenges, and the Role of the Neurosurgeon

“…29 Metrics were selected and reviewed on a monthly basis and opportunities for vendor consolidation projects were discussed. Under a comanagement agreement (a legal contract, reviewed in another paper in this Supplement) 7 , a committee was formed, chaired by the senior author, with membership guidelines and a commitment to report and review quality data. Three subcommittees were formed: 1 to oversee quality efforts and peer review across the entire system and another 2 to address spinal and cranial implants.…”

“…A physician can also receive a bonus for CI participation (a review of regulations around CI is provided in the "A Review and Survey of NeurosurgeonHospital Relationships: Evolution and Options" paper, in this Supplement). 7 MHMD developed a process for doctors to undergo observation and investigation prior to membership.…”