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   Hospital-Physician Relations
… Deteriorating relations between hospitals and physicians are imperiling a wide range of health care objectives, researchers from the Center for Studying Health System Change (HSC) report in a Health Affairs Web Exclusive published December 5 th , 2006.

Hospital-Physician Relations: Cooperation, Competition, Or Separation?
Robert A. Berenson, Paul B. Ginsburg, and Jessica H. May

         Because many services performed in hospitals can safely and conveniently be performed in ambulatory settings, physicians have become owners of entities directly competing with hospitals for patients in a new medical arms race. Hospitals and medical staff physicians face growing tensions as a result of physicians' growing reluctance to take emergency department call and the consequences of hospitalists replacing physicians in the care of inpatients. Although there are increasing expectations that health system challenges will lead hospitals and physicians to collaborate, in many markets the willingness and ability for hospitals and physicians to work together is actually eroding

Creating Accountable Care Organizations: The Extended Hospital Medical Staff
Elliott S. Fisher, Douglas O. Staiger, Julie P.W. Bynum, and Daniel J. Gottlieb

         Many current policies and approaches to performance measurement and payment reform focus on individual providers; they risk reinforcing the fragmented care and lack of coordination experienced by patients with serious illness. In this paper we show that Medicare beneficiaries receive most of their care from relatively coherent local delivery systems comprising physicians and the hospitals where they work or admit their patients. Efforts to create accountable care organizations at this level--the extended hospital medical staff--deserve consideration as a potential means of improving the quality and lowering the cost of care.

Gain Sharing: A Good Concept Getting A Bad Name?
Gail R. Wilensky, Nicholas Wolter, and Michelle M. Fischer

         The introduction of diagnosis-related groups (DRGs) created a clear misalignment between the incentives facing hospitals and those facing physicians. The interest in gain sharing that developed in the 1990s represented an attempt by physicians to extract and hospitals to offer some of the savings being produced by physicians. Advisory bulletins by the Office of Inspector General (Department of Health and Human Services) quickly put a stop to further interest in these strategies. Newer, narrowly defined types of gain sharing have been under consideration. More broadly defined strategies that will be tested under a new Centers for Medicare and Medicaid Services demonstration are more promising.

Taking Steps Toward Integration
Denis Cortese and Robert Smoldt

         If patients are to be at the center of health care, then providers should work diligently to better organize the delivery system. In this Perspective, two Mayo Clinic leaders provide their views on why it is necessary for physicians and hospitals to set aside their differences and work together for the good of their patients. They cite successful enterprises nationwide that combine hospital and physician control. Many of them have been recognized as examples.

Hospitals And Physicians: Not A Pretty Picture
Jeff Goldsmith

         Hospital-physician relationships in the United States have deteriorated markedly in the past few years. An asymmetry of obligations to caring for the uninsured and inappropriate financial incentives have worsened the conflict between hospitals and physicians in many markets. Sadly, the resources and political bandwidth consumed by managing this conflict have been diverted from the fundamental challenge of providing universal health coverage--the root cause of much of this conflict.

Medical Staff Organizations: A Persistent Anomaly
Ken Smithson and Stuart Baker

         Medical staff organizations (MSOs) originated to reconcile hospitals' hierarchical management structure with the professional autonomy demanded by physicians. MSOs' primary purpose is to hold physicians collectively accountable for patient safety and clinical performance. However, in an era of declining hospital activity, most physicians no longer understand this. More often, they view the MSO as a political body whose purpose is to foster physicians' interests with the hospital's administration and board of trustees. In many hospitals, it is difficult to determine whether the MSO is the key to clinical improvement or the biggest barrier.

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