Physician Engagement Trends Show Room for Improvement
By Debra Wood, RN, contributor
July 13, 2011 - Although collaboration seems more important than ever, physician engagement with hospitals is not increasing, in large part due to the uncertainties associated with healthcare reform and reimbursement.
Rick Blizzard reported that physician engagement is important to increasing hospital outpatient volume.
“At a time when we are placing greater and greater emphasis on building a cooperative relationship, we’re seeing all of the change is actually increasing disengagement,” said Rick Blizzard, the healthcare subject matter expert for the polling and consulting firm Gallup.
Gallup measures emotional attachment—the positive bond—between hospitals or health systems and physicians and categorizes physicians as (1) fully engaged; (2) engaged but not strongly; (3) not engaged or neutral; and (4) actively disengaged, which can include active antagonism.
Blizzard reports a drop of about 5 percent in the number of physicians who are fully engaged and an increase of about 10 percent in the actively disengaged. He attributes that to worries about the impact of value-based purchasing, and changing reimbursement and incentives.
The surveying and consulting firm Morehead Associates of Charlotte, N.C., has found physician engagement has plateaued, after an uptake in 2009, said Brad Morton, senior vice president of product management at Morehead. He credits that to uncertainty in the marketplace and physician satisfaction with their careers.
The company defines physician engagement as the association and partnership physicians feel toward a healthcare organization. It measures four domains that affect physician engagement: administration, organization, department and staff.
The highest scoring items in the Morehead 2010 survey were physicians’ satisfaction with radiology services and the nursing staff, while the lowest scoring items were hospitals’ communication methods and the quality of patient care.
Gaspere (Gus) C. Geraci, M.D, believes physicians must become reengaged, so they can lead the changes occurring in healthcare.
“Building trust and creating partnerships is going to be a consistent challenge going forward,” Morton said.
Gaspere (Gus) C. Geraci, M.D., vice president of physician leadership in quality and value at the Pennsylvania Medical Society in Harrisburg, agreed that physicians are less engaged, adding that many reasons contribute. In addition to coming payment changes, a conflict of goals may exist. Employed physicians and health systems may not share the same objectives.
“To secure better health, and quality and value in healthcare, physicians need to get reengaged if they are disengaging,” Geraci said.
The Pennsylvania Medical Society has launched an initiative to position physicians to lead and shape healthcare delivery to assure that the evolving system provides quality and value to patients and the community. Rather than let hospitals continue taking the lead, the society is helping physicians develop leadership skills and gain the knowledge to successfully advance healthcare in the future.
“To most optimally move forward, physicians should be engaged as leaders in determining quality and value in healthcare,” Geraci said.
Why is physician engagement so important?
Engagement is important to hospitals, even if reimbursement doesn’t change.
Blizzard reported at one health system, outpatient volume increased 17.5 percent for physicians in the top quartile for improved engagement, whereas physicians in the bottom quartile, their outpatient volume declined 11.7 percent.
“That’s quite a dramatic difference if you are the hospital,” Blizzard said.
Morehead has found some association between high-performing hospitals and physician engagement.
Brad Morton suggested that hospitals adapt communication methods to physician preferences.
“Typically, when we see physician engagement move, we see other important metrics move,” Morton said. “Physician engagement is the lynchpin of many strategies in the organization, and without it, [those strategies] will not happen.”
Rochell Pierce recommends visiting with physicians and having a serious discussion about their goals and how the hospital can help them achieve those goals.
Morehead reported a shift in balance, with physicians treated less as customers and more like partners in patient care.
“The way they are responding to survey items, they’re more focused on patient-centric than physician-centric, which we had seen in the past,” Morton said.
Morehead considers the most significant driver of physician engagement to be confidence in administration leaders, followed by patient care, quality improvement and nursing expertise.
The three key drivers to better engagement, according to Gallup, include hospitals knowing what the physician needs to be successful, hospitals providing the resources to address the issues, and the hospital having a positive effect on the practice.
“That’s the credibility and the minimum foundation you have to have,” said Blizzard, adding that communicating well and involving the physicians in decision-making about strategies also build engagement.
Rochell Pierce, vice president of physician relationship management at Aegis Health Group in Brentwood, Tenn., added that physicians often consider hospitals to be bureaucratic, inflexible and slow to make decisions.
“We don’t do a good job of staying in contact and communicating with our doctors,” Pierce said. “Hospitals need to be more creative in our contracting and which physicians we align ourselves with.”
Pierce suggested that hospitals must find a way to foster relationships with newer physicians while avoiding alienating current doctors. Hospitals try to lock up big referrers, but those practices are often closed to new patients, so to grow patient volume, the facility must start reaching out to other physicians as well.
In addition, she recommended hospital leaders talk with all physicians, not just the squeaky wheels. She has found success rounding on high-priority practices to discuss needs and plans and how the hospital’s visions and goals align with the physician to advance the relationship.
Pierce said physicians are struggling to maintain the same income as a few years ago and do not have the time to track coming changes. She indicated physicians often look to hospitals for information about new technologies and reimbursement methodology, such as accountable care organizations.
“Hospitals have a lot of work to do,” Blizzard said. “At the time of all of this change, you need to understand the relationship and what’s driving the relationship and build the partnership.”