successful, radiologists and cardiologists
must be willing to rethink their training
and both traditional and current practice
behaviors. In essence, physicians must be
asked to shed their egos in the interest of
the greater good.
Sometimes it’s just a matter of bringing the parties together and outlining
the fair and reasonable benefit logic of
the proposed collaboration juxtaposed
against the rules of the game in today’s
new and competitive healthcare environment. Bringing the parties together
to face the inevitabilities of accountable
care organizations (ACOs), vertical integration, global billing, and new payment
paradigms can sometimes lead to that
“ah ha!” moment. Oftentimes, however,
it takes a bit more effort.
Building a Foundation—The Clinical
Figure 1 • Institute’s organizational and membership structure.
Radiologists and cardiologists need a
solid clinical and business structure that
allows them to join forces relative to the
design, development, and deployment of
a collaborative practice model, with imaging as a starting point.
As the transition to a collaborative model moves from initial planning
phases towards more of a reality, expert
consulting and legal services may be in
order. Multiple, viable physician collaboration options do exist, but more often
than not that model comes to fruition in
the form of a hospital sponsored clinical
institute model with a co-management
As a service line driven structure, the
clinical institute model serves to blur the
distinction between specialists, and patients are referred to a program rather
than an individual physician. The model
encourages evidenced-based best practice, and physicians benefit from monitoring patient care from a more global
perspective, both clinically and financially, preparing them to compete in the
new outcome driven healthcare economy
where quality is king.
The institute model also allows the
sponsoring hospital to create an economic
model in which physicians benefit from
joint efforts that enhance quality and efficiency, which likewise leads to a focus
on streamlined care delivery. In essence,
the sponsoring hospital encourages collaboration by minimizing the financial
competition between the radiologists
and cardiologists—better clinical care
can lead to better financial outcomes for
both the hospital and the physicians.
In the traditional institute model, the
hospital and physicians create a charter
or bylaws for the model, detailing the
institute’s organizational and membership structure, as seen in Figure 1. The
new institute and the physicians enter
into individual membership agreements,
detailing the rights and obligations of
membership. Usually, to be eligible for
membership, physicians must hold active hospital medical staff membership
and unrestricted clinical privileges in one
of the institute’s subspecialties.
Membership duties and responsibilities are detailed in written agreements
that also include statements on benefits
of membership, any non-compete covenants and conflict of interest statements, and statements regarding how
the institute will be marketed to the
community and referring physicians.
The agreement should also detail the
fair market hourly compensation that
physician members will be paid for any
administrative services they provide to
the institute, any research related compensation, and/or compensation for
rural outreach activities.
With an embedded co-management
services agreement in the model, physician members of the institute may also
be eligible for fair market value incentive
compensation based on meeting and/
or exceeding pre-determined goals for
clinical delivery and patient outcomes.
See Figure 2.
In creating a co-management institute, the sponsoring hospital must be