Becker's Hospital Review

24 Clinical Integration & ACOs P hysician recruitment has always been a competitive arena for hospitals and health systems, and it is poised to become more competitive as the supply of physicians dwindles. The Association of American Medical Colleges estimates that the nation will be short more than 91,000 physicians by 2020. For small, rural and community hospitals, the competition can be even fiercer, as many physi- cians prefer to practice in urban settings, and those who desire to perform research tend to be drawn to larger academic medical centers. But community hospitals shouldn't give up hope in attracting the primary care and specialty physi- cians they need. While offering competitive com- pensation, a loan repayment program or hous- ing assistance have been go-tos for many smaller hospitals, these hospitals do have other tactics or approaches they can take when recruiting physi- cians that will give them more equal footing with academic medical centers. Below are three that are becoming more common in the industry. Bring in support through midlevel providers Having a robust residency program can be a selling point for many physicians, according to Joshua Yedvab, vice president of network devel- opment at Oceanside, N.Y.-based South Nassau Communities Hospital. "In many cases, physi- cians are looking for an academic environment and the support that comes on an inpatient unit from a residency program," he says. However, most community hospitals have a limited number of residents available or no residents at all. But lacking residents doesn't necessarily have to put community hospitals out of the running. In- stead, these hospitals can invest in hiring and us- ing advanced-practice clinicians who can provide support, according to John Staley, MD, president of recruitment and retention TeamHealth. Mr. Yedvab notes this approach has been put into practice at SNCH. "We have midlevel providers assigned to units that aren't covered by our resi- dents," he says, which makes the hospital more at- tractive to physicians who want academic stimu- lation and practice support. Look for affiliates Just because many community hospitals don't have the resources to maintain some of the pro- grams common in their larger, research-minded counterparts, does not mean offering those at- tractive programs is impossible. For example, SNCH has an academic affiliation with the Hof- stra NorthShore LIJ School of Medicine which offers faculty appointments to those members of SNCH's medical staff that apply. For physicians looking for the opportunity to teach medical stu- dents and stay active academically, it helps attract and keep physicians on the medical staff. SNCH also participates in a shared pediatrics hospitalist program with Winthrop University Hospital, and the pediatrics unit is also supported by rotating residents from Winthrop. "The things that you don't have that your larger counterparts do have, look for affiliations and partnerships where you can align and provide the highest quality service to the communities you serve," Mr. Yedvab urges. Don't discount communications Many hospitals, even large ones, struggle to main- tain a robust website and social media presence. But small or community hospitals especially should make a point to attempt a strong Internet presence, as it can have a large impact on their physician re- cruitment efforts. "It is an important aspect of pro- moting physicians professionally," Mr. Yedvab says. In other words, hospitals should be able to show physicians how they will support their practice and promote them to the community. That could be through the hospital's website or social media platform as well as through publications, news- letters or arranging interviews with local maga- zines and newspapers. "My physicians love when they're asked to do that," Mr. Yedvab says, and it can be a big selling point during recruitment. By using advanced practitioners, affiliating when possible and offering creative ways to promote physicians professionally, community hospitals can compete with academic medical centers to at- tract quality physicians to serve their patients. n H ospital-physician alignment arrangements are becoming an in- creasingly sought-after integration model as health organizations are redesigning their approaches to care in the pay-for-perfor- mance environment. Mercy Gilbert (Ariz.) Medical Center, part of San Francisco-based Dignity Health, and OrthoArizona Southeast Valley Co-Management Group entered into the one of the latest co-management agreements. OrthoArizona physicians will co-manage Mercy Gilbert's entire orthopedic service line, including foot and ankle surgery, fractures and dislocations, hand surgery, orthopedic spine surgery, sports medicine and total joint replacement. "The rationale for this agreement is to create and standardize best practices, processes and procedures with a focus on systems of care," said Tim Bricker, president and CEO of Chandler Regional and Mercy Gilbert Medical Cen- ters, in a news release. In light of this recent announcement, here are five things to know about co- management agreements. 1. Co-management agreements are growing in popularity as orga- nizations turn to pay-for-performance reimbursement models. Co- management agreements are quality oriented, pay-for-performance-based arrangements in which physician groups contract with hospitals to manage a ser- vice line. Physicians oversee and manage the service line — such as orthopedics, oncology or cardiology — and ensure it runs smoothly, effectively and at a high quality. The hospital continues to oversee administrative duties, such as budgets, marketing and personnel issues. Co-management allows for hospital-physician integration without requiring physicians to become hospital employees. Quality improvement is a main goal in these arrangements since everybody benefits when quality improves. Physicians are rewarded with incentive bonuses for reaching certain quality measures and benchmarks, hospitals see higher reimbursements under the pay-for-performance model and patients receive better care. Recruit Physicians Like an Academic Medical Center: 3 Tips for Community Hospitals By Heather Punke 5 Things to Know About Co-Management Agreements By Akanksha Jayanthi

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