Career and Life Planning Guidebook for Medical Residents

SECTION I: T MINUS THREE YEARS R E A D : The Changing Landscape of Healthcare Throughout medical school and residency, you may have been exposed to or even experienced for yourself the political turmoil and silo mentality that has been beleaguering many physicians in the hospital setting for a long time. With the onslaught of rapid-fire change occurring within the healthcare industry, let’s gain a basic understanding of hospital structures that exist today and briefly discuss the new structures of tomorrow. Recent Past: Silos For decades, healthcare organizations operated essentially as independent units within a larger whole. Until very recently, hospitals and physicians functioned in separate worlds. Hospitals provided practice privileges for physicians seeking to provide patient care in the hospital setting. Those physicians made up the “independent medical staff,” and largely functioned as a group of individuals. The medical executive committee (MEC) typically was (and still is) the interface between hospital ad- ministration and the medical staff. This independence was encouraged over the years, with the traditional payment structure in which physicians and hospitals were reimbursed separately for services, based on a fee-for-service payment schedule. This encouraged doctors and hospitals to provide more services in order to get paid more — more volume, not value. It did not provide incentives for hospitals and doctors to coordinate care. Today: Moving Away from Silos into Clinically Integrated Networks The healthcare systemoverall is still very fragmented, with thousands of independent providers — many in the same market area — duplicating services. However, this duplication of services is reducing rapidly as private and government payers (Medicare, Medicaid) are increasing pressure on providers to reduce waste, duplication, and total cost of care. The main driver of this shift is payers moving toward value-based reimbursement models and a focus on “population health” (e.g., targeted/standardized CAREER AND LIFE PLANNING GUIDEBOOK FOR MEDICAL RESIDENTS 92