Though strained relationships between physicians and hospitals get the most attention, many are finding ways to work to their mutual benefit. There is no one solution, but everyone can benefit from good communications and creative thinking. "Hospitals and physicians can improve their relationships if they do nothing more than just communicate more effectively with one another," says Jay Weatherly, principal and co-founder of Cullman-based Salient Health Ventures. He admits this is not always easy. "You have two very busy parties who know they need one another and have great intentions of communicating with one another," says Weatherly. He says one way to open lines of communication is finding important and tangible things to do together. "That's why we encourage hospitals to develop proactive strategies for working with their doctors." "The first thing both sides can do is commit to a greater level of communication," says Jim Stroud, CPA of the accounting firm Warren Averett Kimbrough & Marino, LLC. "When information is lacking, human nature is to fill in that void with a worst-case situation." "One side must listen to the other and listen with ears wide open," says Gary Griffin, healthcare advisor with Gary Griffin & Associates, Inc. in Gadsden. "The first part in making any deal is finding out where the other guy is coming from, taking it seriously and seeing how you can work with that." Working harmoniously starts with strategic planning and can evolve to include shared projects and even shared ownership of anything from diagnostic and therapeutic equipment to office buildings. "Hospitals and physician groups need to engage in strategic planning efforts together," says Stroud. "Any hospital doing strategic planning and leaving their physician community out of that loop is making a terrible mistake." He believes periodic off-campus retreats — perhaps with outside facilitators — can be very beneficial. Some hospitals take representatives from physician groups to a weekend planning retreats. "Then they come back and report the results to the physician population — what they are strategically going to do and the tactical steps they will use to accomplish those strategies." Every time Stroud's firm facilitates a planning retreat the results are positive. Participants come away knowing where they're going and all going in the same direction. Weatherly says hospital CEOs need input from their medical staff leaders to effectively deal with tough issues. He believes most physicians with a preferred hospital affiliation want to be included and involved to some extent especially at critical junctures. Common interests can build relationships. "They need to find ways to get into economic parallel with each other where both have a common interest in the success of a venture," says Stroud. "They need to look for ways to be on the same team rather than waiting for the other side to buy the equipment." Both physician goals of practice growth and hospital goals of increased admissions can be realized through satellite offices. Hospitals could help doctors with space in satellite offices one day a week or two days a month. Doctors pay for what they use. "It's a way for doctors to triage patients back to the main campus if they need it while meeting the needs of an outlying community," says Stroud. "It's a way to increase volume and patient census by taking service to them." Such expansion efforts offer a cost-effective way for individual physicians or groups to establish remote offices. By establishing a steady rotation of doctors, the hospital can spread the cost among them. "Everybody gets a good deal," says Stroud. "The hospital gets more admissions as a result." Ways to Share Opportunities for mutual benefit seem almost endless. They range from active committee participation to shared information services and reimbursement practices. Other opportunities include recruiting, referrals, staff evaluations and continuing education. One of the quickest ways for doctors to understand the hospital's perspective is through medical staff committees. "Most physicians participate in those," says Weatherly. "Participating gives them a sense of what's involved in making sure a hospital runs properly." Information systems also offer opportunities for collaboration. "A hospital may have all the information the practice needs," says Mary Elliott, CPA of the accounting firm Warren Averett Kimbrough & Marino, LLC. "Some hospitals may be better than others at sharing information." For the most part, advances in diagnostics and therapeutic capacities have far outpaced those concerned with storing and delivering patient information. Many patient records are still in paper files. The pressure for practices and hospitals to have totally electronic patient records has brought an explosion of software and hardware. This costly updating effort could provide an opportunity for physician-hospital cooperation. Together they could create a system with comprehensive patient information accessible to all who need it. Such a system would create a climate where patients could say, "I've got to get back to that campus because all my records are there and all my doctors are there." "Hospitals and physicians groups could find some synergy by teaming up," says Stroud. "They are all spending boatloads of money on equipment and software. They could probably do it cheaper together and the systems would be compatible." Primarily seen in orthopedics because of that high cost of implants and supplies, the practice of gain sharing is possible in other areas. This collaborative effort helps hospitals and orthopedic physicians reduce costs. "Those savings can be legally shared between the physicians and hospital," says Griffin. He says the government makes sure the savings are valid ones. More Opportunities Elliott says hospitals and physicians have begun to work together more on recruiting efforts. "Whenever a physician group is looking for a doctor, the hospital may employ someone to help them," says Elliott. "Hospitals outside of Birmingham have recruitment agreements." She explains that these hospitals lend the physician money to start the practice. For the first 12 months the physician receives loaned money to ensure a salary. After 12 months, the physician enters a work-off period for several years. "The hospital will forgive that debt over the years if the physician stays in that community." A hospital can do this only if there is a need for the physician. "We see that a lot in Sylacauga, Talladega, Cullman and all those areas. The hospitals really work with the physicians. It's a big incentive for somebody to go to a rural area." Hospitals have a number of ways to encourage on-campus referrals, particularly for new physicians. These include introductions to other medical staff, particularly potential referring practices. Hospitals may help new doctors or groups with marketing materials such as practice brochures. Sometimes the hospital has a reception to introduce new doctors. Most hospitals also offer phone lines for patients to get referrals. Physicians can offer their services as speakers in a hospital's community education programs, staff meetings or grand rounds. "Hospitals need to be sensitive to the fact that the doctors may be their best source of information on the performance of their staff," says Stroud. "I don't think the hospitals often solicit that kind of information from the doctors. The doctors could make performance contributions that would help with the review process." Elliott says on-campus education efforts such as updating physicians on a coding issue offers another opportunity. "The hospital knows what issues the administrators are facing." She says continuing education on the clinical side also can be provided by the hospitals. "Physicians and hospitals need each other. That's the bottom line," says Griffin. "It all comes down to patient care and I hope it always will." NEXT MONTH: Can Joint Venture Projects Enhance Physician-Hospital Relationships?