Professional Documents
Culture Documents
CHAPTER OBJECTIVES
Understand influences that have shaped
U.S. medical education and practice
Understand how scientific and clinical
advances contributed to the evolution of
specialty medicine
Acquire knowledge of current delivery
system developments and how they have
and will affect medical education and
practice
Review Affordable Care Act and other
reform impacts on physician education
and practice
Changing Physician-Hospital
Relationships (1)
Historically, unique, interdependent relationship
based on patient admissions; MDs paid fee-forservice, hospital for costs incurred; medical staff
organization carried out responsibilities to ensure
quality care; MDs sole decision-makers about
admissions, lengths of stay, resource use &
referrals.
System changes: hospital fiscal penalties for
lengths of stay; admissions require payer
approval; readmissions carry penalties; health
plans select hospitals based on cost-effectiveness
Changing Physician-Hospital
Relationships (2)
Technology advancements allow MDs
to compete with hospitals for
outpatient services (diagnostic,
surgical, etc.)
Hospital MD employment increase of
32% since 2000.
MDs leaving private practices due to:
flat reimbursement, complex insurance,
HIT requirements, desire for work-life
balance
Changing Physician-Hospital
Relationships (3)
Hospitals desire MD employment to
secure market share, use of diagnostic &
outpatient services, referrals to highrevenue specialty services, ACO
development