Boston's Faulkner Hospital supports its ED physicians from the top down
In the effort to get hospitals to support their physicians, it helps to have an administrator on your side. It's even better when the administrator also happens to be an emergency physician. Faulkner Hospital's emergency department (ED) had just such an ally in Martin Bak, MD, who went from associate director of the ED to recently appointed president of the 144-bed Boston, MA hospital.
Although it is a rarity for an ED physician to rocket to the top of the administration, the event has effectively put an end to a rough period for Faulkner's emergency medicine program. It has also put a new face on physician-hospital relationships. "The hospital (administration) is now one of our greatest allies," says Richard Larson, MD, Faulkner's chief of emergency medicine.
For the rank-and-file physician, the hospital has come a long way in bettering relations. But for a long time, administrators were suspicious. In 1990, the hospital terminated its contract with its former emergency medical group, Larson says about his predecessors. "The department was getting a bad rap. Things weren't getting done. Doctors weren't even reading x-rays. Patients were unhappy," Larson reports.
Under the new contract group, which is part of large, Dallas-based EM Care, administrators were suspicious, at first. There was considerable daily department oversight. Physicians had to sign with certain health plans, mainly Tufts Health Plan and Harvard Pilgrim Healthcare, the city's two largest payers. And everyone had to be accountable for their actions, Larson says.
But administrators also made concessions, once the new medical group started to turn the department around, Larson adds. "They let the physicians run the show," he observes, including the ability to directly negotiate better rates with payers. The hospital also built a new $1.8 million ED, which included a larger 15-room pavilion and a drastically new design.
And they supported emergency practitioners when they complained that certain primary-care physicians who belonged to large payers were pressuring them on clinical decisions. Overall, everything has gotten better, Larson reports. ED visits for level one complaints have dropped by about 25% in the past few years. For part of this, physicians credit better hospital-physician relations and improved terms with payers. "Most of the cases of sore throats and sniffles have gone away. And that's made life a little easier," Larson adds.
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