DMI Transitions Clinical Institutes: The Ultimate Integration ...


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DMI Transitions Clinical Institutes: The Ultimate Integration ...

  1. 1. Clinical Institutes: The Ultimate Integration Strategy Presented by: Jerry Youkey, M.D. Vice President, Medical and Academic Services Greenville Hospital System and Ken E. Mack, FACHE President, DMI Transitions September 2003 Society for Healthcare Strategy and Marketing Development
  2. 2. Jerry Youkey, M.D. <ul><li>Jerry R. Youkey, M. D., is Vice President, Medical and Academic Services for Greenville Hospital System in Greenville, SC. Dr. Youkey received his Bachelor of Arts degree from Stanford University, Palo Alto, CA, and his medical degree from Medical College of Wisconsin, in Milwaukee WI. He served a rotating internship and general surgery residency at William Beaumont Army Medical Center, El Paso, Texas and a fellowship in peripheral vascular surgery at Walter Reed Army Medical Center, Washington, DC. </li></ul><ul><li>Dr. Youkey served in the United States Army, attaining the rank of Colonel, Medical Corps, and then served as Chief, Department of Surgery, and Director, Peripheral Vascular Surgery Fellowship program at Geisinger Medical Center, Danville, PA prior to coming to Greenville. Dr. Youkey is certified by the American Board of Surgery in general surgery and general vascular surgery, and is a member of numerous professional societies. He is widely published in his specialty field of general vascular surgery, having authored books, abstracts, and journal articles. In his current capacity he is the Director of Medical Education for the Greenville Hospital System, and the Chief Medical Officer for their 230-physician multi-specialty group practice. </li></ul><ul><li>Dr. Youkey holds the academic appointment of Professor and Associate Dean at the University of South Carolina, Columbia, SC, and the Medical University of South Carolina in Charleston. In addition to his administrative duties, Dr. Youkey has an active general vascular surgery practice at the Greenville Hospital System. </li></ul>
  3. 3. Ken E. Mack, FACHE <ul><li>Ken E. Mack, FACHE , is President of DMI Transitions (DMI). DMI has aided its </li></ul><ul><li>health provider clients across the country in a wide range of revenue development and operations turnaround projects. Under Ken’s direction, DMI has, in the last seventeen years, assisted over five hundred healthcare providers in developing profitable business solutions. DMI’s client list includes hundreds of hospitals such as Stanford and Scripps Medical Centers in California, Baylor Medical Center in Dallas, The Cleveland Clinic, University of Maryland Medical System, and Northwestern Medical Center in Chicago. Prior to founding DMI, Ken Mack was Vice President of Business Development for Akron General Medical Center, (Akron, Ohio), a Strategic Planner and Product Manager for General Electric and National Marketing Director for the Stouffer Corporation. He has been a frequent faculty member for the American College of Healthcare Executives, HFMA, AMA and the American Hospital Association. </li></ul><ul><li>His achievements and professional honors include 1990 Who’s Who in America, Editorial Advisory Board for “Healthcare Competition Weekly,” board member Academy for Health Services Marketing, AMA Keynoters on Tour, Trendwatchers Panel AMA, JC’s Outstanding Young Men in America, Omicron Delta Kappa Leadership Fraternity, Review Board of the Journal of Health Care Marketing, as well as recognition awards by American Marketing Association and Ohio Hospital Association. Ken earned an MBA in marketing from Cleveland State University and a BS in management from Bowling Green State University and is a Fellow in the American College of Healthcare Executives. </li></ul>[email_address]
  4. 4. Who is DMI Transitions? <ul><li>DMI Transitions , Inc. (DMI) was founded in 1985 to assist healthcare systems and their medical staffs to maximize their individual profitability. Our clients’ success has been achieved through revenue and operations solutions that have improved the working relationships between physicians and the administrative staff. </li></ul><ul><li>We are a consulting firm made up of experienced practitioners who are involved in practical and profitable programs, services and joint ventures and department turnarounds. Our team has serviced over 500 healthcare clients from Bangor, Maine to La Jolla, California. </li></ul><ul><li>DMI is widely recognized for its excellent “hands-on” client support. Over the last sixteen years we have assisted clients in developing successful physician group practices, joint ventures, primary care networks, business development programs, and the implementation of operations improvement solutions. We have also assisted our clients in fixing a wide range of revenue related problems. These include managed care contracting, employed physicians, department performance, specialty contracting and market share declines. </li></ul>Tel: 440-838-8551
  5. 5. <ul><li>Course Expectations </li></ul>
  6. 7. How would you rate your organization’s overall effectiveness in aligning with its physicians? <ul><li>1 Excellent </li></ul><ul><li>2 Good </li></ul><ul><li>3 Fair </li></ul><ul><li>4 Poor </li></ul>
  7. 8. <ul><li>1 Excellent </li></ul><ul><li>2 Good </li></ul><ul><li>3 Fair </li></ul><ul><li>4 Poor </li></ul><ul><li>5 No PHO </li></ul>If your organization presently has or has had in the past a PHO, how would you rate its effectiveness in aligning with physicians?
  8. 9. If your organization employs or has employed PCP’s, how would you rate this alignment strategy? <ul><li>1 Excellent </li></ul><ul><li>2 Good </li></ul><ul><li>3 Fair </li></ul><ul><li>4 Poor </li></ul><ul><li>5 No Employed PCP’s </li></ul>
  9. 10. <ul><li>1 Yes </li></ul><ul><li>2 No </li></ul>Does your organization have joint ventures with physicians?
  10. 11. <ul><li>1 Excellent </li></ul><ul><li>2 Good </li></ul><ul><li>3 Fair </li></ul><ul><li>4 Poor </li></ul>If your answer was yes, how would you rate the joint venture(s)’ effectiveness?
  11. 12. <ul><li>1 Yes </li></ul><ul><li>2 No </li></ul>Do you believe your physicians are trying to capture a share of “ your ” technical revenues?
  12. 13. <ul><li>Industry State of the Union </li></ul>
  13. 14. National Healthcare Expenditures * Projected Source: Centers for Medicare and Medicaid Services
  14. 15. National Per Capita Healthcare Expenditures * Projected Source: Centers for Medicare and Medicaid Services
  15. 16. Economic <ul><li>Skyrocketing supply, pharmaceutical, and personnel costs </li></ul><ul><li>Escalating liability premiums </li></ul><ul><li>Rising numbers of uninsured </li></ul><ul><li>Shrinking state and federal reimbursement </li></ul><ul><li>Increasing contractual discounts </li></ul><ul><li>Balanced Budget Act-97 and beyond </li></ul><ul><li>Impact of rising healthcare costs on business community </li></ul><ul><li>Shift of healthcare costs to consumer </li></ul>
  16. 17. Regulatory <ul><li>HIPPA </li></ul><ul><li>State agencies </li></ul><ul><li>JCAHO </li></ul><ul><li>CMS/OIG </li></ul><ul><li>Compliance </li></ul><ul><li>Patient safety </li></ul><ul><li>Work hour limitations </li></ul>
  17. 18. Social <ul><li>Shortage of physicians, nurses, and allied health care professionals </li></ul><ul><li>Geriatric baby boomers+AARP </li></ul><ul><li>Medicare demonstration projects </li></ul><ul><li>Leap Frog </li></ul><ul><li>Consumerism </li></ul><ul><li>Focus on medical errors </li></ul><ul><li>Evidence based medicine </li></ul><ul><li>Internet based health care report cards </li></ul>
  18. 20. Overall Trends Physician Income Hospital Margins Competition Between Physicians and Hospitals
  19. 21. Pay For Performance <ul><li>CMS </li></ul><ul><li>Payers </li></ul><ul><li>Employers </li></ul>
  20. 22. “ One day you are sipping the wine, the next day you are picking the grapes.” - Lou Holtz
  21. 23. Hospitals Want <ul><li>Patients </li></ul><ul><li>Medical staff to bring patients </li></ul><ul><li>Cost control </li></ul><ul><li>Contracting leverage </li></ul><ul><li>Medical leadership </li></ul><ul><li>Market differentiation </li></ul>
  22. 24. Physicians Want <ul><li>Income preservation </li></ul><ul><ul><li>Indirect compensation </li></ul></ul><ul><ul><li>Access to patients </li></ul></ul><ul><ul><li>Access to ancillaries </li></ul></ul><ul><ul><li>Improvement in efficiency </li></ul></ul><ul><ul><li>Reduction in overhead </li></ul></ul><ul><li>Access to capital </li></ul><ul><li>Contracting leverage </li></ul><ul><li>Participation in decision making </li></ul><ul><li>Market differentiation </li></ul>
  23. 26. The Spectrum of Physician/Hospital Relationships <ul><li>Employment </li></ul><ul><li>Institute model </li></ul><ul><li>Joint venture arrangement </li></ul><ul><li>Mutual project development including medical staff procedures and governance </li></ul><ul><li>Neutral medical staff participation (membership) </li></ul><ul><li>Competitive position </li></ul><ul><li>Aligned with or employed by a competing hospital </li></ul>
  24. 27. A Wide Range of Options Neutral medical staff participation Competitive position Institute model Mutual project development including medical staff procedures and governance Employment Joint venture arrangement $ Risk Potential ROI
  25. 28. Hospital Needs <ul><li>Physician specialty-specific: </li></ul><ul><li>Input into strategic planning </li></ul><ul><li>Collaborative involvement in operations </li></ul><ul><li>Integrated involvement in quality of care initiatives </li></ul><ul><li>Participation in medical education, research initiatives, and CME activities </li></ul><ul><li>Referral network development for third party contracting </li></ul>
  26. 29. The Bottom Line
  27. 30. You are either building bridges… … or putting up walls
  28. 31. Definitions
  29. 32. Clinical Program <ul><li>A coordinated, but limited scope of diagnostic and therapeutic services designed to deliver clinical care to a defined group of like patients, i.e., an endovascular program, a complex spine program, etc. </li></ul>
  30. 33. Center <ul><li>A comprehensive and expanded group of clinical services delivered at a single site and designed to provide care to a subgroup of patients within a service line, i.e., cancer center, dialysis center, etc. </li></ul>
  31. 34. Clinical Institute <ul><li>A clinical and business structure designed to integrate the efforts of a hospital with a group of variously aligned physicians in order to: </li></ul><ul><li>Develop market differentiating excellence of care </li></ul><ul><li>Increase market share through a broad scope of high quality services for patients with related clinical needs, i.e., a women’s institute, a cardiovascular institute, etc. </li></ul>
  32. 35. Institute Model Clinical Institute Governance Physician Hospital/ Members Health System <ul><li>Clinical quality benchmarking and improvement </li></ul><ul><li>Revenue generation </li></ul><ul><ul><li>Clinical trials </li></ul></ul><ul><ul><li>Gain sharing </li></ul></ul><ul><ul><li>Medical management </li></ul></ul><ul><li>Membership exclusivity </li></ul><ul><ul><li>Benefits of membership </li></ul></ul><ul><li>Fund raising </li></ul><ul><li>Promotional and public relations support </li></ul><ul><li>Research </li></ul><ul><li>Employer/Payer links </li></ul>
  33. 36. Institute Model <ul><li>Very proactive and flexible physician integration and alignment vehicle </li></ul><ul><li>Institutes can be constructed to reflect the unique needs of the Hospital/Health System, its physicians and the market place </li></ul><ul><li>Components can include: </li></ul><ul><ul><li>Independent and employed physicians </li></ul></ul><ul><ul><li>Clinical management contracts (medical directorships) </li></ul></ul><ul><ul><li>Clinical drug trials </li></ul></ul><ul><ul><li>Gain sharing </li></ul></ul><ul><ul><li>Joint ventures </li></ul></ul><ul><ul><li>Clinical protocols </li></ul></ul><ul><ul><li>Preferred privileges including scheduling and block OR time </li></ul></ul><ul><ul><li>Clinical benchmarking and quality improvement </li></ul></ul><ul><ul><li>Preferred local and regional access to referrals </li></ul></ul>
  34. 37. Avoiding “Turf” Wars <ul><li>Nationally, approximately 12,000 procedural specialists are competing for vascular patients </li></ul><ul><ul><li>2,500 Vascular Surgeons </li></ul></ul><ul><ul><li>4,000 Interventional Cardiologists </li></ul></ul><ul><ul><li>5,500 Interventional Radiologists </li></ul></ul>Technology advances in non-invasive techniques have fueled the war, but success requires collaboration
  35. 38. Peripheral Vascular Disease (PVD) <ul><li>300,000 patients diagnosed each year </li></ul><ul><li>8-10 million affected </li></ul><ul><li>2-5 times more common in men </li></ul><ul><li>Those affected have a 6 times higher death rate from cardiovascular disease </li></ul><ul><li>15% chance of dying within 5 years when symptomatic </li></ul><ul><li>50% chance of dying within 10 years from initial diagnosis </li></ul><ul><li>Disease should be treated as a systemic disease </li></ul>
  36. 39. Vascular Market Growth Estimated Number of Procedures Source: 2003 The Advisory Board Company
  37. 40. Growing the Pie – Skyview Health System Source: 2003 The Advisory Board Company
  38. 41. Physician Integration Options Physician Autonomy Hospital Control Physician Integration Market Share Physician Financial Improvement Hospital Financial Improvement Payer Contracting Clinical Quality Improvement Physician Risk Hospital Risk                                                      Employment Institute Joint Venture PHO IPA
  39. 42. Components of a Clinical Institute <ul><li>Clinical activities: </li></ul><ul><ul><li>Comprehensive, coordinated clinical care </li></ul></ul><ul><ul><li>Individual professional services, programs and centers </li></ul></ul><ul><ul><li>Laboratory services </li></ul></ul><ul><ul><li>Imaging services </li></ul></ul><ul><li>Business structure </li></ul><ul><ul><li>Closed staff including selected physicians from any practice setting </li></ul></ul><ul><ul><li>Flexible to include employment, joint ventures, contractual affiliation, etc. </li></ul></ul><ul><ul><li>Many physicians may spend only a portion of their work time providing specific clinical services under the auspices of the Institute </li></ul></ul>
  40. 43. Components of a Clinical Institute <ul><li>Academic initiatives </li></ul><ul><ul><li>Clinical trials </li></ul></ul><ul><ul><li>CME programs </li></ul></ul><ul><ul><li>Subspecialty post-CME training programs e.g. new technology training </li></ul></ul><ul><ul><li>Applied basic science research </li></ul></ul><ul><li>Foundation strategy </li></ul><ul><ul><li>Philanthropy </li></ul></ul><ul><ul><li>Grants and endowment to help pay for activities not funded by traditional professional or technical revenue </li></ul></ul>
  41. 44. <ul><li>Pros : </li></ul><ul><ul><li>Benchmarks and improves quality outcomes </li></ul></ul><ul><ul><li>Provides a vehicle to develop comprehensive clinical pathways </li></ul></ul><ul><ul><li>Provides revenue opportunities for physician members </li></ul></ul><ul><ul><ul><li>Joint ventures </li></ul></ul></ul><ul><ul><ul><li>Medical management fees </li></ul></ul></ul><ul><ul><ul><li>Gain-sharing </li></ul></ul></ul><ul><ul><ul><li>Clinical trials </li></ul></ul></ul><ul><ul><li>Non-revenue physician benefits </li></ul></ul><ul><ul><ul><li>Preferred scheduling </li></ul></ul></ul><ul><ul><ul><li>Medical equipment purchases </li></ul></ul></ul><ul><ul><ul><li>Office links </li></ul></ul></ul><ul><ul><ul><li>CME’s </li></ul></ul></ul><ul><ul><ul><li>Promotional and speaking options </li></ul></ul></ul><ul><ul><ul><li>Priority referrals </li></ul></ul></ul><ul><ul><li>Branding </li></ul></ul><ul><ul><li>Fund Raising </li></ul></ul><ul><ul><li>Clinical research </li></ul></ul><ul><ul><li>Non-compete qualifications </li></ul></ul><ul><ul><li>Enhanced ability to recruit physicians </li></ul></ul>Institute Model
  42. 45. <ul><li>Cons : </li></ul><ul><ul><li>Not all physicians on staff would be Institute members </li></ul></ul><ul><ul><li>Physician “control” of Institute activities </li></ul></ul><ul><ul><li>Long-term commitment required </li></ul></ul><ul><ul><li>Pressure to create additional institutes </li></ul></ul><ul><ul><li>Potential to limit capital expenditure flexibility </li></ul></ul>Institute Model
  43. 46. Example: A Cardiovascular Institute
  44. 47. Cardiovascular Institute Screening Education/ Prevention Self Referral/ Call Center Primary Care Physician Emergency Department Diagnostic Testing and/or Sub-specialist Referral Non-Invasive Treatment Invasive Treatment HHC PCP / Specialist Rehab Disease Identified? Continued Treatment Yes No Care Management Physician Care Management Physician Benchmarking – Clinical Pathways Measurable Clinical Outcomes
  45. 48. <ul><li>Integrated services providing cardiology, cardiac surgery, vascular medicine, vascular surgery, and endovascular diagnostic and therapeutic cares </li></ul><ul><li>In addition to their traditional professional services: </li></ul><ul><ul><li>Cardiologists could be involved in leadership initiatives and strategically develop the geographic catchment area for the Institute </li></ul></ul><ul><ul><li>Cardiac surgeons can be involved in the development of a new clinical program, i.e., off-pump bypass surgery, arrhythmia surgery, etc. </li></ul></ul><ul><ul><li>Vascular surgeons lead academic endeavors to include development of a post-GME subspecialty training program in vascular surgery and a multi-specialty annual cardiovascular CME program </li></ul></ul>Cardiovascular Institute Features
  46. 49. <ul><li>The vascular medicine specialists developed a multispecialty vascular interventional service (with vascular surgeons, cardiologists, and interventional radiologists) that is the primary driver of a PVD clinical trials program. </li></ul><ul><li>Various diagnostic/therapeutic services such as a non-invasive cardiovascular laboratory or MRA will be included in the Institute. </li></ul><ul><li>The Institute is collaboratively managed, subject to a single strategic planning process and marketed under the banner of the Cardiovascular Institute. </li></ul>Cardiovascular Institute Features
  47. 50. Responsibilities of Physician Members of Institute <ul><li>Development of and participation in standardized clinical protocols </li></ul><ul><li>Development of and participation in utilization initiatives </li></ul><ul><li>Assistance with outcomes data collection and reporting </li></ul><ul><li>Participation in peer review activities </li></ul><ul><li>Contribution to patient satisfaction goals </li></ul><ul><li>Compliance with professional behavior standards </li></ul>
  48. 51. Responsibilities of Physician Members of Institute <ul><li>Involvement in medical education and research activities as appropriate </li></ul><ul><li>Participation in research activities as appropriate </li></ul><ul><li>Contribution to program development as appropriate </li></ul><ul><li>Participation in philanthropic efforts as needed </li></ul><ul><li>Assistance in negotiations with vendors as requested by management </li></ul><ul><li>Performance of a predetermined portion of their patient care activity within Institute facilities in order to assure ability to track quality outcomes </li></ul>
  49. 52. <ul><li>1 Excellent </li></ul><ul><li>2 Good </li></ul><ul><li>3 Fair </li></ul><ul><li>4 Poor </li></ul>How would you rate your organization’s effectiveness in improving clinical outcomes through the use of Centers of Excellence and/or service lines?
  50. 53. <ul><li>1 Less Than 5% </li></ul><ul><li>2 5-10% </li></ul><ul><li>3 10-20% </li></ul><ul><li>4 More Than 20% </li></ul>What percentage of your costs could be improved if your physicians and the hospital were economically aligned?
  51. 54. <ul><li>1 Trust </li></ul><ul><li>2 Power </li></ul><ul><li>3 Money </li></ul><ul><li>4 Control </li></ul>What is the primary reason you have not achieved optimal alignment with your physicians?
  52. 55. <ul><li>1 Yes </li></ul><ul><li>2 No </li></ul>Do you believe that clinically we are still in the era of “piecework medicine?”
  53. 56. Physician Alignment
  54. 57. The Physician Specialist “ Customer” Value! This list of the top 10 specialties bringing in the most revenues for acute care hospitals includes all the major specialties investing in surgery hospitals Source: Merritt, Hawkins & Associates, based on 2002 survey of 4.000 hospital CFOs $1.5 million General internist 10 $1.6 million Obstetrician/gynecologist 9 $1.7 million Nephrologist 8 $1.8 million Hematologist/oncologist 7 $1.8 million General surgeon 6 $1.8 million Orthopedic surgeon 5 $1.8 million Cardiologist 4 $2.2 million Vascular surgery 3 $2.3 million Neurosurgeon 2 $3.1 million Cardiac surgeon 1 Revenue generated per year Specialty Rank
  55. 58. Institute Concierge Club
  56. 59. Privileges of Physician Institute Members <ul><li>Inclusion in Institute mediated third-party contracting negotiations </li></ul><ul><li>Marketing </li></ul><ul><ul><li>Channeled referrals through Institute physician referral system </li></ul></ul><ul><ul><li>Participation in patient care promotional activities </li></ul></ul><ul><ul><li>Indirect marketing through Institute promotional activities </li></ul></ul>
  57. 60. Privileges of Physician Institute Members <ul><li>Recruitment assistance </li></ul><ul><li>Access to Institute based clinical trials </li></ul><ul><li>Appropriate house staff coverage through teaching activities </li></ul><ul><li>Gainsharing </li></ul>
  58. 66. Screening Example Target Population for High Cholesterol Store 1 Store 2 Store 3 Store 4 Store 5 Store 6 100 Screenings 100 Screenings 100 Screenings 100 Screenings 100 Screenings 100 Screenings 600 Screenings 80% learn about sponsors 55% at Risk 40% seek MD Referral 57% seek MD w/in 1 mo. MD Referral Other Services Retail or Institute Physicians’ Offices 66
  59. 68. <ul><li>Operational infrastructure to support Institute programs </li></ul><ul><li>Access to otherwise exclusive joint ventures </li></ul><ul><li>Appropriate reward for leadership in medical management initiatives </li></ul><ul><li>Participation in Institute strategic planning initiatives </li></ul><ul><li>Differential access to hospital resources through the Institute (e.g. scheduling, block time) </li></ul><ul><li>Input into Institute related capital acquisition decisions </li></ul>Privileges of Physician Institute Members
  60. 69. <ul><li>Assistance with individual physician practice development and practice management to the extent that it contributes to Institute success </li></ul><ul><li>Participation in Institute CME activities </li></ul><ul><li>Participation in Institute Foundation strategy </li></ul><ul><li>Institute sponsored physician training opportunities </li></ul><ul><li>Access to Institute patient education materials </li></ul><ul><li>Staff RN and technician training programs </li></ul><ul><li>Inpatient physician extender support </li></ul>Privileges of Physician Institute Members
  61. 70. <ul><li>Preferred lease rates </li></ul><ul><li>Input into who are the Institute Fellows (physician members) </li></ul><ul><li>Provider outreach assistance </li></ul><ul><li>Participation in visiting clinician programs </li></ul>Privileges of Physician Institute Members
  62. 71. Legal Opinion Letter
  63. 72. Institutes
  64. 74. Example: Cole Eye Institute Cleveland Clinic Foundation
  65. 76. Cole Eye Institute <ul><li>Opened in 1999, state-of-the-art institute that handles over 140,000 patient visits a year </li></ul><ul><li>Ranked nationally by U.S. News & World report and is ranked the best in Ohio </li></ul><ul><li>Provided an ideal environment for research and top quality patient care, comfort and convenience </li></ul><ul><li>Established a strategy to capture market share in surrounding suburbs of Cleveland, Ohio </li></ul><ul><ul><li>Extended its ophthalmic care to six locations around Northeastern Ohio </li></ul></ul>
  66. 77. Cole Eye Institute <ul><li>Philanthropy – donations from patients and civic leaders played an essential role in its development and continuing delivery of high-quality care and research </li></ul><ul><li>Includes a team of vision researchers committed to understanding genetic-based eye diseases </li></ul><ul><li>Created to support ophthalmologists: </li></ul><ul><ul><li>Treating a wide range of eye problems </li></ul></ul><ul><ul><li>Conducting research </li></ul></ul><ul><ul><li>Teaching </li></ul></ul>
  67. 78. Review of Expectations
  68. 79. Institutes Benefits <ul><li>Clinical synergies </li></ul><ul><li>Patient Care </li></ul><ul><li>Brand identity </li></ul><ul><li>Physician commitment </li></ul><ul><li>Market share </li></ul><ul><li>Preferred contracting </li></ul><ul><li>Long-term life cycle </li></ul>
  69. 80. Institute Development – Hospital Role <ul><li>Although a clinical Institute can be conceived as a corporate strategy, it cannot be developed top down. It is highly dependent upon physicians to develop the array of high quality clinical activities upon which it is built. </li></ul><ul><li>As a proactive strategy, a hospital can facilitate building of these individual physician-dependent programs and practices, but it cannot create them. The same is true of the academic endeavors. </li></ul><ul><li>Once the clinical and academic components are sufficiently established, the hospital may best play a lead role in definition and implementation of the business structure, development of necessary infrastructure, and provision of appropriate corporate support services. </li></ul><ul><li>Development of an institute will result in: </li></ul><ul><ul><li>A true business partnership between the physicians and the hospital </li></ul></ul><ul><ul><li>Alignment and integration of the physician members </li></ul></ul><ul><ul><li>Recognition that the Institute is a differentiating factor in the market </li></ul></ul>
  70. 84. Veni Vidi Vici