ACEP News
January 2006

By Patricia L. Kirk
Elsevier Global Medical News

DALLAS - Retaining an emergency medicine practice's hospital contract is a matter of both performance and politics, according to the advice and anecdotes offered by a panel of emergency medicine experts at the Emergency Department Directors Academy, a meeting sponsored by the American College of Emergency Physicians.

The two major issues for an emergency medical group defending its contract with a hospital are managed care and malpractice, noted Dr. Daniel J. Sullivan of the department of emergency medicine at John H. Stroger, Jr. Cook County Hospital and Rush Medical College in Chicago.

"If you don't want a hospital to hold you to ironclad rules, you must play the game, negotiate with the hospitals, and let administrators know you are in negotiations with a managed care organization," he said. "And if you're not on top of the medical errors situation, you're not in the game at all."

Emergency medicine groups must become invaluable to the hospital--so that "administrators can't imagine doing without you," added Dr. Sullivan who is also a lawyer. He also recommended that emergency medical directors take the lead in implementing a performance improvement program.

"The only reason a hospital looks elsewhere for an emergency medical group is if you fail to address problems immediately and provide medical leadership," pointed out Dr. J. Brian Hancock, regional vice president and senior medical officer for Sterling Healthcare in Durham, N.C.

"You must align front and center with the hospital [and] meet expectations of the hospital and medical staff. You become integrated into the life and death of the hospital--there's no way the hospital can do without you," he said, suggesting that members of the group should volunteer for every hospital committee that is appropriate.

Dr. Thom A. Mayer agreed. Members of an emergency medicine group should serve on search committees so they know the issues, said Dr. Mayer, professor of emergency medicine and pediatrics at Georgetown University in Washington and president/CEO of BestPractices Inc. in Fairfax, Va.

"Hospital administrators usually give hints to the medical director before terminating a contact," noted Dr. Robert Strauss Jr., associate chairman of the department of emergency medicine at Saint Francis Hospital in Poughkeepsie, N.Y.

"If patients aren't happy with a doctor, if there's poor patient satisfaction, and the hospital considers the medical group nonresponsive, that's what causes a hospital to look elsewhere," he explained.

It's a huge disruption to change groups, Dr. Strauss added. A hospital doesn't do it if a slightly better promise is made. "But no administrators will risk their butts for an ER group," he stressed. "You have to be performing, be an active participant, and not assume anything."

Being an active participant, for example, means eating in the doctors' dining room, said Dr. Gregory L. Henry of the department of emergency medicine at the University of Michigan.

"Otherwise, they view us as old backpack ER doctors, because all of us started out there. Pick a target to dine with every day to keep the lines of communication open," he suggested.

Dr. Strauss pointed out that with consolidation in the health care industry, 1 in 10 hospitals changes hands every year. "You may have had a relationship with the former administration; but if your hospital changes hands, you'd better get in there and tell the new people what you're going to do for them," he advised.