Health care reform offers an opportunity to achieve the type of systemic changes that can expand coverage, improve quality and care coordination, reward better care, promote innovation and reduce cost. But delivering on that promise requires the removal of longstanding barriers to clinical integration among hospitals, physicians and other caregivers.
Clinical integration can take many forms. In some, different providers may collaborate to tackle a single condition, like diabetes. In others, the hospital, physicians and other caregivers may function as a single entity, working together to provide seamless care to all patients.
The AHA has long recognized the importance of clinical integration. Nearly five years ago, I had the privilege of chairing an AHA task force that looked very deeply into past practices in health care delivery that led to the fragmentation we see today.
The need for change was apparent everywhere we looked. Not in the individual practices, but in how practitioners and hospitals could better connect with each other, for the benefit of the patient. What the task force found can be boiled down to six simple words: "Superior health care calls for teamwork."
At its heart, clinical integration is teamwork: hospitals, doctors, nurses and other caregivers working together to make sure patients get the right care, at the right time, in the right place. The Institute of Medicine's (IOM) seminal work on quality created a framework for the field that has become its mantra: care that is safe, effective, efficient, timely, equitable and patient centered.
Achieving the IOM's quality goals demands that hospitals and physicians work together as never before.
Like so much else in health care, clinical integration should be easier than it is; a number of legal obstacles discourage many hospitals and doctors from pursuing it. They range from confusing antitrust policies to outdated rules governing relationships between hospitals, doctors and other caregivers.
As the AHA's task force on delivery system fragmentation ended its work in 2005, the AHA's work on promoting clinical integration was just beginning.
In 2007, the AHA asked former Federal Trade Commission (FTC) officials to help the association craft guidance for the hospital field on antitrust clinical integration. We shared the paper, "Guidance for Clinical Integration," with the FTC, the Department of Justice's (DOJ) Antitrust Division, as well as those on Capitol Hill who oversee antitrust policy. (For more on the paper, see the article below.)
We are working with DOJ's Antitrust Division and the FTC on creating more user-friendly guidance for hospital-physician collaboration. As part of that effort, I participated in a 2008 FTC workshop on clinical integration and spoke about its importance to the nation's hospitals and their patients.
I contended that the rules themselves are not unsolvable barriers to clinical integration. The real barrier is confusion about what the laws do and do not allow. I also discussed the need to tackle other legal and regulatory barriers, such as the Stark, anti-kickback and civil monetary penalty laws. Solutions include safe harbors, clear congressional directives and refocusing the law on its original intent.
The AHA also kept the issue on the congressional radar screen through our Health for Life initiative, a framework for genuine health reform built upon goals and ideas for creating better, safer, more affordable care and a healthier America. I served as chairman of Health for Life's advisory group on clinical integration, which recognized that harnessing its power is key to meaningful health reform, and the quality and efficiency improvements it promises.
Many hospitals are using a broad range of approaches to work more closely with physicians and other providers.
But hospitals seeking greater integration must overcome various legal hurdles that often force them to spend substantial time and expense in finding solutions.
Let's bring the health care rules and regulations governing clinical integration into the 21st Century. Congress and the administration should act now to clear these hurdles and allow hospitals to forge the teamwork that can lead to superior health care.
Petasnick is president of Froedtert & Community Health in Milwaukee and a former AHA chairman.
