4 Trends and Best Practices of Service Line Co-Management Relationships

In a session at the Becker's Hospital Review annual meeting in Chicago on May 17, Surgical Care Affiliates’ Senior Vice President Gerry Biala and Senior Director Matthew Kossman discussed service line co-management relationships — both how they’ve evolved and how hospitals and surgeons are functioning under those agreements.

Mr. Biala opened the discussion by providing a general definition of co-management as it pertains to hospitals and health systems. He considers co-management “an alternative structure to engage a group of physicians to achieve higher levels of operational efficiencies and improved patient care outcomes.”

"We've had a natural evolution to looking at partnership models with surgeons," Mr. Biala said.

He noted four trends in physician alignment among surgeons:

1. Medical chairs or directorships are chosen as a single point of contact
2. There’s a transition from traditional operating room committees with little voice or management responsibility
3. Governance councils have a firmer say
4. Surgeons and hospitals are setting up co-management agreements

In co-management agreements, hospitals and physicians tend to share involvement of management and operations for individual or multiple service lines. Additionally, necessary clinical services are covered. Mr. Biala said the purpose is to improve quality and efficiency of care by pooling resources.

The co-management package needs to consider overall design of the agreement —committee structure, incentive metrics and call coverage — as well as quality measures. Those should be clearly and separately identified and the structure f the metrics should utilize objective and verifiable methodology. Both physicians and the hospital should have a say in choosing the metrics, Mr. Biala said. Additionally, incentive payments should be based on a hospital’s historical baseline data with target levels ideally aimed to match or exceed national benchmarks.

A service council may act as an oversight body to ensure evolution of the co-management agreement.

“It’s important to look at the results. Did the co-management company do and achieve what it said it would?” Mr. Biala said.

The speakers with Surgical Care Affiliates ended their presentation with suggestions for moving forward in a co-management agreement. Both hospitals and physicians should have:

1. A clear set of objectives for meetings
2. An agenda and materials distributed prior to meetings
3. Meeting times scheduled in and structured in away that ensures all topics are adequately covered
4. Data provided that can help both sides quantify the co-management setup
   
   

"Co-management agreements provide a good vehicle for physician-clinical alignment," Mr. Biala said.

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