A Complex Case Worthy of Dr. House

Each week in a mythical New Jersey hospital, Dr. Gregory House collaborates with his team to solve an incredibly complex medical case.

Now a dozen real-life New Jersey hospitals are collaborating to solve an incredibly complex financial case.

For 10 years, New Jersey hospitals have suffered from an average profit margin of less than 1 percent. To improve financial health, New Jersey hospitals must reduce waste and cut cost while improving patient care.

A recently approved demonstration project will help determine if hospitals and physicians can collaborate more closely to improve safety and quality of care while reducing costs.

CMS approved a gainsharing plan proposed by the New Jersey Hospital Association in which hospitals are allowed to use current Medicare funds to provide incentives to participating physicians who excel at achieving exemplary outcomes while helping hospitals save money. (Physician participation is voluntary.)

The plan takes collaboration to new levels in many respects. Each hospital and its physicians will become more closely aligned in efforts to improve quality and efficiency. Governing the incentive program will require active steering committees with at least 50 percent physician participation. The dozen hospitals will work together through representatives on a global steering committee to share ideas, expertise and best practices.

In each episode of House, specialists and the hospital have less than 60 minutes to solve the case. This demonstration project brings together motivated physicians and administrators in twelve hospitals over three years to help find a way to restore the financial health of New Jersey's hospitals.

CMS is overseeing the project and will monitor success based on hospital readmissions and other data. Will collaboration bring success? The case is enormously complex and only time will tell. Stay tuned.

— Tom DeSanto

Based on "Gainsharing Pilot Tests if Hospitals, Physicians Can Reduce Costs," Mark Taylor, H&HN, October 2009. Image: fanpop.com

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