Changes in health care delivery and payment are changing the relationships between health systems and physicians. Historically, with some notable exceptions, there has been a divide between hospitals and physicians. Hospitals existed as places patients were admitted when sick or needing surgery. Doctors were, for the most part, independent of the hospital and self employed. They would utilize the hospital’s facilities to admit their sick patients or perform procedures, but were not contractually or economically linked to the hospital. Notable exceptions were University Hospitals, where the doctors were employed by the university’s medical school and the hospital was a part of the University. Mayo Clinic, Cleveland Clinic and Geisinger operated on a different model. These not-for-profit foundations were started by physicians, led by physicians and operated an integrated enterprise where the hospitals, clinics and doctors were wrapped up in one organization.
For a multitude of reasons, doctors are migrating to some form of employment. New residents graduating from their training programs are choosing employment by a health system over private practice and not too long from now, the vast majority of physicians will be employed by a health system. As we strive to integrate the care of the patient across the entire continuum, from inpatient to outpatient, closer alignment and integration between health systems and physicians will be necessary. Changes in payment methodologies and the elimination of the traditional “fee for service” model and the development of Accountable Care Organizations (ACOs) will accelerate the movement toward what has been termed “physician alignment”, that is doctors and hospitals working together in the care of the patient and getting paid a lump sum to do so.
Recognizing these developments, we have reorganized ourselves to better reflect the realities of 21st century health care. We have created Frederick Regional Health System as the parent of all we do to care for our community. Under this banner, we now have Frederick Memorial Hospital and Monocacy Health Partners.
Monocacy Health Partners is organized as a not-for-profit, physician run, group practice currently encompassing 70 physicians and other health care providers. Current membership includes the physicians of the:
- Center for Breast Care,
- Center for Chest Disease,
- Oncology Care Consultants,
- Orthopedic Specialists of Frederick,
- Frederick Urology Specialists,
- Immediate Care,
- Pain and Palliative Care,
- Parkview Medical Group,
- Union Bridge Family Practice,
- and our pediatric hospitalists.
Over the course of the next year, we plan to recruit additional physicians and move additional practices into Monocacy Health Partners.
While physicians are increasingly choosing to join health-system-based practices like Monocacy Health Partners, our community still has a very high quality, dedicated mostly private practice medical staff who provide a great deal of care and are very much engaged with FMH. As health care continues to evolve, it is likely that some of our physicians will choose to join Monocacy Health Partners and that some will not. As the group grows and develops, it is our intention that it serve as a vehicle to help integrate the care of our patients, improve outcomes and allow our private community based physicians to participate in the future of health care, whatever it holds and whatever choices they make about how they interface with Frederick Regional Health System.