Hospitals taking great care to keep doctors happy.

WHILE Valley Presbyterian Hospital is soliciting bids to build an information technology infrastructure into that institution, the final decision in selecting a system will not rest solely in the hands of hospital administrators.

"We're in the process of selecting an IT vendor, and we've involved physicians in those discussions," said Hal Wurtzel, vice president Of corporate development for the hospital.

Wurtzel said that while an IT system is off course a critical part of ruing a hospital, giving physicians some kind of access to the-system for use in their practices can also be effective in maintaining good relationships with the doctors that use the hospital.

Hospitals are of course a linchpin in the health care system but they do depend on doctors, each one with a small business to run. to keep their doors open. And doctors can choose to avoid one hospital in favor of another, or limit their exposure to any of them. Some doctors choose to avoid hospital rounds and inpatient work and prefer to focus on outpatient work as much as possible. Some choose to set up their own surgical centers rather than pay hospitals for theirs.

Wurtzel is constantly aware of these issues as he recruits doctors for the hospital's staff. He and other hospital administrators are taking every opportunity to recruit physicians onto staff, keeping in mind that While hospitals are closing, doctors are still selective when it comes to joining a staff.

"We try to sell them on our nursing quality of care, and why (we) think we might be different from other hospitals," said Wurtzel.

Valley Presbyterian offers seminars on topics ranging from practice management to malpractice insurance and other educational topics that Wurtzel said are aimed mostly at a physician's business staff.

There are limits to what a hospital can offer its doctors, however.

"We can't provide any kind of financial incentive to a-physician that already has a practice in the area," Wurtzel said.

High-tech help

Providence Health System is also turning to high tech innovations to make physicians' practices easier to manage. The hospital is saving all of its imaging tests, X-rays, MRI scans and others as digital files.

"With the new system, doctors can actually access patients' images immediately at their offices from the hospital," said Dan Boyle, spokesman for Providence.

Boyle added that Providence's newest effort will be to build what he called "the largest integrated cancer center in the San Fernando Valley."

"Oncologists are going to be able to work more closely with physicians and specialists from all different areas within oncology."

Wurtzel's doctor's are looking forward to being able to offer treatment for their patients in one center, rather than being forced to send them someplace different for every procedure.

Like some other hospital owners, Providence also reserved some land near its buildings exclusively for medical office space.

Doctors who are tired of negotiating with hospitals and insurance companies are in no short supply, however.

Virginia Ambrosini, Kaiser Permanente's medical director in Panorama City, recruits doctors constantly, and finds no shortage of both new and veteran physicians looking to join the company. Kaiser physicians work in partnership with Kaiser Health. Doctors joining Kaiser make a conscious choice to join a staff instead of starting a small business. Their sole concern is the treatment of patients without having to worry about "back room" functions, said Ambrosini.

Ambrosini said that continuing education, both formal and informal, is another strong lure for physicians.

"When you work in a big group practice, you learn from each other," she said. "You don't feel like you're alone, you can pick up the phone and call any specialist and get an answer right away."

The stability of the program, which has been in existence for over 50 years, and the fact that physicians have a built-in patient base relieves a lot of pressure from Kaiser physicians, Ambrosini said.

The drawbacks

At the same time, she said the physicians do give up some of the freedoms that go with being a business owner.

"You're not going to become a multi-millionaire working for Kaiser as a physician," she said.

Kaiser's physician salaries are driven by the local market, and Ambrosini said the company has a good record of offering wages comparable to what physicians would be making in private practice in addition to offering a generous benefits package to offset any salary sacrifices.

Rather than choose between different business models and hospitals, some doctors are doing as much work as they can in their own facilities. Private surgical centers, for example, present constant competition for hospitals.

Providence in years past has had a surgical center for its physicians, but the doctors using the facility left to start their own, Wurtzel said.

No hospital administrator is in a position to deny that keeping physicians happy will be a constant endeavor. At the same time, hospitals accept the fact that they cannot be a remedy for every doctor's ills. Collaboration best occurs, it seems, when the two sides realize that they share same problems.

In the case of declining reimbursements, Wurtzel said that hospital administrators and physicians are both better off when submitting invoices to insurance companies.

"Hospitals are working closer with doctors to ensure that charts are properly documented and making sure that there is ample justification for having a payer deny reimbursement for any portion of patient care," said Wurtzel.