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Emergency: Advantages in Contracting with an Emergency Physician Group John H. Mangold Published online: 13 Jul 2010.
To cite this article: John H. Mangold (1976) Emergency: Advantages in Contracting with an Emergency Physician Group, Hospital Topics, 54:3, 6-8, DOI: 10.1080/00185868.1976.9950332 To link to this article: http://dx.doi.org/10.1080/00185868.1976.9950332
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
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JOHN H. MANGOLD is adminbtrator of Emergency Ph.psicians, an emergency physician group operating in a number of states, and based in Sun Leandro, Calvornia. He holdr a B.A. from the University of Notre Dame, an M.B.A. from Oklahoma State University. and served in the Medical Senices Corps (hospital adminutration branch) of the Air Force. Mr. Mangold huq participated in numerous emergency departin enr ho.spital consultations, feasibility studies, and ph.v.qician sem inars.
Advantages In Contracting With An Emergency Physician Group For Coverage Of The Emergency Department ull-time emergency physicians generally add depth to the quality of care rendered in the emergency department and ability of the emergency department to handle major trauma. The standard of care usually increases in hospital emergency departments with contract emergency physician groups because emergency physicians derive their total professional, intellectual and financial rewards from the emergency department. The emergency physicians have no office in the community to satisfy any of the aforementioned drives. These physicians consider the emergency department to be their medical career commitment arena. Hence, it is in their best interest and in the best interest of the patient that they demand a quality emergency care environment both in terms of paramedical competency and efficiency and physical plant. Yet, commensurate with the demand for quality is the commitment of the emergency physician to train, guide, and advise emergency department personnel in the smooth operation of the emergency department. Once this “team” knows what it is doing, and does it, the word gets around. Action-oriented PMD’s (private medical doctors) - e.g. surgeons, learn of the competency and ability of the emergency physicians at a particular hospital and the referrals that will come from the emergency physicians. These surgeons soon begin performing more surgery at this hospital because more interesting cases are being referred to them from the eniergency department. Hence, changes by PMD s in hospital utilization patterns occurs. This phenomenon of changing
F
6
PMD’s utilization of several hospitals to one or for example, has a dramatic effect on the census of a hosptial and utilization of ICU, CCU, surgery and ancillary services. These areas, as we all know, are major revenue producing areas for the hospital. The community soon realizes that a n emergency department with full-time 24 hour emergency physician coverage often provides more efficient service to the patient than the emergency department which is staffed by physicians who are “on call” and are not physically present 24 hours per day within the hospital. Parenthetically, service is really the secret of patient satisfaction - and medical staff satisfaction. Patients who are seen in an efficient, courteous, competent and expeditious manner relate these thoughts to their own family doctor when they next see him. The family doctor then realizes that the patient was satisfied with the care rendered in the emergency department by the emergency physician and emergency staff. The PMD then feels more comfortable about referring patients to the emergency department at 3 o’clock in the morning. The life-style of the PMD becomes a more reasonable one in that he need not - unless he desires - come to the emergency department at 3 a.m. to see his patient. Now there is an alternative and that alternative is the emergency physician. This more reasonable alternative life-style often manifests itself in the PMD looking more favorably on the hospital that does provide 24 hour emergency physician coverage. The rapidly escalating malpractice insurance premiums are forcing more and more elderly two,
Continued on Page 8
HOSPITAL TOPICS
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Downloaded by [University of Illinois at Urbana-Champaign] at 15:19 30 January 2015
PMD’s, part-time PMD’s, and even young PMD’s to discontinue their specialty practices - particularly those that are primary care physicians. The emergency department will become, in an even greater capacity, the primary care center for many patients who cannot gain entry into the office of a PMD. Accordingly, the hospital with a contracted group of emergency physicians can fill this void and gain entry into the health care delivery system for many of these “disenfranchised” patients. The Emergency Medical Services Systems Act of 1973 placed emphasis on emergency medical care as a priority for the future. Private grants such as those from the Robert Wood Johnson Foundation placed additional interest in emergency medical services as an important contemporary issue, In that regard, hospitals operating emergency department with full-time emergency physicians committed to emergency medicine can become integrally involved in emergency health care delivery via telemetry, trauma center designation, emergency medical technician (EMT) training, etc. This will become more and more important as categorization and regionalization become potent forces with clout when the determination is made as to which emergency departments will remain open and which will be closed. An emergency physician group can aid in the solution of problems that seem to be indigenous to an emergency department. A quality conscious group usually has much material on the management of an emergency department primarily because a number of the doctors have been in the practice of emergency medicine for many years, and have written numerous emergency department protocols, procedures, and policy manuals. These manuals can usually be adapted to the individual needs and requirements of most hospitals - all in an effort to foster quality control within the emergency department. Emergency physicians also can aid in the teaching commitment of a hospital. This teaching aspect applies to in-service education classes for nurses and also to interns and house staff, should the hospital have a formalized teaching program. Emergency physicians augment the in-service nurse education program by speaking on CPR, e.g. and other medical and surgical emergency situations that do present in the emergency treatment area. Many times these in-service programs are attended by interested parties outside of the ER. From the intern and resident’s standpoint, the emergency physician can be the consultant when the intern resident is assigned to the ER. This ongoing relationship is not all one sided, for usually the emergency physician enjoys the pedagogic aspect of the house-staff-physician relationship. Rotation in the emergency department by 8
medical staff members is a constant albatross for the administrator and/or the emergency committee who must schedule the doctors for this rotation. If this is a mandatory rotation, some medical staff members will object to being a part of the rotation. This objection is not all one-sided if we consider the case of the ophthalmologist who dreads his one night per month in the emergency department because he might be called upon to treat a myocardial infarction, do cardiopulmonary resuscitation, or insert a chest tube, when as an ophthalmologist he hasn’t done any of these procedures in years. Therefore, his apprehension about being part of the mandatory rotation is well-founded. With an emergency physician group contracted to the hospital, no longer will the administrator trouble himself with getting coverage for the emergency room for a Saturday night when the “moonlighting” resident can’t make it or when the ophthalmologist on emergency room call for his once monthly emergency room rotation gets sick. Now it is the group’s contractual obligation to provide coverage - it’s the group’s problem and not the administrator’s. And because the group is very proficient at emergency physician selection, such last-minute “no-shows” usually never occur. A director of the emergency physicians is chosen to function as a buffer or intermediary between the emergency physician and the medical staff, the emergency physician and administration, and the emergency physician and the patient. This alleviates the need for the administrator, e.g. to confront all the emergency physicians separately with the problems. The administrator need only apprise the director who in turn can discuss the problem with the other emergency physicians. The director also functions as the “captain of the ship,” and sets the tone for the emergency department, as well as administering admonishments and accolades when needed. With an emergency physician group, sleepy hospital emergency departments become active ones. With a full-time group, emergency department patient volume grows. As in every other profession, the secret to keeping doctors, nurses and emergency department personnel intellectually, and financially satisfied, is volume. Volume also keeps the administration satisfied in terms of financial viability of the emergency department. Finally, one point should be well-emphasized. Only when members of the medical staff become convinced of the competency, ethics and reliability of the emergency physicians will they then refer an increasing number of their patients to the emergency department - with the knowledge that the emergency department is not an overt competitor to the private medical doctor but a consultant much like any other physician colleague. m For More Ad Facts Circle # 77 On Reply Card-
HOSPITAL TOPICS
Hospital Topics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vhos20
Emergency: Advantages in Contracting with an Emergency Physician Group John H. Mangold Published online: 13 Jul 2010.
To cite this article: John H. Mangold (1976) Emergency: Advantages in Contracting with an Emergency Physician Group, Hospital Topics, 54:3, 6-8, DOI: 10.1080/00185868.1976.9950332 To link to this article: http://dx.doi.org/10.1080/00185868.1976.9950332
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
Downloaded by [University of Illinois at Urbana-Champaign] at 15:19 30 January 2015
JOHN H. MANGOLD is adminbtrator of Emergency Ph.psicians, an emergency physician group operating in a number of states, and based in Sun Leandro, Calvornia. He holdr a B.A. from the University of Notre Dame, an M.B.A. from Oklahoma State University. and served in the Medical Senices Corps (hospital adminutration branch) of the Air Force. Mr. Mangold huq participated in numerous emergency departin enr ho.spital consultations, feasibility studies, and ph.v.qician sem inars.
Advantages In Contracting With An Emergency Physician Group For Coverage Of The Emergency Department ull-time emergency physicians generally add depth to the quality of care rendered in the emergency department and ability of the emergency department to handle major trauma. The standard of care usually increases in hospital emergency departments with contract emergency physician groups because emergency physicians derive their total professional, intellectual and financial rewards from the emergency department. The emergency physicians have no office in the community to satisfy any of the aforementioned drives. These physicians consider the emergency department to be their medical career commitment arena. Hence, it is in their best interest and in the best interest of the patient that they demand a quality emergency care environment both in terms of paramedical competency and efficiency and physical plant. Yet, commensurate with the demand for quality is the commitment of the emergency physician to train, guide, and advise emergency department personnel in the smooth operation of the emergency department. Once this “team” knows what it is doing, and does it, the word gets around. Action-oriented PMD’s (private medical doctors) - e.g. surgeons, learn of the competency and ability of the emergency physicians at a particular hospital and the referrals that will come from the emergency physicians. These surgeons soon begin performing more surgery at this hospital because more interesting cases are being referred to them from the eniergency department. Hence, changes by PMD s in hospital utilization patterns occurs. This phenomenon of changing
F
6
PMD’s utilization of several hospitals to one or for example, has a dramatic effect on the census of a hosptial and utilization of ICU, CCU, surgery and ancillary services. These areas, as we all know, are major revenue producing areas for the hospital. The community soon realizes that a n emergency department with full-time 24 hour emergency physician coverage often provides more efficient service to the patient than the emergency department which is staffed by physicians who are “on call” and are not physically present 24 hours per day within the hospital. Parenthetically, service is really the secret of patient satisfaction - and medical staff satisfaction. Patients who are seen in an efficient, courteous, competent and expeditious manner relate these thoughts to their own family doctor when they next see him. The family doctor then realizes that the patient was satisfied with the care rendered in the emergency department by the emergency physician and emergency staff. The PMD then feels more comfortable about referring patients to the emergency department at 3 o’clock in the morning. The life-style of the PMD becomes a more reasonable one in that he need not - unless he desires - come to the emergency department at 3 a.m. to see his patient. Now there is an alternative and that alternative is the emergency physician. This more reasonable alternative life-style often manifests itself in the PMD looking more favorably on the hospital that does provide 24 hour emergency physician coverage. The rapidly escalating malpractice insurance premiums are forcing more and more elderly two,
Continued on Page 8
HOSPITAL TOPICS
Downloaded by [University of Illinois at Urbana-Champaign] at 15:19 30 January 2015
Downloaded by [University of Illinois at Urbana-Champaign] at 15:19 30 January 2015
PMD’s, part-time PMD’s, and even young PMD’s to discontinue their specialty practices - particularly those that are primary care physicians. The emergency department will become, in an even greater capacity, the primary care center for many patients who cannot gain entry into the office of a PMD. Accordingly, the hospital with a contracted group of emergency physicians can fill this void and gain entry into the health care delivery system for many of these “disenfranchised” patients. The Emergency Medical Services Systems Act of 1973 placed emphasis on emergency medical care as a priority for the future. Private grants such as those from the Robert Wood Johnson Foundation placed additional interest in emergency medical services as an important contemporary issue, In that regard, hospitals operating emergency department with full-time emergency physicians committed to emergency medicine can become integrally involved in emergency health care delivery via telemetry, trauma center designation, emergency medical technician (EMT) training, etc. This will become more and more important as categorization and regionalization become potent forces with clout when the determination is made as to which emergency departments will remain open and which will be closed. An emergency physician group can aid in the solution of problems that seem to be indigenous to an emergency department. A quality conscious group usually has much material on the management of an emergency department primarily because a number of the doctors have been in the practice of emergency medicine for many years, and have written numerous emergency department protocols, procedures, and policy manuals. These manuals can usually be adapted to the individual needs and requirements of most hospitals - all in an effort to foster quality control within the emergency department. Emergency physicians also can aid in the teaching commitment of a hospital. This teaching aspect applies to in-service education classes for nurses and also to interns and house staff, should the hospital have a formalized teaching program. Emergency physicians augment the in-service nurse education program by speaking on CPR, e.g. and other medical and surgical emergency situations that do present in the emergency treatment area. Many times these in-service programs are attended by interested parties outside of the ER. From the intern and resident’s standpoint, the emergency physician can be the consultant when the intern resident is assigned to the ER. This ongoing relationship is not all one sided, for usually the emergency physician enjoys the pedagogic aspect of the house-staff-physician relationship. Rotation in the emergency department by 8
medical staff members is a constant albatross for the administrator and/or the emergency committee who must schedule the doctors for this rotation. If this is a mandatory rotation, some medical staff members will object to being a part of the rotation. This objection is not all one-sided if we consider the case of the ophthalmologist who dreads his one night per month in the emergency department because he might be called upon to treat a myocardial infarction, do cardiopulmonary resuscitation, or insert a chest tube, when as an ophthalmologist he hasn’t done any of these procedures in years. Therefore, his apprehension about being part of the mandatory rotation is well-founded. With an emergency physician group contracted to the hospital, no longer will the administrator trouble himself with getting coverage for the emergency room for a Saturday night when the “moonlighting” resident can’t make it or when the ophthalmologist on emergency room call for his once monthly emergency room rotation gets sick. Now it is the group’s contractual obligation to provide coverage - it’s the group’s problem and not the administrator’s. And because the group is very proficient at emergency physician selection, such last-minute “no-shows” usually never occur. A director of the emergency physicians is chosen to function as a buffer or intermediary between the emergency physician and the medical staff, the emergency physician and administration, and the emergency physician and the patient. This alleviates the need for the administrator, e.g. to confront all the emergency physicians separately with the problems. The administrator need only apprise the director who in turn can discuss the problem with the other emergency physicians. The director also functions as the “captain of the ship,” and sets the tone for the emergency department, as well as administering admonishments and accolades when needed. With an emergency physician group, sleepy hospital emergency departments become active ones. With a full-time group, emergency department patient volume grows. As in every other profession, the secret to keeping doctors, nurses and emergency department personnel intellectually, and financially satisfied, is volume. Volume also keeps the administration satisfied in terms of financial viability of the emergency department. Finally, one point should be well-emphasized. Only when members of the medical staff become convinced of the competency, ethics and reliability of the emergency physicians will they then refer an increasing number of their patients to the emergency department - with the knowledge that the emergency department is not an overt competitor to the private medical doctor but a consultant much like any other physician colleague. m For More Ad Facts Circle # 77 On Reply Card-
HOSPITAL TOPICS
