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	MEDICAL STAFF
	In today's competitive care environment, an important key to success is partnering between the hospital and medical staff. More than ever, the growth of managed care demands that hospitals and medical staff develop and foster a symbiotic relationship.  Relationships  The medical staff is the engine of every hospital. It is the medical staff that determines case mix, admits patients, controls the use of resources, assures quality of care, creates the documentation that forms the basis for billing, and helps to assure that regulatory standards are met. The full participation and support of the medical staff is critical to the attainment of all quality and revenue goals. All too often, hospitals and their medical staff find themselves on what appears to be opposite sides of the issue. Unfortunately, in some instances, this "matter of perspective"has become part of the institutional culture. Health Systems Management Network has found that this need not be the case. Partnering with the medical staff is a key to the success of all management strategies. Health Systems Management Network has a demonstrated ability to build a bridge between the revenue goals of the medical staff and the requirements of the institution through the realization of common interests. Once convergence has been identified and a culture of sharing has been achieved, strategies can be developed that benefit both the hospital and medical staff. Early success in areas of clear consensus will then facilitate work on more challenging issues.
	Issues and Benefits  Through our experience in acute-care hospitals, we have found many general areas where partnering yields benefits for both administration and physicians. Examples are billing, documentation, case mix, resource utilization, case management and best demonstrated practices. The benefits for the institution are improved competitiveness in managed care and revenue capture through timely billing that truly reflects severity and resource use. However, identifying the benefits to the physicians is more critical in the enlistment of their support. These benefits typically include:  Improved communication between referred and referring physicians.  Improved availability and accessibility of patient data.  Documentation with improved interdepartmental consistency.  Improved physician support from nursing and other hospital departments. assistance in meeting third-party payor requirements.  Real growth.
	Capturing Information Once/Meeting Requirements  To reflect and understand the realities of different "perspectives,"Health Systems Management Network's approach is two-phased. One phase is the analysis of patient demographic and payment data to determine pattern sof resource utilization and related documentation. A sample of patients also will be studied on a concurrent basis to determine the quality of documentation, ancillary usage, severity level and DRG assignment.  In the second phase, we will perform in-depth interviews with members of the medical staff to gain an understanding of the context in which they practice and to clarify their needs. This research allows us to create a profile of the medical staff and the population served. This will form a foundation for a strategic plan that outlines the direction in which the medical staff should move to be aligned with the population served. The plan also will detail strategic and procedural improvements, by specialty, with an emphasis on opportunities for best demonstrated practices. The plan will address ways to facilitate the progress of patients through the system and identify ways to streamline documentation so that information is captured only once, but is accessible system wide. Many large hospitals, including academic medical centers, find inconsistency between hospital diagnosis and physician procedure billing. Our plan will reconcile these inconsistencies.
	Implementation  The culture of every institution is different, and specific implementation methods must be tailored to that culture. However, Health Systems Management Network has developed core procedures for consensus building between administration and the medical staff. By working side by side with physicians and administration,we discover key individuals with well-articulated concerns and/or specific departmental successes. Their experience often yields strengths that can be applied to the organization as a whole. In addition, these individuals can be developed as "champions" to help lead cultural change within their peer groups. With the strategic plan data and the input from key individuals, we carefully choose the ground for early implementation of process improvements. This prioritization is very important. Considering the pressures of their profession, the medical staff is most likely to cooperate on solving issues that meet their immediate concerns. With our guidance, inter- and intradisciplinary work groups will implement improvements and, in the process, discover more commonality of interest than difference. A culture of cooperation for change must be built on a foundation of clear success for all concerned. It must be nurtured through open dialogue and honest feedback. The result can yield significant gains in both revenue and quality, while simultaneously improving morale and efficiency.
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Health Systems Management Network, Inc. is a healthcare consulting firm specializing in the following practices: healthcare consultants; consulting. managed care. subacute care, patient flow, information systems. electronic patient record management. Electronic medical records, billing,insurance, acute care, case mix, case management, ambulatory care, and resource management are areas of experience. We are familiar with UB, length of stay, DRG, in patient, out patient and TQM methods. More recently Health Systems Management Network, Inc has been pioneering work with APC, (All Patient Grouper). clinical data, clinical documentation. benchmarking. critical paths and receivables. We work with utilization review. acute care hospitals. practice groups. ICD, ICD-9, ICD-9-CM, CPT, CPT-4, HCPCS, HCFA, medicare, referrals. JCAHO, claims, RBRVS, HMO, reimbursement, Joint Commission compliance, regulations, training, reengineering, (re-engineering) total quality management for both inpatient, outpatient.