Development Team

Success in a VBP model will require coordinated care between hospitals, physicians and ancillary facilities. Several ways exist for participants to organize a VBP system to achieve collaboration. The choice of organizational structure will be influenced by many of the same factors that influence other hospital/physician joint ventures. Creating an organizational structure that assures that the physicians and hospitals are able to collaborate effectively is a primary determinant.

The creation of a collaborative organization implicates several regulatory compliance issues such as fraud and abuse, self-referral, the Health Care Quality Improvement Act and antitrust. The addition of the VBP reimbursement methodology to this network model significantly increases the operational and regulatory issues involved in implementation.

The vehicle that an organization uses to facilitate a VBP system or network is a decision driven by the facts of each situation. The decision as to the appropriate organizational model should be made after careful reflection on the unique circumstances of your hospital and medical staff.

The decision is not only driven by legal considerations, but also by practical considerations. The governance of the organization must engender a sense of “buy-in” by the physician participants. Physicians control many of the clinical decisions that will determine whether the hospital can meet the established quality guidelines. An enthusiastic physician component of the VBP network will significantly increase the chances for success. A group of physicians who do not believe that the organization gives them adequate say over their destiny will be less likely to cooperate, or even join the network.

Success in a VBP model will require coordinated care between hospitals, physicians and ancillary facilities. Several ways exist for participants to organize a VBP system to achieve collaboration. The choice of organizational structure will be influenced by many of the same factors that influence other hospital/physician joint ventures. Creating an organizational structure that assures that the physicians and hospitals are able to collaborate effectively is a primary determinant.

The creation of a collaborative organization implicates several regulatory compliance issues such as fraud and abuse, self-referral, the Health Care Quality Improvement Act and antitrust. The addition of the VBP reimbursement methodology to this network model significantly increases the operational and regulatory issues involved in implementation.

The vehicle that an organization uses to facilitate a VBP system or network is a decision driven by the facts of each situation. The decision as to the appropriate organizational model should be made after careful reflection on the unique circumstances of your hospital and medical staff.

The decision is not only driven by legal considerations, but also by practical considerations. The governance of the organization must engender a sense of “buy-in” by the physician participants. Physicians control many of the clinical decisions that will determine whether the hospital can meet the established quality guidelines. An enthusiastic physician component of the VBP network will significantly increase the chances for success. A group of physicians who do not believe that the organization gives them adequate say over their destiny will be less likely to cooperate, or even join the network.