Service line-specific clinical integration programs


The DFW Hospital Council is posting blogs submitted by our Associate Members. The following was provided by the Coker Group. For guidelines, please contact Chris Wilson at

As hospitals prepare to operate successfully under value-based reimbursements such as bundled payments, they need to consider re-tooling some of their higher profile service lines. Orthopedics and cardiac care service lines are particular targets for the Centers for Medicare & Medicaid Services’ (CMS) latest round of bundled payment programs, some of which are mandatory. Actions to consider include:

1. Engaging physician providers to help identify service line expenses that can be eliminated without jeopardizing quality and patient safety.

a. Clinical co-management agreements with service line providers can serve as a suitable way to do this, and shared savings can be utilized to reward physicians and other providers for their efforts. (NOTE: Gainsharing arrangements of this type need to be set up with the assistance of experienced legal counsel, who can ensure that these agreements are compliant.)

2. Targeting expenses that free up savings to the hospital or healthcare system and not necessarily the payers.

a. Examples of “low-hanging fruit” in most hospitals that may offer opportunities to trim costs include the OR supply chain, blood utilization, implant costs, and antibiotic stewardship.

3. Co-marketing of integrated services to traditional and non-traditional purchasers.

a. One of the advantages of setting up a service line-specific clinical integration program that meets the definition of clinical integration as determined by the Federal Trade Commission and others is that the hospital and providers can then jointly contract for services, especially for bundled services specific to the service line.

b. Target markets for these clinically integrated services include CMS, commercial payers, large self-insured employers, and other clinically integrated networks or accountable care organizations that are looking to fill in specialty-specific gaps in their networks.

Coker Group has assisted small, medium and large hospitals and healthcare systems with the development of service line-specific clinical integration programs. If you are interested in learning more about how Coker can help your organization with these initiatives, call 678-832-2021 to speak with Dr. Ellis “Mac” Knight.