title: Factors driving physician-hospital alignment in orthopaedic surgery.
abstract: BACKGROUND
  The relationships between physicians and hospitals are viewed as central to the proposition of delivering high-quality health care at a sustainable cost. Over the last two decades, major changes in the scope, breadth, and complexities of these relationships have emerged. Despite understanding the need for physician-hospital alignment, identification and understanding the incentives and drivers of alignment prove challenging.
  
  
  OBJECTIVE
  Our review identifies the primary drivers of physician alignment with hospitals from both the physician and hospital perspectives. Further, we assess the drivers more specific to motivating orthopaedic surgeons to align with hospitals.
  
  
  METHODS
  We performed a comprehensive literature review from 1992 to March 2012 to evaluate published studies and opinions on the issues surrounding physician-hospital alignment. Literature searches were performed in both MEDLINE(®) and Health Business™ Elite.
  
  
  RESULTS
  Available literature identifies economic and regulatory shifts in health care and cultural factors as primary drivers of physician-hospital alignment. Specific to orthopaedics, factors driving alignment include the profitability of orthopaedic service lines, the expense of implants, and issues surrounding ambulatory surgery centers and other ancillary services.
  
  
  CONCLUSIONS
  Evolving healthcare delivery and payment reforms promote increased collaboration between physicians and hospitals. While economic incentives and increasing regulatory demands provide the strongest drivers, cultural changes including physician leadership and changing expectations of work-life balance must be considered when pursuing successful alignment models. Physicians and hospitals view each other as critical to achieving lower-cost, higher-quality health care.
authors.affiliation: Kaiser Permanente, San Diego, CA, USA.
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Page
authors.forename: Craig A
authors.initials: CA
authors.lastname: Butler
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Bozic
mesh_terms: D003299:Cooperative Behavior; D016208:Databases, Factual; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D018166:Health Care Reform; D018578:Hospital-Physician Relations; D006801:Humans; D016239:MEDLINE; D015279:Organizational Culture; D009985:Orthopedics / Q000191:economics / Q000458:organization & administration*; D011357:Product Line Management