The tectonic plates are shifting: cultural change vs. mural dyslexia.

In response to a rapidly changing healthcare marketplace, a variety of new business models have arisen, including new specialties (hospitalists), selective care (concierge medicine), and joint ventures (ambulatory surgical centers, specialty hospitals), some with hospitals and others with independent vendors. Since both hospitals and physicians are feeling the squeeze of rising expenses, burdensome regulations, heightened consumer expectations, and stagnant or decreasing reimbursement, the response to global economic competition and the need to improve clinical and financial outcomes can bring physicians and hospitals together rather than drive them farther apart. In response to perceived threats, physicians and hospital executives can engage in defensive reasoning that may feel protective but can also lead to mural dyslexia, the inability or unwillingness to see the handwriting on the wall.

Making hospital-physician collaboration work.

Hospital-physician collaboration can reduce costs, alleviate unproductive competition, increase revenue, and foster productive working relationships. Using structured dialogue can improve communications. A hospital medical advisory panel of physicians can champion collaboration.

Overview of physician-hospital ventures.

An ongoing environment of reimbursement lagging behind escalating expenses has led physicians to explore new sources of revenue. The goal of physician-hospital ventures is to create a valuable entity that benefits patients, physicians, and the hospital. Physicians may choose to invest in healthcare facilities to improve patient care and obtain increased control over daily operations.