Abstract
BACKGROUND: Physician-hospital alignments are becoming more common in today's healthcare environment. In the community setting, these relationships can impact quality of care as well as physician and hospital bottom lines. Alignment strategies take many different forms and can be advantageous to both the community orthopaedist and the community hospital, but certain key factors must be present to prevent a failed effort. Both the physician and hospital must be clear about their goals and expectations to overcome barriers and ensure success. QUESTIONS/PURPOSES: We outline alignment strategies, goals, expectations, and implementation of a community-based, hospital alignment program and key factors that must be present to prevent a failed effort. SEARCH STRATEGY: We queried PubMed and the AAOS web site for the terms "physician hospital alignment", "hospital physician alignment", and "clinical integration". We initially identified 65 articles and identified 19 that described the formation, evaluation, and examples of community hospital alliances. RESULTS: In 2012, multiple business arrangements have been developed to deal with this vision for our healthcare future. One of these strategies known as alignment is generally considered to be a relationship among patients, orthopaedic surgeons, and stakeholders to fulfill these quality benchmarks and deliver improved quality care. Community practices have unique developmental barriers that must be negotiated for this process to be successful. CONCLUSIONS: The majority of hospital-based, orthopaedic care is practiced in the community settings far away from large, urban medical centers. Despite the relatively rural nature of these orthopaedic practices, patients, physicians, and all other orthopaedic stakeholders share a common goal of providing safe, quality health care at an affordable price.