Identifying and recruiting the best physicians is a ­growing concern nationwide. As baby boomer docs start to retire, not only must hospitals replace them, but they must also reinvent their recruitment tactics to reach the younger generation of physicians.

We are about to enter an era of formalized surveys that will finally give patients a chance to talk back to their doctors en masse, to say how they really feel about their office visit experiences. Perceived mistreatment by physicians and their staffs may have a subtle but enormous ­impact on patient compliance, and ultimately on quality and outcomes. And that's why value-based purchasing "satisfaction" scorecards for primary care doctors as well as specialists are just around the corner. Soon these scorecards will be posted on some state health department websites, or on Physician Compare.

Patients today are overwhelmed by the complexity of medical bills. Physicians regret their patients' frustration, but they often don't realize how much it can impact a practice's revenue.

As the HealthLeaders Media intelligence report ­Service Lines Grow Amid Strategic Challenges shows, most ­healthcare leaders anticipate that their service lines will grow over the next few years, with a big baby boomer-fueled push for oncology, orthopedic, and cardiology needs. And younger patients will generate the demand for wellness or neurological care, with new service lines to come.

Yet hospitals shouldn't automatically count on return on investment. There's great angst among hospital leaders, the survey shows, in plans to integrate physicians to deliver that bottom line.

One common complaint about the transition from fee-for-service reimbursement to value-based schemes is that such groundbreaking changes cannot be done overnight and must be phased in. That's a problem for healthcare ­organizations that seek to be forward-thinking yet must ­continue to exist under current rules. A common refrain is that senior leaders feel as unsettled as a person with one foot on the boat and the other foot on the dock.

But there may be a way to bridge that transition through vehicles such as the physician hospital organization (PHO), which many hospitals and health systems formed under capitation more than a decade ago-and which many subsequently discarded as HMOs gave way to preferred provider organizations and as government payers continued to use fee-for-service reimbursement. However, the PHO, or at least something like it, is making a comeback as payers and the government make slow progress toward accountable care.

In March 2011, CMS announced its esMD (­Electronic Submission of Medical Documentation) tool, which is an option for providers to electronically send medical documentation that is requested of them by Recovery Auditors and other government entities' contractors. Phase 1 of esMD kicked off on September 15, 2011. During this period, providers will still receive medical documentation requests via paper mail but will have the option to send their documentation to the requesting review contractor electronically.