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Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
The Changing Medical StaffWhat Physician Employment, Service Lines, and Clinical Integration Mean for your Medical Staff
Rick Sheff, MD
The Greeley Company
©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
Institute for Healthcare Improvement (IHI) Triple Aim
• Improve the health of the population
• Enhance the patient experience of care (including quality, access, and reliability)
• Reduce, or at least control, the per capita cost of care
©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
Clinical integration models
• Physician Employment?
• Service Line Management
• Accountable Care Organization (ACO)/Clinically Integrated Network (CIN)
©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
To whom are physicians accountable and for what?
©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
Governing Board
CEO MEC
Single hospital traditional self-governed organized medical staff org chart
Department Chair
Individual Practitioners
©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
System board, medical staff and management relationships
System Governing Board
Local Board
MECHospital CEO
System CEO
Regional VP
©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
Board of directors
CEO MEC
VPMA/CMO
It’s getting complicated…
Medical Director
Department Chair
Individual Practitioners
Other Entities (Employed Phys, ACO/CIN, SL Co-Mgmnt, etc.)
©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
Appoint excellent physicians
Set, communicate, and achieve buy-in to expectations
Measure performanceagainst expectations
Provideperiodicfeedback
Manage poor performanceTake corrective action
The Physician Performance PyramidKeys to achieving great physician performance
© 2014 The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
Manage poor performance
Take corrective action
Provide periodic feedback
Set, communicate, and achieve buy-in to expectations
Appoint excellent physicians
Measure performance against expectations
The Physician Performance Pyramid
© 2014 The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
Manage poor performance
Take corrective action
Provide periodic feedback
Set, communicate, and achieve buy in to expectations
Appoint excellent physicians
Contract to reinforce expectations
The Physician Performance Pyramid
Measure performance against expectations
© 2014 The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
How does physician employment by hospitals impact the medical staff?
Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
Key medical staff issues for practitioner employment• To whom is the practitioner accountable for their
performance?
• Who manages practitioner performance (implements the layers of the Pyramid)?
• Will peer review information be shared with HR and HR information be shared with peer review?
• Will there be a relationship between membership/privileges and employment or not?
• Will employed physicians be eligible for medical staff leadership positions?
©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
How do service lines impact the medical staff?
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©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
What do we mean by a service line?
• Coordinating and optimizing care across the cointinuum for a defined group of patients
• Typical service lines– Cardiovascular– Ortho– Neuro– Oncology– Women and Children
• May or may not involve service line co-management
©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
Key medical staff issues for service lines
• To whom is the practitioner accountable for their performance?
• Who manages practitioner performance (implements the layers of the Pyramid)?
• Who conducts peer review?
• Will peer review information be shared between the service line and the organized medical staff?
• Will peer review in the service line be protected from discoverability?
• Will service line leaders have a role in medical staff leadership?
©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
How does an ACO/CIN impact the medical staff?
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©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
Key medical staff issues for ACO/CINs• Who’s in and who’s out?
• Will the medical staff services department play a role in credentialing for the ACO/CIN?
• To whom is the practitioner accountable for their performance?
• Who manages practitioner performance (implements the layers of the Pyramid)?
• Who conducts peer review?
• Will peer review information be shared between the ACO/CIN and the organized medical staff?
• Will peer review in the ACO/CIN be protected from discoverability?
• Will ACO/CIN leaders have a role in medical staff leadership?
©2012, The Greeley Company, a division of HCPro, Inc. Confidential. All rights reserved. Copyright 2014, The Greeley Company, Inc. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company, Inc.
Questions?