hfma physician alignment - buy in march 2013

A HORSE OF A DIFFERENT COLOR… PHYSICIAN BUY-IN

Cheryl L. Coors, PresidentCoors Healthcare Solutions

Paul Hiltz, CEOMercy Hospital Springfield

Coors Healthcare Solutions © 2013

Create Physician Buy-In Through The Alignment Process


Learning Objectives• Successfully transition practicing physicians to key leadership

roles using an assessment inventory and coaching process• Assist physicians in transitioning to both an employee and

clinical integrated delivery model; including both monetary and non-monetary incentives

• Use unique non-monetary physician incentives to drive the change process while enhancing the quality of patient care

• Determine what really matters to physicians and promotes buy-in with different delivery models, e.g. Employee physician, medical home

• Use innovative and creative solutions to promote physician buy-in


Good Morning!

• Let’s switch seats…


MISSION, VISION & VALUES – MAKING IT PRACTICAL

The Road Map to Creating Physician Buy-In


Mission(home = who you are)

Strategy(Road map = goals, objectives, metrics, dashboards)

Vision(final destination = success)

The Journey

Vehicle(Resources)

Driver(Leadership)

Values(who gets to go and how

do we get there)

Culture(did we have funon the journey)


CommunicationCreative -- Slow Start / Fast Finish

Vacillating -- TemperamentalCompetitive

ConfrontationalDirect

Results-OrientedSense of Urgency

Change Agent

Good Supporter -- Team Player -- Persistent & Cooperative -- Sensitive to Other’s Feelings

High Trust LevelNot Fearful of Change

ContractibilityRather Talk than Listen

Verbal SkillsProjects Self-Confidence

Process-OrientedQuick to Change

IndependentOptimistic

AccommodatingDislikes Confrontation

PersistentControls Emotion

AdaptableGood Listener

Product-OrientedSlow to ChangeSelf-Disciplined

Pessimistic

PreciseAccurate

Concern for QualityCritical Listener

Non-Verbal CommunicatorAttention to Detail

Organizational Strategy

Needs Assessment / Gap Analysis

Physician Strategy

Physician AlignmentContracts,

Compensation & Implementation

Physician Recruitment &

Retention

Physician Integration

Strategic Physician Solutions™




Physician Strategy





Physician Strategy

Physician Alignment



PHYSICIAN ALIGNMENT = BUY-IN

Ensuring the current medical staff is strategically aligned with the

organizational strategy for optimum growth and success.


Alignment Drivers – National Perspective• Physician Drivers:

– Reimbursement / Bundle Payments

– Health Reform– Administrative Complexity– Recruitment– Concern for Future

Referrals– Financial Security

• Hospital Drivers:– Clinical Integration– Health Reform– Fear of Market Share Loss– Competition – Hospital Based

Reimbursement– Committed Medical Staff


Healthcare Integration Trend

Source: MGMA Connexion “Medical Practice Today” July 2011


• Alignment of Model Options• Health System Motivations• Referral Sources• Financial Security• Governance, Term and Exit Strategy• Health Care Reform

Top Considerations For Doctors




Physician Strategy

Physician Alignment: Physician Advisory

Council



Physician Engagement = Buy In


• Getting Physicians’ Participation

• Getting Physicians’ Attention

• Getting Physicians’ Committed

Physician Leadership Attributes• Is a global thinker• Builds partnerships and a

network of relationships• Creates a shared vision• Ensures customer

satisfaction• Is technologically savvy• Develops and empowers

people

• Encourages constructive dialogue - asks for input and genuinely listens to others

• Has achieved personal mastery

• Demonstrates integrity with honest and ethical behavior

• Leads change - Sees change as an opportunity, not a problem


PHYSICIAN ADVISORY COUNCIL (P.A.C.)™


Creating a partnership between hospital administration and medical staff.

Physician Engagement – Built Not Bought


PAC™ Philosophy

• Physicians are a hospital's number #1 customer!

• This philosophy is the foundation to create a Physician-centric customer service model


PAC™ Design• TRANSPARENT COMMUNICATION – Open atmosphere• SEAT AT THE TABLE – Physician and decision makers• DIRECT INPUT TO CEO - Input for decisions effecting

physicians and patient care• OPEN FORUM – Early discussion with Physicians –

avoiding crisis• ALIGNMENT with Strategic Needs – Physician alignment

with Organization’s strategic needs



PAC™ Wins! Northwest Medical Center

• Developed a strategic Master Plan that ensured "vested constituencies"

• Developed a 5-year physician recruitment plan (successfully recruited 23 physicians with one year)

• Increased physician satisfaction from 4th quartile to 1st quartile and maintained 1st quartile for 3 years, until company was sold

• Increased admissions by 14% Open Heart Surgeries 72% O/P Surgeries 30% Cardiac Cath 58%

PAC™ Wins! Gateway Regional Medical Center

• Developed a 5 year Master plan that charted the hospitals course for becoming Surgical and cardiac based hospital verses Psychiatric

• Grew cardiac business 60% in 2012 opening hospital's 1st cardiac cath lab in 2011

• Established robotic surgery program (daVinci) - First year 140+ robotic surgeries

• Increased Physician satisfaction from 34% very satisfied in 2011 to 54% very satisfied in 2012

• Geriatric Hospitalist program decreased readmissions by 20% in 4 months

• Successfully recruited 22 physicians as part of the succession plan without cannibalizing existing medical staff




Physician Strategy

Physician Alignment: Structure Options



Physician Alignment• Alignment of current medical staff with organizational

strategy• Development of Physician Advisory Council (PAC)™• Options for Physician/Hospital Alignment:Employment Business Services Contracts

Physician Compensation/ Productivity Models

Single-Specialty Group Multi-Specialty Group Physician Network

Development

Management Services Organization (MSO)

Practice Leasing Lease / Real Estate

Contracts I.T. Infrastructure Payor Contracting

Organizations Clinical Integration /

Physician Networks

Physician Recruitment Call pay arrangements Medical Directorships Clinical co-management

arrangements Professional Services

Agreements Joint Ventures Practice Leasing

Coors Healthcare Solutions © 2012 Coors Healthcare Solutions © 2013

Horse of a Different Color• Physician employment requires education!• Physicians are not accustomed to being employees• Employment options facilitate alignment but require buy-

in from physicians– Communication with complete transparency– Addressing “What’s in it for me?” – Education– Creativity – Trust



Physician Employee Handbook

• Mission, Vision, Values • Governance structure• Written code of conduct• Workplace policies• Operating policies for

medical practice• Compensation/ Bonus

Distribution formula

• Benefits Program• Billing Practice• Hiring • CME Requirements• Intellectual property• Outside income / activities

Flexible Work Environment = Flexibility

• An increasing number of physicians are working part time• Current data suggests that nearly 20% of physicians work part time (31

percent of women, 8 percent of men)• By promoting and enhancing part-time medical careers, organizations

may be able to attract and retain satisfied, healthy, capable, and connected physicians.

• Without a strategy in place, employers may find physicians either leaving for a more flexible employment model, or “informally” cutting back either their hours or productivity while maintaining the same salary.

• Physicians should choose how MUCH they work and how HARD they work within standards set by the employing organization.


Flexible Work EnvironmentThe table below provides an example of employment options for a general internal medicine physician with productivity expectations and incentives.

0.5 FTE

• 4 sessions per week• 2,250 work RVU/year

• $75,000 base salary• $24 per wRVU in excess of 2,250

0.6 FTE



0.7 FTE



0.8FTE



0.9 FTE



1.0 FTE




• Relying only on financial statements• Producing documents that are too confusing/detailed• Not understanding what really drives the business• Not trending data – presenting only a historical

perspective• Failing to re-design data reporting to reflect the Vision and

Strategic Plan• Focusing solely on finances and not on operations• Not using both internal and external benchmarks

Common Errors to Avoid




Physician Strategy





CONTRACTS, COMPENSATION & IMPLEMENTATION

(STAGE 5)

Developing a collaborative working environment by establishing a cohesive

compensation program and setting performance expectations.


Physician Contracts / Employment Agreements

• Assess the relative productivity of each physician in order to perform compensation and productivity analyses

• Performance measured against established industry benchmarks:

– Charges – Collections– Patient Encounters– Performance/ Quality Initiatives – Work Relative Value Units

• Fair market value compensation for each proposed agreementCoors Healthcare Solutions © 2013

Common Errors to Avoid• Lengthy and complex contracts• Not building in an out-clause for multiple years• Locking in compensation without risk for lengthy periods• Customizing the body of the contract• Either being too restrictive, or not restrictive enough with non-

competes• Forgetting to include non-solicitation clauses• Forgetting to address outside income• Not having a Code of Conduct and enforcing it


Examples of Metrics• Physician productivity metrics

– How busy are we really?

• Ambulatory care metrics– How efficiently do we

operate?

• Staffing metrics– Are we staffed appropriately?

• Billing office metrics– How well do we collect the

money?

• Finance metrics– How costly are we?

• Quality metrics– Do we deliver great care? Are

our patients, physicians and employees satisfied?


Keep in mind: Physicians are scientists – they think in numbers and data

Dashboard & Metrics Reports

• Simplicity of reports helps to create buy-in

• Example: Stop Light Reports


KEY: Red Red - Not meeting target

Variance 1.5% over/under

Yellow Yellow - Target in jeopardy

Variance 0.1% to 1.5%

Green Green - Target being met

or exceeded

Department Department DepartmentBudget to

ActualBudget to

ActualBudget to

Actual

WRVU'S

REVENUE

EXPENSE

Salary & Benefits

Non-Personnel

OPERATING MARGIN

TOTAL MARGIN

RESERVES

ACCOUNTS RECEIVABLE

Performance, Not Just Productivity

• Annual Performance Incentives reward and promote both an improved patient care experience and specific organizational goals.

• Performance Incentive targets encourage physicians to:– View the bigger picture by sharing in the organization’s overall strategic

mission.– Focus on quality, compliance, and patient satisfaction measures.– Increase awareness of the cost of delivering care.– Participate in the budgeting process.– Respect a positive group culture.– Value governance and citizenship contributions.– Promote teamwork.

• Annual physician performance reviews are critical Coors Healthcare Solutions © 2013



Physician Strategy



Physician Recruitment



PHYSICIAN RECRUITMENT

Building an effective in-house training program, establishing best practices for

consistent, effective and long-term physician recruitment and retention.


Get Your House In Order: Build Your Foundation



Community Need Analysis

Proof: Support for Road Map

Needs Assess /

GAPPrioritize

goals

Practice Viability &

Due Diligence

Develop Road Map

Physician Strategy

Re-engage Med Staff

Transparency = Trust

PAC™

Alignment Structure Options

Physician Alignment

Standardized Contracts

Performance Incentives

Create Compensation

Equality

Contracts &

Compen-sation

Physician

Recruitment & Retention

Training

Challenges Organizations Face

• Physician satisfaction scores• Physician retention• Profitability of physician practices• Physician recruitment • High use/costs of Locums




Physician Strategy



Physician Retention Strategies



PHYSICIAN RETENTION

Designing comprehensive and creative programs focused on Physician-centric

customer service to attract and retain top talent.


Physician RetentionSix most common reasons why physicians leave (MGMA Study):

1. Lack of professional interaction, support, call coverage, collegiality and camaraderie

2. Spousal and/or family dissatisfaction3. Economic dissatisfaction4. Management that does not seek or use input5. Facility, equipment, support and personnel quality issues6. Fear of loss of professional skills because of non-challenging

workload or lack of support for continuing medical education


Physician Retention

• Press Ganey estimates that the replacement costs of one physician equals $250,000 – not accounting lost revenue and practice set up.

• All studies show that physicians are more likely to leave because of factors related to the job itself than because of compensation

• Many studies recommended a formal mentoring program


Common Errors to Avoid• Failing to recognize that it’s rarely just about the money• Not realizing that first impressions count• Not understanding the young physician out of training and assuming “one

size fits all”• Failing to ask for physician input to organizational priorities• Not looking at satisfaction and morale• Discounting life-style issues• Forgetting that small investments in existing physicians are usually a far

better investment that costly new recruitments• Failing to address bad behavior• Not letting people take time off to get away



Effective Retention InitiativesWhat physicians say would increase their job satisfaction:• Desire for greater involvement in decision-making • Greater control over work hours - increased flexibility • Compensation plans that better recognize individual

contributions to improved patient care, productivity and profitability

• Long-term financial security – incentives to stay


Create Physician Benefit Program

– Disability – opportunity to buy into supplemental group policies

– Whole life insurance policy with vesting schedule 5 or 10 years

– SERP Program (funded through whole life policy)– Opportunities to provide additional cash revenue service

options that support quality outcomes and increase practice revenue.

• Historically hospital administration has been more "reactive" verses "proactive" in listening to and addressing physicians concerns, complaints and attitudes

• Physicians are a hospital's number #1 customer! • PAC™ uses this philosophy as the foundation in which to

build a strong, vibrant and successful physician strategy and committed partnership

• Integral component of overall Physician Strategy, Alignment, buy-in and retention initiatives

The PAC™ - A Retention Tool


Physician Satisfaction SurveyExample of questions to ask:

• What influenced their decision to work at your organization?• What keeps them working here?• What is their level of job satisfaction?• What has happened to their satisfaction over the last 3 years?• What would improve their job satisfaction?• Are they considering leaving in the next 2-3 years?• To select factors that were would influence their decision• Which type of organization they would join if they left?• How would they rate their satisfaction with support staff? • Who do they respect as leaders?• What should leadership focus on?




Physician Strategy



Physician Recruitment &

Retention

Physician Integration



PHYSICIAN INTEGRATION

Completing each step of the Strategic Physician Solutions™ process creates the

platform for full integration.


Physician Integration• Manage employed physicians

– Operations improvement– Coding compliance program– Revenue cycle management– Practice compliance & integrity programs– Develop Primary Care feeder programs

• Involve physicians in measuring quality goals• Clinical Integration, Co-Management, IT infrastructure


Actions To Help Foster Physician Buy-in

A Case Study:Paul Hiltz, CEO

Community Mercy Health PartnersSpringfield, Ohio



Physicians' Perceptions of Quality of Care

Mercy Hospital Mount Airy


Physicians' Perceptions of Patient Safety


An ''Excellent'' Percentile Ranking is not available for 2004.


Physicians' Perceptions of Administration



Physicians' Perceptions of Mission and Values



Physicians' Perceptions of Mercy Hospital Mount Airy as a Place to Practice Medicine



2006 Mercy Hospital Mount Airy(''Excellent'' Percentile Rankings)


90thPercentile


2010 Mercy Hospital Mount Airy(''Excellent'' Percentile Rankings) 2010

% Excellent90th Percentile

% Excellent

59.7% 45.5%

53.9% 44.1%

42.1% 37.1%

52.0% 49.5%

59.4% 57.6%

55.6% 55.1%

50.0% 52.0%

42.9% 48.4%

48.7% 57.4%

50.6% 58.0%

38.9% 46.1%

33.8% 42.5%

35.7% 49.4%

28.9% 43.0%


90thPercentile

Cheryl Coors, MHA – PresidentCheryl Coors has over 25 years experience in healthcare, including 15 years in healthcare recruiting. She began her career in healthcare in nursing and progressively transitioned through several different avenues within the industry. Her background has given Cheryl a unique perspective in understanding the challenges facing the healthcare industry. Cheryl’s diversified background in nursing, practice management, Biotech sales management, and executive search lend to her expertise. Today, she has established herself as one of the top search consultants in the recruiting industry.

In 1999, Cheryl founded Coors Healthcare Solutions to bring the highest standard of professionalism, integrity, and personalized service to the healthcare search industry. With a Master’s Degree in Healthcare Administration and significant experience in the field, she chose to specialize in healthcare industry recruiting and consulting services. Cheryl has dedicated Coors Healthcare Solutions to identifying and placing highly skilled, committed and passionate senior level executives in healthcare organizations nationwide.


Paul Hiltz, CEO, Community Mercy Health Partners

Paul Hiltz, MHA, FACHE, is currently the CEO of Community Mercy Health Partners, a 2 facility system in Springfield, OH. Paul has been with Mercy Health since 1985, when he joined Mercy Health - Clermont Hospital as an assistant administrator. In his more than 20 years with Mercy Health, Paul has been responsible for hospital clinical and administrative operations and physician services.

Paul holds a Master’s degree in Health Administration from Xavier University, is a Fellow in the American College of Healthcare Executives, and has worked for Mercy in Cincinnati for more than 25 years. Over the years, Paul has held many senior roles, including heading the employed physician organization and serving as President and CEO of Mercy Mt. Airy Hospital for many years. Most recently Hiltz has been responsible for starting and leading Mercy Health’s Accountable Care Organization (ACO), which is one of only 154 Medicare-approved ACOs in the United States and has developed it to include 22,000 Medicare patients. He will continue to serve in this role with the help of his current team.


hfma physician alignment - buy in march 2013

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