National Health Policy Forum (3/25/11)


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National Health Policy Forum (3/25/11)

  1. 1. Physician Employment Greenville Hospital System University Medical CenterNational Health Policy Forum Michael C. RiordanWashington, DC President and CEOMarch 25, 2011 Greenville Hospital System
  2. 2. Agenda1.  GHS Overview •  Greenville Hospital System and University Medical Group2.  Physician Employment •  Conceptual Continuum •  Motivation3.  Quality and Operational Efficiency •  What’s the impact?4.  Summary 2  
  3. 3. 1. System Overview
  4. 4. Our VisionTransform health care for the benefit of the people and communities we serve. Our MissionHeal compassionately. Teach innovatively. Improve constantly.
  5. 5. Bird’s Eye View •  5 Campuses •  1,268 beds •  11 Specialty Hospitals Baptist Easley Hospital •  746 bed Tertiary Care Center •  More than 120 Practice Sites (and growing) 5
  6. 6. GHS: A CriticalCommunity Resource Academics •  174 medical residents and Data Snapshot fellows in 7 residency and 5 FY ‘10 FY ‘11 fellowship programs Actual Budget •  Half of USC medical studentsRevenue* $1,346.1 $1,397.0 receive 3rd and 4th year trainingExpenses* $1,313.6 $1,376.0 at GHSDischarges 42,570 42,259 •  More than 1,350 nursingPatient 285,871 286,487 students receive part of theirDays training at GHS each year (over 2.100 nursing studentOutpatient 2,107,575 2,367,661 encounters yearly)Visits*Millions •  Training for multiple allied health professions 6
  7. 7. Quick Tour
  8. 8. Greenville Memorial MedicalCampus
  9. 9. Greenville Memorial MedicalCampus • Greenville Memorial Hospital • GHS Children’s Hospital • Roger C. Peace Rehabilitation Hospital • Marshall I. Pickens Hospital • Cancer Center • Medical Offices • Institute for Advancement of Health Care
  10. 10. Patewood Medical Campus -Outpatient Centers -Patewood Medical Offices -Patewood Memorial Hospital GHS / Clemson UniversityTranslational Research Hub
  11. 11. Greer Medical CampusHospital, Medical Office Buildings, andlong term care located on this site.
  12. 12. Cottages at Brushy CreekOne of just two such innovative skilled nursing facilities in the USoffering residents a unique, home like experience. National award for providing environments conducive to quality living.
  13. 13. Simpsonville Medical Campus •  Hillcrest Memorial Hospital •  Hillcrest Medical Offices
  14. 14. North Greenville Campus• North Greenville Hospital - Long Term Acute Care• North Greenville Medical Offices
  15. 15. Baptist Easley Hospital 50/50 Ownership
  16. 16. Continuing the Tour:University Medical Group 16  
  17. 17. Employed PhysiciansUniversity Medical Group Primary Care Physicians Specialty Physicians Specialty # MDs Specialty # MDs Family Practice 45 Behavioral Medicine 13 General Internal Medicine* 40 Cardiology 30 MD360 6 Hospitalists 37 OB/GYN 25 Neurology 5 Pediatrics 43 Neurosurgery 6 TOTAL 159 OB/GYN 26 Ophthalmology 1 * Includes 3 Medicine/Pediatrics Ortho/Sports Medicine 28 physicians Other Medicine Specialties 37 543 Otolaryngology Pediatrics 6 78 Total MDs Physiatry 8 Pulmonary 16 Radiology 39 Surgery 54Source: UMG Master Physician File, dated 3.1.11 17NOTE: These numbers do not include 111 non-MD providers TOTAL 384
  18. 18. University Medical GroupWhere Are We Now? 1994 1995 1998 2006 2007 2008 2009 2010# of Providers 69 104 145 320 396 454 559 647Gross Revenue $90M $200M $232M $278M $358M $503MGross Collection Rate 36% 43% 46% 49% 49% 48%Net Collection Rate 63% 86% 86% 88% 89% 89%Days in AR 168 53 47 43 37 35% of GHS Admissions 35% 68% 82% 80% 83% 84%Note:In addition to the above, GHS has mutually exclusive relationships with 134physicians providing hospital based services: anesthesiology, emergencymedicine, neonatology, and pathology. 18  
  19. 19. University Medical Group •  GHSUMC has an open medical staff – 1,300 providers •  Around 1990 began employing physicians –  Medical Education –  Specialty programs (Trauma, specialty pediatrics, etc.) –  Referral network (Partners in Health) •  Organized in 7 departments – Medicine, Surgery, Childrens, Womens, Orthopaedics, and Community Medicine, Radiology 19  
  20. 20. Physician Employment 20  
  21. 21. Physician Alignment ModelsFully Integrated Practice/EmploymentInstitute Member (Partial Employment) Our TheoryContract Affiliation PhysicianJoint Venture Arrangement engagementMutual Project Development increases as relationships /Supportive participation in medicalstaff procedures and governance connectionsNeutral medical staff participation becomeCompetitive position stronger. 21  
  22. 22. Conceptual Continuum “Soft” “Hard” Affiliated Employed Aligned Integrated Engaged Partner Physician Leaders 22  
  23. 23. Conceptual Continuum “Soft” “Hard” Affiliated Employed Partner Integrated GHS Model Engaged Aligned Physician Leaders 23  
  24. 24. What is motivating physicianpractice acquisition at GHS and why are physicians interested? 24  
  25. 25. There exists the opportunity for physiciangroups to become part of something bigger than they can be alone.GHS Strategic Direction Physician Integration 25  
  26. 26. Alignmentis Not EnoughThe physicians and the hospital must recognize and share interdependent well-being. Desired state is to get physicians to see the hospital as nothing more and nothing less than another part of their practice. -- Spence Taylor, MD Chair, GHS Department of Surgery 26  
  27. 27. Alignmentis Not Enough The physicians and the hospital must recognize and share interdependent well-being. Desired state is to get physicians to see the hospital as nothing more and nothing less than another part of their practice. -- Spence Taylor, MD Chair, GHS Department of SurgeryBenefits•  Creates a structure that facilitates collaboration and mutual commitment toward desired behaviors and outcomes: –  Financial – cost savings as well as revenue –  Higher Quality –  Improved Patient Care and Satisfaction 27  
  28. 28. It’s About Much More thanEconomics... Integrated Delivery Model – Philosophy Establishing a Culture of Shared Responsibility with Engaged Physician Leadership 28  
  29. 29. Why Do We EmployPhysicians?•  COMMUNITY: Fulfill our responsibilities as a Safety Net Hospital – improve access to and quality of care available in our community.•  TEACHING: To be the core faculty for LCME and ACGME accreditation processes•  INTEGRATION: To be known within and without the organization as the GHS physicians responsible for development of their specialty area AND to lead our QUALITY, PATIENT SAFETY, AND UTILIZATION INITIATIVES•  CONTRACTING: To offer a full slate of specialty physicians for third party contracting and grant applications•  FUTURE HEALTH CARE CHANGES: To present a full service integrated delivery system for CMS and insurers/payors involving regionalized health care delivery and risk-sharing by providers. 29  
  30. 30. Why are PhysiciansInterested in Employment?•  Environment that better allows them to do the things that led them into medicine initially•  Administrative Support = more time for patient care•  Improved / Expanded Benefits –  Lower cost of malpractice coverage –  Additional tax deferred retirement savings•  Affordable access to sophisticated EMR, billing systems and other large scale information systems•  Improved managed care contracting•  Costs savings through vendor contracting•  Access to funding for capital purchases•  Opportunity to be part of something bigger (e.g., teaching, quality, highly integrated delivery system, etc.) 30  
  31. 31. Impact on Quality andOperational Efficiency Moving from physician employment to physician engagement 31  
  32. 32. Physician Engagement•  Board of Trustees (Physician leaders are voting members of Board Committees)•  GHS President’s Council (Executive Team includes key physician leaders)•  Operations Council (COO, VP Medical Services, CFO, Clinical Chairs, Campus Presidents)•  Physician Operations Council (Physician Executives, Clinical Chairs)• • •  Unit Leaders – Physician/Nurse Leader Partnership Partnership/collaboration at all levels directed toward clinical and operational improvements. 32  
  33. 33. University HealthSystem ConsortiumGHS: A Top PerformerIn Readmissions RES ULTS ©2011  University  HealthSystem   33   Consor>um  
  34. 34. University HealthSystem ConsortiumGHS: Core Measures ResultsAre Outstanding RES U LTS AMI   HF       Pneumonia   Composite   Composite   Composite   2009   99.5%   98.0%   96.2%   2010   97.0%   96.3%   95.8%   UHC  Median  (2010)   95.8%   89.5%   83.1%   NaConal  Target   90%   90%   90%   Greenville  Rank  (2010)   31/106   13/109   11/110   ©2011  University  HealthSystem   34   Consor>um  
  35. 35. Physician EngagementExamples of Physician Leader Engagement•  Supply Standardization•  Length-of-Stay – Discharge Planning Process•  Improving Operational Efficiency – Targeted DRGs•  Utilization of Inpatient Radiology Services•  Orthopaedics – Inpatient Process Improvements•  Blood Conservation Initiative•  Pharmaceutical Formulary Development FY 2010 Result: $14 million in cost savings achieved. 35  
  36. 36. University HealthSystem Consortium:GHS Now Top 10 In Efficiency RES ULT S •  Adjusted cost/discharge declined in all major categories, 2009 to 2010 •  Clinical portfolio intensification a significant contributor •  Total cost/discharge now 17% below UHC 25th percentile •  Supply cost/discharge now 12% below UHC 25th percentile •  Labor cost/discharge now 8% below UHC 25th percentile ©2011  University  HealthSystem   36   Consor>um  
  37. 37. Benefits of PhysicianEngagement•  Transparent and collective focus on clinical quality through development and adoption of evidence-based care protocols•  Collaborative/collegial opportunities to highlight unexplained physician practice variation•  Linking a strong organization bottom line to enhanced physician support for patient care•  Shared focus/unified goals foster relationship building and team approach among physicians, nurses, and administrators•  Fostering physician creativity in streamlining / maximizing quality, safety, and operational efficiency 37  
  38. 38. Summary 38  
  39. 39. Summary•  Future success for community-based academic medical centers will depend upon prioritizing patient care and competing by providing cost efficient, quality total health care.•  Such care likely can only be provided by regionalized integrated systems of health care.•  The key relationship is and will be that between the hospital and its highly engaged/employed physicians.•  GHS is becoming progressively positioned for success in the coming complex and tumultuous health care environment. 39  
  40. 40. Summary Our Core Belief GHS cannot effectively take responsibility for improved quality and reduced costs for thegovernmental and private pay populations unless all parts of the health care continuum are highly integrated. 40  
  41. 41. Summary•  GHS is becoming progressively positioned for success in the coming complex and tumultuous health care environment…. Accountable Care Organization•  Challenges to moving toward highly integrated models include some legal/legislative restrictions including: •  Stark Rules •  Anti-Kickback and Civil Monetary Penalty Laws •  Anti-Trust Regulations •  Tax laws for non-profits dealing with private use and private inurement 41