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HFMA Physician Alignment - Buy in March 2013

A customized, comprehensive approach that delivers strategic solutions to communities, physicians, hospitals & health systems. Each component builds the foundation for the next to create true physician alignment & integration.

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HFMA Physician Alignment - Buy in March 2013

  1. 1. A HORSE OF A DIFFERENT COLOR… PHYSICIAN BUY-IN Cheryl L. Coors, President Coors Healthcare Solutions Paul Hiltz, CEO Mercy Hospital Springfield Coors Healthcare Solutions © 2013
  2. 2. Create Physician Buy-In Through The Alignment Process Coors Healthcare Solutions © 2013
  3. 3. 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 Coors Healthcare Solutions © 2013
  4. 4. Good Morning! • Let’s switch seats… Coors Healthcare Solutions © 2013
  5. 5. MISSION, VISION & VALUES – MAKING IT PRACTICAL The Road Map to Creating Physician Buy-In Coors Healthcare Solutions © 2013
  6. 6. 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 fun on the journey) Coors Healthcare Solutions © 2013
  7. 7. Communication Creative -- Slow Start / Fast Finish Vacillating -- Temperamental Competitive Confrontational Direct Results-Oriented Sense of Urgency Change Agent Good Supporter -- Team Player -- Persistent & Cooperative -- Sensitive to Other’s Feelings High Trust Level Not Fearful of Change Contractibility Rather Talk than Listen Verbal Skills Projects Self-Confidence Process-Oriented Quick to Change Independent Optimistic Accommodating Dislikes Confrontation Persistent Controls Emotion Adaptable Good Listener Product-Oriented Slow to Change Self-Disciplined Pessimistic Precise Accurate Concern for Quality Critical Listener Non-Verbal Communicator Attention to Detail
  8. 8. Organizational Strategy Needs Assessment / Gap Analysis Physician Strategy Physician Alignment Contracts, Compensation & Implementation Physician Recruitment & Retention Physician Integration Strategic Physician Solutions™ Coors Healthcare Solutions © 2013
  9. 9. Organizational Strategy Strategic Physician Solutions™ Coors Healthcare Solutions © 2013
  10. 10. Organizational Strategy Needs Assessment / Gap Analysis Strategic Physician Solutions™ Coors Healthcare Solutions © 2013
  11. 11. Organizational Strategy Needs Assessment / Gap Analysis Physician Strategy Strategic Physician Solutions™ Coors Healthcare Solutions © 2013
  12. 12. Organizational Strategy Needs Assessment / Gap Analysis Physician Strategy Physician Alignment Strategic Physician Solutions™ Coors Healthcare Solutions © 2013
  13. 13. PHYSICIAN ALIGNMENT = BUY-IN Ensuring the current medical staff is strategically aligned with the organizational strategy for optimum growth and success. Coors Healthcare Solutions © 2013
  14. 14. 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 Coors Healthcare Solutions © 2013
  15. 15. Healthcare Integration Trend Source: MGMA Connexion “Medical Practice Today” July 2011 Coors Healthcare Solutions © 2013
  16. 16. • Alignment of Model Options • Health System Motivations • Referral Sources • Financial Security • Governance, Term and Exit Strategy • Health Care Reform Top Considerations For Doctors Coors Healthcare Solutions © 2013
  17. 17. Organizational Strategy Needs Assessment / Gap Analysis Physician Strategy Physician Alignment: Physician Advisory Council Strategic Physician Solutions™ Coors Healthcare Solutions © 2013
  18. 18. Physician Engagement = Buy In Coors Healthcare Solutions © 2013 • Getting Physicians’ Participation • Getting Physicians’ Attention • Getting Physicians’ Committed
  19. 19. 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 Coors Healthcare Solutions © 2013
  20. 20. PHYSICIAN ADVISORY COUNCIL (P.A.C.)™ Coors Healthcare Solutions © 2013 Creating a partnership between hospital administration and medical staff.
  21. 21. Physician Engagement – Built Not Bought Coors Healthcare Solutions © 2013
  22. 22. PAC™ Philosophy • Physicians are a hospital's number #1 customer! • This philosophy is the foundation to create a Physician-centric customer service model Coors Healthcare Solutions © 2013
  23. 23. 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 Coors Healthcare Solutions © 2013
  24. 24. 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% Coors Healthcare Solutions © 2013
  25. 25. 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 Coors Healthcare Solutions © 2013
  26. 26. Organizational Strategy Needs Assessment / Gap Analysis Physician Strategy Physician Alignment: Structure Options Strategic Physician Solutions™ Coors Healthcare Solutions © 2013
  27. 27. 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 © 2012Coors Healthcare Solutions © 2013
  28. 28. 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 Coors Healthcare Solutions © 2013
  29. 29. 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 Coors Healthcare Solutions © 2013
  30. 30. 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. Coors Healthcare Solutions © 2013
  31. 31. Flexible Work Environment The 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 • 5 sessions per week • 2,700 work RVU/year • $90,000 base salary • $24 per wRVU in excess of 2,700 0.7 FTE • 6 sessions per week • 3,150 work RVU/year • $105,000 base salary • $27 per wRVU in excess of 3,150 0.8FTE • 7 sessions per week • 3,600 work RVU/year • $120,000 base salary • $27 per wRVU in excess of 3,600 0.9 FTE • 8 sessions per week • 4,050 work RVU/year • $135,000 base salary • $30 per wRVU in excess of 4,050 1.0 FTE • 9 sessions per week • 4,500 work RVU/year • $150,000 base salary • $30 per wRVU in excess of 4,500 Coors Healthcare Solutions © 2013
  32. 32. • 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 Coors Healthcare Solutions © 2013
  33. 33. Organizational Strategy Needs Assessment / Gap Analysis Physician Strategy Physician Alignment Contracts, Compensation & Implementation Strategic Physician Solutions™ Coors Healthcare Solutions © 2013
  34. 34. CONTRACTS, COMPENSATION & IMPLEMENTATION (STAGE 5) Developing a collaborative working environment by establishing a cohesive compensation program and setting performance expectations. Coors Healthcare Solutions © 2013
  35. 35. 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 agreement Coors Healthcare Solutions © 2013
  36. 36. 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 Coors Healthcare Solutions © 2013
  37. 37. 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? Coors Healthcare Solutions © 2013 Keep in mind: Physicians are scientists – they think in numbers and data
  38. 38. Dashboard & Metrics Reports • Simplicity of reports helps to create buy-in • Example: Stop Light Reports  Coors Healthcare Solutions © 2013 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 Department Budget to Actual Budget to Actual Budget to Actual WRVU'S REVENUE EXPENSE Salary & Benefits Non-Personnel OPERATING MARGIN TOTAL MARGIN RESERVES ACCOUNTS RECEIVABLE
  39. 39. 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
  40. 40. Organizational Strategy Needs Assessment / Gap Analysis Physician Strategy Physician Alignment Contracts, Compensation & Implementation Physician Recruitment Strategic Physician Solutions™ Coors Healthcare Solutions © 2013
  41. 41. PHYSICIAN RECRUITMENT Building an effective in-house training program, establishing best practices for consistent, effective and long-term physician recruitment and retention. Coors Healthcare Solutions © 2013
  42. 42. Get Your House In Order: Build Your Foundation Coors Healthcare Solutions © 2013 Organizational Strategy Community Need Analysis Proof: Support for Road Map Needs Assess / GAP Prioritize 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 Compensatio n Equality Contracts & Compen- sation Physician Recruitment & Retention Training
  43. 43. Challenges Organizations Face • Physician satisfaction scores • Physician retention • Profitability of physician practices • Physician recruitment • High use/costs of Locums Coors Healthcare Solutions © 2013
  44. 44. Organizational Strategy Needs Assessment / Gap Analysis Physician Strategy Physician Alignment Contracts, Compensation & Implementation Physician Retention Strategies Strategic Physician Solutions™ Coors Healthcare Solutions © 2013
  45. 45. PHYSICIAN RETENTION Designing comprehensive and creative programs focused on Physician-centric customer service to attract and retain top talent. Coors Healthcare Solutions © 2013
  46. 46. Physician Retention Six most common reasons why physicians leave (MGMA Study): 1. Lack of professional interaction, support, call coverage, collegiality and camaraderie 2. Spousal and/or family dissatisfaction 3. Economic dissatisfaction 4. Management that does not seek or use input 5. Facility, equipment, support and personnel quality issues 6. Fear of loss of professional skills because of non-challenging workload or lack of support for continuing medical education Coors Healthcare Solutions © 2013
  47. 47. 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 Coors Healthcare Solutions © 2013
  48. 48. 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 Coors Healthcare Solutions © 2013
  49. 49. Effective Retention Initiatives What 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 Coors Healthcare Solutions © 2013
  50. 50. 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. Coors Healthcare Solutions © 2013
  51. 51. • 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 Coors Healthcare Solutions © 2013
  52. 52. Physician Satisfaction Survey Example 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? Coors Healthcare Solutions © 2013
  53. 53. Organizational Strategy Needs Assessment / Gap Analysis Physician Strategy Physician Alignment Contracts, Compensation & Implementation Physician Recruitment & Retention Physician Integration Strategic Physician Solutions™ Coors Healthcare Solutions © 2013
  54. 54. PHYSICIAN INTEGRATION Completing each step of the Strategic Physician Solutions™ process creates the platform for full integration. Coors Healthcare Solutions © 2013
  55. 55. 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 Coors Healthcare Solutions © 2013
  56. 56. Actions To Help Foster Physician Buy-in A Case Study: Paul Hiltz, CEO Community Mercy Health Partners Springfield, Ohio Coors Healthcare Solutions © 2013
  57. 57. Physicians' Perceptions of Quality of Care Mercy Hospital Mount Airy Coors Healthcare Solutions © 2013
  58. 58. Physicians' Perceptions of Patient Safety Mercy Hospital Mount Airy An ''Excellent'' Percentile Ranking is not available for 2004. Coors Healthcare Solutions © 2013
  59. 59. Physicians' Perceptions of Administration Mercy Hospital Mount Airy Coors Healthcare Solutions © 2013
  60. 60. Physicians' Perceptions of Mission and Values Mercy Hospital Mount Airy Coors Healthcare Solutions © 2013
  61. 61. Physicians' Perceptions of Mercy Hospital Mount Airy as a Place to Practice Medicine Mercy Hospital Mount Airy Coors Healthcare Solutions © 2013
  62. 62. 2006 Mercy Hospital Mount Airy (''Excellent'' Percentile Rankings) Mercy Hospital Mount Airy 90th Percentile Coors Healthcare Solutions © 2013
  63. 63. 2010 Mercy Hospital Mount Airy (''Excellent'' Percentile Rankings) 2010 % Excellent 90th 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% Mercy Hospital Mount Airy 90th Percentile Coors Healthcare Solutions © 2013
  64. 64. Cheryl Coors, MHA – President Cheryl 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. Coors Healthcare Solutions © 2013
  65. 65. 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. Coors Healthcare Solutions © 2013
  66. 66. Coors Healthcare Solutions © 2013