Strategic Physician Solutions - Physician Advisory Council

STRATEGIC PHYSICIAN
SOLUTIONS™
Coors Healthcare Solutions
Coors Healthcare Solutions © 2013 1

Challenges
• [Physician satisfaction scores]
• [Physician retention]
• [Profitability of physician practices]
• [Physician recruitment ]
• [High use/costs of Locums]
2Coors Healthcare Solutions © 2013

Program Objectives
• Physician Advisory Council (PAC)™ to develop foundation of
communication between administration and physicians
• Develop alignment options (MSO, Co-management, etc.)
• Physician recruitment and retention training through Coors Right
Hire™

Organizational
Strategy
Needs Assessment /
Gap Analysis
Physician Strategy
Physician Alignment
Contracts,
Compensation &
Implementation
Physician
Recruitment &
Retention
Physician
Integration
Strategic Physician
Solutions™

DATA SUPPORTING THE NEED FOR
INCREASED PHYSICIAN
ALIGNMENT

Alignment Drivers – National Perspective
• Physician Drivers:
– Reimbursement
– Health Reform
– Administrative Complexity
– Recruitment
– Concern for Future Referrals
• Hospital Drivers:
– Clinical Integration
– Health Reform
– Fear of Market Share Loss
– Competition
– Hospital Based
Reimbursement

0 10 20 30 40 50 60 70 80
Orthopaedics
General Surgery
Cardiology
Hospitalists
Primary Care
Hospitals With MD Employment Plans:
Top 5 Areas Over Next 3 Years
7
Healthcare Integration Trend
Source: HealthLeaders “Physician Alignment in an Era of Change” September 2010
Coors Healthcare Solutions © 2013

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Healthcare Integration Trend
Source: MGMA Connexion “Medical Practice Today” July 2011

Top Considerations For Doctors
• Alignment of Model Options
• Health System Motivations
• Referral Sources
• Financial
• Governance, Term and Exit Strategy
• Health Care Reform

WORRY MOST CONCERNING SOMEWHAT CONCERNING LEAST CONCERNING
2011 2008 2011 2008 2011 2008
Availability of Free Time 48% 33% 45% 46% 7% 22%
Dealing with Payors 42% 13% 45% 44% 13% 43%
Earning a Good Income 41% 38% 47% 45% 12% 18%
Malpractice 40% 32% 44% 37% 16% 31%
Health System Reform 39% N/A 47% N/A 14% N/A
Educational Debt 30% 60% 36% 14% 34% 27%
Ability to Find a Practice 24% 41% 34% 38% 42% 21%
Insufficient Practice Management Knowledge 22% 4% 57% 47% 21% 49%
Insufficient Medical Knowledge 7% 30% 25% 24% 68% 46%
Dealing with Patients 2% 4% 15% 35% 83% 42%
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What Worries First-time Doctors
Source: 2011 Survey of Final-Year Medical Residents, Merritt Hawkins & Associates, Oct. 5

MUST-HAVE MOST IMPORTANT SOMEWHAT IMPORTANT LEAST IMPORTANT
2011 2008 2011 2008 2011 2008
Geographic Location 81% 57% 19% 12% 0% 31%
Adequate Call/Coverage/Personal Time 68% 28% 31% 53% 1% 19%
Lifestyle 64% N/A 34% N/A 2% N/A
Good Financial Package 56% 46% 42% 41% 2% 13%
Proximity to Family 52% 30% 35% 37% 13% 33%
Good Medical Facilities/Equipment 44% 23% 51% 43% 5% 34%
Specialty Support 31% 17% 54% 51% 15% 32%
Low Malpractice Area 16% 33% 58% 31% 26% 36%
Education Loan Forgiveness 12% 42% 38% 24% 50% 34%
11
Location Tops List Of Must-haves

COMMUNITY POPULATION 2011 2001
10,000 or less <1% 0%
10,001 – 25,000 4% 8%
25,001 – 50,000 2% 13%
50,001 – 100,000 10% 21%
100,001 – 250,000 15% 15%
250,001 – 500,000 21% 25%
500,001 – 1 million 20% 12%
More than 1 million 28% 6%
12
More Prefer Major Metro Areas

Physician Alignment: Due Diligence / Required
Evidence
• Financial Performance
• Key Financial and Operating Indicators
• Care Statistics
• Quality Indicators
• Compliance
• Coding Compliance program
• Character
• Personal History
• Succession Planning
• Ages/Demographic Group
• Malpractice Record
• Past/Current Malpractice Action
• Tail Coverage
• Physician Office
• Location
• Operational Issues
• Quality and Productivity
• Mission/Patient Service
• Physician Compensation and
Productivity Analysis

PHYSICIAN ALIGNMENT TOOLS
Featuring the PAC™

Physician Alignment Goals
1. Development of Physician Advisory Council (PAC)™
2. Engage Medical Staff
3. Physician/Hospital Alignment Options
Coors Healthcare Solutions © 2012Coors Healthcare Solutions © 2013 15

Physician Engagement
• Getting Physicians’ Participation
• Getting Physicians’ Attention
• Getting Physicians’ Commitment

Physician Engagement – Built Not Bought

Goal 1: Physician Advisory Council (PAC)™
• Implementation of full program
• Creating a partnership between hospital administration and
medical staff
• Increasing communication and promoting transparency to build
trust

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

Benefits of the PAC™
• PAC™ members create a who’s who buzz among the medical
community
• Informal dialogue between P.A.C. members and the medical
community circulates fresh feedback, ideas, issues or concerns
• Monthly meeting notes create tangible evidence of progress on
known issues and circulates positive feedback
• Overall improved physician satisfaction and relationships

PAC™ Structure
Board
P.A.C.™Administration
Medical
Staff
Communication
Coors Healthcare Solutions ©
2013
22

• Successfully aligns current physicians with the strategic needs of the
organization
• Establishes the groundwork for the assimilation of new physicians
coming into the organization
• The PAC™ is not designed to assume or disrupt any functions of the
MEC or other committees of the medical staff such as:
– Peer Review
– Credentialing
– Quality assurance/CQI functions
– Writing changes in bylaws
• PAC™ strategically aligns and strengthens the existing medical
community
PAC™ - An Alignment Tool

PAC™ Wins! Mercy Hospital Mt. Airy
2006 – Physician Perception of “Excellence”
Percentile Rankings
2010 – Physician Perception of “Excellence”
Percentile Rankings

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 Patient satisfaction from 4th quartile to 1st quartile and
maintained that quartile for 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 first cardiac cath lab in 2011
• Established robotic surgery program (daVinci) First year did over 140 robotic surgeries
• Increased Physician satisfaction from 34% very satisfied in 2011 to 54% very satisfied in
2012
• Developed a 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.

Goal 2: Engage Medical Staff
• Engage medical staff to increase physician satisfaction &
communication
• Set attainable goals for physician satisfaction scores based on
national averages / best practices
• Create a positive medical staff environment
• Increase quality patient outcomes

Building Physician Engagement
Five questions to build more powerful physician engagement:
1. What do you want your physicians to do?
Physicians will be more highly engaged when they are actively included on the substantive issues
2. Do they know how to do the work?
Physicians are problem solvers on steroids
3. Do they have the resources to do the work?
CEOs must demonstrate that leadership and strategic work are legitimate and important parts of
physicians’ jobs
4. Are physicians motivated to do the work?
Many capable physicians avoid taking on the leadership work
5. How will CEOs know they have been effective?
Being clear about the positive impact of better physician engagement in the change process is a
critical step in shaping the message to physicians

Goal 3: Alignment Options
Employment Business Services Contracts
 Physician Compensation/
Productivity Models
 Single-Specialty Group
 Multi-Specialty Group
 Physician Network
Development
 Management Services
Organization (MSO)
 Practice Leasing /
Enterprise Model
 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

Blueprint For MSO Development
• Business Development
– Central Business Office (CBO)
– Clinical Services
• Physician Development
– Practice Management
– Practice Operations
– Regulatory and Compliance
• Contract Management
• Data Management
– Facilities Management
– Financial Management
– Human Resources
– It Support
– Marketing

• Benefits of this arrangement:
– Hospital agrees to operate the practice at a fixed percentage of
collections; both parties incentivized to produce results
– No capital expenditures required
– Hospital benefits from stronger alignment with physicians in a less formal
manner than employment
– Physicians preserve the private practice model and autonomy
– Physicians can achieve balance of security and independence
– Should the venture become unsatisfactory or unsuccessful, the
arrangement is much easier to unwind than a practice acquisition
31
The Physician Enterprise Model:
A Non-Employment Alternative

The Physician Enterprise Model:
A Non-Employment Alternative
Illustration:

Clinical Co-Management
• Service line partnerships between hospitals and physicians
• Align hospital / physician incentives to achieve improved patient
outcomes with greater efficiency and lower costs
• Allows hospital flexibility to utilize employed or independent
physician groups
• Typical co-management service lines: Cardiology, Orthopedics,
General Surgical

 Licensing Arrangements
 Coding Compliance Program
 Revenue Cycle Management
 Billing/Collections Services
 Practice Compliance and Integrity Programs
 Physician Practice Start-Up Services
 Comprehensive Physician Practice
Assessment/Business Plan
 Medical Practice Valuation
 Standardized Policy/Procedure Development
 Educational Programs
 Quality Standards/Benchmarking
 Fair Market Value Opinion Letters
 Physician Contract Compliance Program
 Interim Management
 Advisory Management Services
 Management Mentoring Program
Value Added Physician Services

Med Auxilium™
Physician Recruitment & Retention
A BLUEPRINT FOR SUCCESSFUL PHYSICIAN
RECRUITMENT

Get Your House In Order: Build Your Foundation
Organizational Strategy
Community
Need Analysis
Proof:
Support for
Road Map
Needs
Assess /
GAP
Prioritize
goals
Practice
Viability &
Due Diligence
Develop Road
Map
Physician
Strategy
PAC™
Engage
Medical Staff
Transparency
= Trust
Alignment
Structure
Options
Physician
Alignment
Standardized
Contracts
Performance
Incentives
Create
Compensation
Equality
Contracts
&
Compen-
sation
Coors Med Auxilium™
Physician
Recruitment & Retention
Training

Med Auxilium™ Program Goals
Robust turn-key approach brings the physician recruitment process in-house:
• Assessment of existing recruitment practices and department
• Sets Standardized Process
• Develops strong communication skills
• Developing relationships and tools – Cure for the Chaos to create a funnel for
Residents / Fellows
• Development of recruitment strategy – goals, process, performance measures
• Full 12-month training and mentoring of recruitment team and leadership for
effective implementation
• Determine practice setup and on-boarding
• Retention strategies for continued success

Med Auxilium™ Program With Toolbox
• Customized based on organizational strategy, goals, existing
structure and scope

Physician Integration
End Goal of Full System

• 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
Physician Integration

STRATEGIC PROGRAM
IMPLEMENTATION
Targeted Goals

Proposed Action Plan
• Review Needs Assessment
• Implement PAC™
• Interview Medical Staff
• Review Alignment Best Options
• Med Auxilium™ Program Implementation

www.CoorsHealthcareSolutions.com
1.800.507.6917
43

Strategic Physician Solutions - Physician Advisory Council

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