Using employed physicians as a competitive weapon involves developing strategic plans to leverage employed physician groups to increase hospital revenue and market share. Key strategies include managing referrals within the employed group, developing primary care and specialty care networks, improving care processes, pursuing clinical integration and risk-based contracting opportunities, and focusing groups on quality and cost metrics. Success requires investing in physician leadership development, marketing the physician brand, and ensuring cultural and operational alignment between the hospital and employed physicians.
This presentation addresses the need for a proactive approach to physician recruiting, increasing a hospital's market awareness & reducing the amount of revenue lost when physicians refer their patients to another hospital.
Presentation to the North Queensland Return to Work Conference in late April 2016. Summarises ISCRR's research on medical certification for return to work and the role of General Practitioners in return to work.
Healthcare Reform and Physician Compensation— Presentation Examines What’s in...PYA, P.C.
Among the many questions facing physicians in the wake of healthcare reform—how will they get paid? PYA Principal David McMillan recently addressed this question at the PKF Healthcare Fly-In with “Current Reform Initiatives and Their Impact on Physician Compensation.”
an empirical approach for provider organizations transitioning during healthcare reform implementation, integrating clinical and financial historical experiences. The presentation, Challenge & Response -- delineates the discovery process within experiential databasesA
The Near Future of Healthcare Delivery - 2015 Policy Prescriptions® SymposiumCedric Dark
The symposium is designed for clinicians – physicians, nurses, nurse practitioners, physician assistants, and students – and healthcare executives interested in expanding their scope of knowledge about currently popular health policy topics.
Maureen Bisognano: An international perspective: Leading for better health careThe King's Fund
Maureen Bisognano, President and CEO, Institute for Healthcare Improvement, gives an international perspective on leading for better healthcare at The King's Fund Second Annual NHS leadership and Management Summit.
This presentation addresses the need for a proactive approach to physician recruiting, increasing a hospital's market awareness & reducing the amount of revenue lost when physicians refer their patients to another hospital.
Presentation to the North Queensland Return to Work Conference in late April 2016. Summarises ISCRR's research on medical certification for return to work and the role of General Practitioners in return to work.
Healthcare Reform and Physician Compensation— Presentation Examines What’s in...PYA, P.C.
Among the many questions facing physicians in the wake of healthcare reform—how will they get paid? PYA Principal David McMillan recently addressed this question at the PKF Healthcare Fly-In with “Current Reform Initiatives and Their Impact on Physician Compensation.”
an empirical approach for provider organizations transitioning during healthcare reform implementation, integrating clinical and financial historical experiences. The presentation, Challenge & Response -- delineates the discovery process within experiential databasesA
The Near Future of Healthcare Delivery - 2015 Policy Prescriptions® SymposiumCedric Dark
The symposium is designed for clinicians – physicians, nurses, nurse practitioners, physician assistants, and students – and healthcare executives interested in expanding their scope of knowledge about currently popular health policy topics.
Maureen Bisognano: An international perspective: Leading for better health careThe King's Fund
Maureen Bisognano, President and CEO, Institute for Healthcare Improvement, gives an international perspective on leading for better healthcare at The King's Fund Second Annual NHS leadership and Management Summit.
Current Practice Alignment Strategies to Ensure Long Term SurvivalHuron Consulting Group
In this MGMA presentation, John Lutz explores the merits and drawbacks of various physician alignment models and provides insights into competencies needed in the new market.
Benchmarking Advisory Board Management at Mid-Sized Pharmaceutical & Medical ...Best Practices
Biopharmaceutical and medical device companies rely on advisory board for strategic inputs and guidance on various business aspects. However, successful advisory board management requires optimum investment in resources and operations. It is also important that the biopharmaceutical and medical device executives ensure quality of meetings and dialogue with advisory boards is excellent for maximum ROI.
This research from Best Practices, LLC showcase the best practices in advisory board management at mid-sized biopharmaceutical and medical device companies. It also highlights the top challenges, winning strategies and best practices for conducting advisory boards.
Understanding the Dynamics of Successful Health System Strengthening Interven...HFG Project
Evidence is scarce, scattered, and not widely disseminated on how interventions to strengthen health system performance contribute to sustained improvements in health status, particularly toward ending preventable child and maternal deaths and fostering an AIDS-free generation. Without this evidence, decision-makers lack a sound basis for investing scarce health funds in health system strengthening (HSS) interventions in an environment of competing investment options. This evidence gap impedes support for HSS from numerous stakeholders, both within and outside of USAID. This study will help address this evidence gap by exploring the dynamics of successful HSS interventions in low-income countries. The study seeks to address four key questions:
How were a range of successful HSS interventions implemented in different countries?
What factors facilitated and constrained the successful implementation and documented outcomes of the interventions?
What were important factors about implementation that emerged across the different cases?
What are the implications of this study for implementing future HSS interventions?
The study will comprise three main activities:
Six qualitative, retrospective case studies of successful USAID-supported HSS interventions to explore what factors contributed to successful implementation
Qualitative cross-case analysis to identify patterns of policy processes, circumstances, relationships, and characteristics that may be associated with successful HSS reforms
Develop and propose a set of strategic recommendations for introducing and sustaining HSS reforms in low-income countries
The tertiary care hospital utilization of the balanced scorecard Nancy Southerland
The tertiary care hospital has as its primary responsibility to deliver health care to the most sick and severely ill. The management of the critically ill is seen as a wrathful driver of costs within the confines of the tertiary care hospital both in the United States and abroad. Through utilization of the Balanced Scorecard not only are the needed financial metrics elevated but the added dimensions of customer (both internal and external), internal business processes, and learning and growth dimensions are part of the balanced scorecard perspectives. Through use of the balanced scorecard in the tertiary care hospital, the wrath of the cost driver of the therapeutic management and intervention of the critically ill is assuaged. Tertiary care hospitals are able to deliver solid operating margins while ensuring patient satisfaction with good clinical outcome of the critically ill while experiencing much employee engagement. The tertiary care hospital enjoys the interconnectedness of the dimensions realizing quickly that over time all the Balance Scorecard perspectives are financial dimensions.
Hardwiring Hospital-Wide Flow To Drive Competitive PerformanceEmCare
Thom Mayer, MD, FACEP, FAAP and Kirk Jensen, MD, MBA, FACEP, authors of “Hardwiring Flow” and “The Patient Flow Advantage, " share their secrets for streamlining processes, changing behaviors, and achieving sustainable advances in hardwiring flow throughout your hospital system.
This presentation is an abridged version of the webinar that Drs. Jensen and Mayer delivered July 9, 2015, in partnership with Becker's Hospital Review.
Current Practice Alignment Strategies to Ensure Long Term SurvivalHuron Consulting Group
In this MGMA presentation, John Lutz explores the merits and drawbacks of various physician alignment models and provides insights into competencies needed in the new market.
Benchmarking Advisory Board Management at Mid-Sized Pharmaceutical & Medical ...Best Practices
Biopharmaceutical and medical device companies rely on advisory board for strategic inputs and guidance on various business aspects. However, successful advisory board management requires optimum investment in resources and operations. It is also important that the biopharmaceutical and medical device executives ensure quality of meetings and dialogue with advisory boards is excellent for maximum ROI.
This research from Best Practices, LLC showcase the best practices in advisory board management at mid-sized biopharmaceutical and medical device companies. It also highlights the top challenges, winning strategies and best practices for conducting advisory boards.
Understanding the Dynamics of Successful Health System Strengthening Interven...HFG Project
Evidence is scarce, scattered, and not widely disseminated on how interventions to strengthen health system performance contribute to sustained improvements in health status, particularly toward ending preventable child and maternal deaths and fostering an AIDS-free generation. Without this evidence, decision-makers lack a sound basis for investing scarce health funds in health system strengthening (HSS) interventions in an environment of competing investment options. This evidence gap impedes support for HSS from numerous stakeholders, both within and outside of USAID. This study will help address this evidence gap by exploring the dynamics of successful HSS interventions in low-income countries. The study seeks to address four key questions:
How were a range of successful HSS interventions implemented in different countries?
What factors facilitated and constrained the successful implementation and documented outcomes of the interventions?
What were important factors about implementation that emerged across the different cases?
What are the implications of this study for implementing future HSS interventions?
The study will comprise three main activities:
Six qualitative, retrospective case studies of successful USAID-supported HSS interventions to explore what factors contributed to successful implementation
Qualitative cross-case analysis to identify patterns of policy processes, circumstances, relationships, and characteristics that may be associated with successful HSS reforms
Develop and propose a set of strategic recommendations for introducing and sustaining HSS reforms in low-income countries
The tertiary care hospital utilization of the balanced scorecard Nancy Southerland
The tertiary care hospital has as its primary responsibility to deliver health care to the most sick and severely ill. The management of the critically ill is seen as a wrathful driver of costs within the confines of the tertiary care hospital both in the United States and abroad. Through utilization of the Balanced Scorecard not only are the needed financial metrics elevated but the added dimensions of customer (both internal and external), internal business processes, and learning and growth dimensions are part of the balanced scorecard perspectives. Through use of the balanced scorecard in the tertiary care hospital, the wrath of the cost driver of the therapeutic management and intervention of the critically ill is assuaged. Tertiary care hospitals are able to deliver solid operating margins while ensuring patient satisfaction with good clinical outcome of the critically ill while experiencing much employee engagement. The tertiary care hospital enjoys the interconnectedness of the dimensions realizing quickly that over time all the Balance Scorecard perspectives are financial dimensions.
Hardwiring Hospital-Wide Flow To Drive Competitive PerformanceEmCare
Thom Mayer, MD, FACEP, FAAP and Kirk Jensen, MD, MBA, FACEP, authors of “Hardwiring Flow” and “The Patient Flow Advantage, " share their secrets for streamlining processes, changing behaviors, and achieving sustainable advances in hardwiring flow throughout your hospital system.
This presentation is an abridged version of the webinar that Drs. Jensen and Mayer delivered July 9, 2015, in partnership with Becker's Hospital Review.
Berikut adalah salah satu materi workshop saya pribadi pada tahun 2013 - 2014, saat mewakili Perdhaki (Asosiasi RS & klinik Katolik seluruh Indonesia).
Kiranya bisa bermanfaat untuk rekan-rekan yang punya minat untuk membuat marketing plan secara sistematik dan terukur. Khususnya untuk industri klinik & RS di perkotaan.
Selamat membaca.
Organizational Structure and Design - A case for a mid-sized HospitalSarang Bhutada
As part of a course on Org. Structure, we worked with a mid-sized hospital - Malar Hospital (which is now owned by Fortis Healthcare) and modelled an organizational structure for them. It is quite a comprehensive analysis and it took us a month and series of consultations with the hospital to deliver this. Thanks again to everyone at Malar for co-operating with our project.
Strategies that strongly position the company against competitor and give the company strongest possible strategic advantage.
Competitive Strategies helps in:
Building profitable customer relationships
Gaining competitive advantage
Analyzing their competitors
Total Quality Management in HealthcareGunjan Patel
Now days, Healthcare systems are of fundamental interests to all level of Hospitals in our societies. Eventually, increasing importance and reliance are placed on total quality management in healthcare systems. Due to this rising importance that is also reflected in the increasing percentage of national and international resources for both private and public sector to allocated in hospital management systems. Hospitals and other healthcare organization across the globe have been progressively implementing TQM to reduce costs, improve efficiency and provide high quality patient care.
What is a Strategy? Michael Porter - Harvard Business ReviewDonny Sitompul
What is Strategy
Operational Effectiveness Is Not Strategy
Strategy Rests on Unique Activities
A Sustainable Strategic Position Requires Trade-offs
Fit Drives Both Competitive Advantage and Sustainability
Rediscovering Strategy
Healthcare Reform & Physician Loyalty: What Can CRM Do To Support ACOs?Perficient, Inc.
Martin Sizemore, Enterprise Architect at Perficient, and Lisa Anderson, CRM Solution Architect at Perficient, discuss Consumerism in Healthcare, Physician Practice Challenges & Alignment, and provide a Physician Loyalty Campaign Demo
Are You Prepared? The Next Generation of Orthopaedic Service LinesWellbe
Is your orthopedic service line keeping up with the changes in healthcare? How does orthopedics fit with the shift to greater accountability for quality and cost? How should you be adapting the service line to market changes? Find out about the next generation of service lines and some key strategies for succeeding under more accountable care, including organizational models and skill sets.
About the Speaker:
Ms. Lohmar is a founding Principal with New Heights Group. With over 25 years in the industry, Ms. Lohmar brings to client engagements specialized expertise in strategic planning, service line planning and development, integration/consolidation strategies and physician strategies, as well as facilitating organizational retreats and planning sessions. She is a frequent speaker on organizational service line development, and business planning for key service lines as orthopedics and neurosciences.
Chris Carnahan, President of Carnahan Group, presented at the National Association of Certified Valuators and Analysts' (NACVA) Advanced Valuation: Applications and Models Workshop on December 6, 2016. The presentation covers valuing physician practices; specifically,fair market valuations (FMVs) in healthcare, the government regulations surrounding FMVs, the current trends and marketplace, as well as valuing physician compensation.
We specialize in the successful placement of all physician specialties and sub-specialties in small rural facilities, large medical centers, healthcare systems, and academics. We ensure that your new physician will integrate well into your community as both a true leader and a valuable asset for your facility.
Presentation by Rich Pollack, VP and Chief Information Officer, VCU Health, at the marcus evans National Healthcare CIO Summit held in Pasadena, CA March 13-14 2017
HCS499 v4Goals for Stevens District Hospital, Part 1HCS499 v.docxshericehewat
HCS/499 v4
Goals for Stevens District Hospital, Part 1
HCS/499 v4
Page 2 of 2
Goals for Stevens District Hospital, Part 1
Clear, actionable, and measurable goals are essential to strategic planning. It is important that the goals are designed to support the mission and vision of an organization.
Answer the following questions witha total of 260 to 350 words. Your analysis should bebased on your review of the data provided in the Stevens District Hospital strategic planning scenario and your SWOT analysis.
Enter your answers beneath the prompts. (Write Answers on this page for this assignment)
Identify a clear, actionable, and measurable technology goal for the organization that clearly supports the mission and vision.
Analyze how this goal supports the mission and vision of the hospital.
Explain how you would measure progress toward the goal.
· Discuss milestones necessary for progress.
· Discuss the criteria you would use to measure that the goal was completed.
Cite 2 peer-reviewed, scholarly, or similar references according to APA guidelines.
References
Copyright 2019 by University of Phoenix. All rights reserved.
Copyright 2019 by University of Phoenix. All rights reserved.
HCS/499 v4
Stevens District Hospital Plan
HCS/499 v4
Page 8 of 8
Strategic Planning ScenarioBackground
Stevens District Hospital is a 162-bed acute care hospital that is qualified as a not for profit facility. The hospital was originally a county-owned facility and its status was transferred to an independent facility three years ago. The hospital receives no external funding from government agencies for operations. The hospital is accredited by The Joint Commission and received reaccreditation during their triannual survey last year. The hospital has an aggressive quality management program and a low volume of medical malpractice claims. The hospital is located in Jefferson City, which is a city of 50,000 with 80,000 in the regional market. The hospital provides a general range of acute care services, including medical/surgical, rehab, and emergency care. Current Performance AnalysisMission and Vision
Our mission: To improve health by providing high-quality care, a comprehensive range of services, and exceptional service.
Our vision: Stevens District Hospital and its affiliates will be the health care provider of choice for physicians and patients. Our five year vision is to create a large, multispecialty physician practice system that would include at least six family practice physicians and specialists in cardiology, oncology, and women’s services. Currently, the hospital employs three family practice physicians, one obstetrician, one medical oncologist, and one non-invasive cardiologist. Previous Strategic Plan Review
Goal
Accomplishments
Increase market share by recruiting three family practice physicians.
The hospital was able to recruit only one family practice physician to increase primary care market this past year. The limited number of state med ...
Presentation Uncovers Trends in the Unpredictable Healthcare IndustryPYA, P.C.
With the healthcare industry in a state of flux, not much is known about what lies ahead; but trends across the industry have become apparent and are likely to stick. These trends were the subject of a presentation given by PYA Principal David McMillan at the PKF North America Healthcare Fly-In.
North highland himss_hardwiringclinicalfinancialperformance_041315North Highland
North Highland's Ricardo Martinez and Donna Houlne's presentation on "Hardwiring Clinical and Financial Performance Through Patient-Centered, Physician-Directed Transformation"
We at Boehringer Ingelheim know that there are many issues affecting health care in the United States. In this presentation Dr. Lee Sacks of Advocate Health takes a look at accountable care organizations (ACOs) and their role in health care reform. Understanding the Implications of Accountable Care Organizations for Patients and Providers, was a web conference given on July 31, 2012 and which we hope will provide offer an understanding of best practices among ACOs and tips for helping constituents adopt and participate in ACOs.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Using Your Employed Physicians as a Competitive Weapon
1. Using Your Employed
Physicians as a Competitive
Weapon
HSG Webseries
March 21, 2012
LOUISVILLE KY | WASHINGTON DC
www.healthcarestrategygroup.com
2. Presenters
David’s primary focus is on strategy development, physician alignment, business
planning, medical staff development planning, and growth strategies for hospitals and
physicians. He draws from 15 years of experience with Norton Healthcare in Louisville, KY
where he served as COO, VP of Managed Care and Quality, CP of Physician
Services, and Administrator of the Brown Cancer Center.
David is a fellow in the American College of Healthcare Executives. He holds a Master's
Degree in Health Administration from The Ohio State University and a Bachelor's Degree
from Virginia Polytechnic Institute.
David Miller | Partner | 502.814.1188 | dmiller@healthcarestrategygroup.com
Travis’s practice focuses on helping hospitals and health systems with physician alignment
issues through strategic planning initiatives, such as Hospital Strategic
Planning, Employed Physician Group Strategic Planning, Physician Alignment
Planning, and Service Line Planning.
Travis holds a Master’s of Business Administration from Vanderbilt University, and
Bachelor’s of Science Degrees in Finance and Business Management from the University
of Tennessee.
Travis Ansel | Manager, Strategic Services | 502.814.1182 | tansel@healthcarestrategygroup.com 2
3. Our Mission
To be Leaders in Hospital/Physician Integration
3
4. About HSG
• Average growth rate of 25% over past four years
• 73% of 2010 revenue was generated through repeat business
Named to 2010 and 2011 Inc.
Magazine’s list of fastest growing
privately-held companies in the
US for past 2 years
Recognized as one of the top-50
fastest growing privately-held
companies in the Louisville
metropolitan area for past 4 years
4
5. Agenda for Today
• State of the Market
• How Employed Physician Groups
Contribute Value
• “Weaponizing the Group”
• Requirements for Success
• Case Studies
5
6. Initial Contributions from
Employed Groups
• Protection of existing volume and referral
sources
• Ability to recruit new physicians
• Serve community need
• ED and hospital coverage
6
7. State of the Market
Growing Physician Networks
• Rapid growth in
last half-decade
• Employment an
expectation for
new grads
• Healthcare
reform driving
many hospitals to
vertically
integrate
• Lack of vision for
employed groups
an issue, leading
to problems
7
Source: 2012 AHA Hospital Statistics
8. State of the Market
Growing Physician Networks
• According to Merritt Hawkins (Dallas-based recruiting firm):
– In 2003 14% of placements were hospital positions
– In 2006 43% of placements were hospital positions
– In 2010 50+% of placements were hospital positions
• Reasons:
– Declining reimbursement and incomes
– Uncertainty of health care reform
– Clinical integration - ACOs, Medical Homes, Bundled Payments
– Cost of electronic health record
– Quality of life
– Security
8
9. State of the Market
Physician Practice Financial Issues
• Average of $212k loss per employed physician
• Hospitals with financially successful groups
experiencing losses at <$100k/physician
• Downstream gains in hospital revenue are
variable
9
Source: 2011 MGMA Cost Survey
10. State of the Market
Lack of Strategic Focus for Employed Groups
• Issues
– Lack of strategic vision
– Recruitment into group done haphazardly
– Lack of solid governance structure
• Collection of practices with no physician leadership
– Not tied to hospital strategy, including service lines
– No plan for mutual success for hospital and group
• Referrals poorly managed; not staying within group
• Leads to:
– Lack of downstream revenue to hospital
– Inability to leverage group to compete in marketplace
10
11. State of the Market
Lack of Operational Capabilities
• Issues
– Limited management capabilities and limited management
infrastructure
– Poor billing, collections, and accounts receivable management
– Physician compensation models lacking proper incentives causing
productivity issues
• Leads to:
– Losses on practices which are difficult to “turn around”
– Board questions and concerns
– Need for significant assessment of groups to define corrective actions
11
12. State of the Market
Physician Practice Financial Issues
Hospital Revenue vs. Average Practice Loss
Average Annual IP/OP Minus 50% Hospital Avg. Practice Loss per
Specialty Net Income
Revenue per Physician* Variable Cost FTE**
Internal Medicine $ 1,678,341 ($839,171) ($254,103) $ 585,068
Family Medicine $ 1,622,832 ($811,416) ($143,776) $ 667,640
Hematology/ Oncology $ 1,485,627 ($742,814) $10,340 $ 753,154
Urology $ 1,382,704 ($691,352) ($246,294) $ 445,058
OB/GYN $ 1,364,131 ($682,066) ($226,667) $ 455,399
Neurology $ 907,317 ($453,659) ($204,678) $ 248,981
Total $ 8,440,952 ($4,220,476) ($1,065,178) $ 3,155,298
• Bottom-line:
– Physicians are seeking employment, if they do not find employment with you
then they’ll find it elsewhere
12
– If this happens then hospital revenue is at risk
Sources: * Merritt Hawkins 2010 Physician Inpatient/Outpatient
Revenue Survey ** MGMA 2011 Cost Survey
(Hematology/Oncology taken from MGMA 2010 Cost Survey
13. State of the Market
Payment Reforms Impacting Strategy
• Fee-for-service transitioning to quality and value focus
• Self-Insured employers focused on lowering costs are pursuing
direct contracting or other risk-based models with providers
• CMS focused on reforming healthcare through payment reforms
and incentives
– Shared Savings Program (ACOs)
– Pay for Performance
– Value-Based Purchasing
– No-Pay/Adverse Events
– Bundled Payments
• Implications
– Hospital/physician relationship must become closer
– Success will require physician leadership and engagement
– Employed groups well positioned to respond 13
14. State of the Market
Looking for Value
CEOs asking:
“How do we produce value
from these groups?”
14
15. State of the Market
Looking for Incremental Value
• Help respond to the evolving market
• Manage quality/care processes
• Increase clinical capabilities
• Provide medical staff leadership
• Build service lines
• Grow regional presence
• Improve hospital financial position
• Build a group culture that aids in meeting our mutual
objectives
15
16. “Weaponizing the Group”
• Referral Management / Control
• Primary Care Strategy
• Regional Specialty Strategy
• Care Process Improvement (Core Measures and
Readmissions)
• Clinical Integration
• Direct Contracting/Assuming Risk
16
17. “Weaponizing the Group”
Referral Management / Control
• Define and measure the problem, both referrals
and dollars
• Assign accountability to the physician advisory
board
• Systematically address problems:
– Gaps in specialties
– Gaps in skills
– Gaps in quality
– Gaps in service 17
18. “Weaponizing the Group”
Referral Management / Control
• Create “preferred” lists of providers that group
will support based on quality of care, customer
service
• Tie to compensation????
18
19. “Weaponizing the Group”
Primary Care Strategy
• Define PCP base required to drive
business to key profitable services
• Define and locate primary care physicians
in outlying areas to draw volumes
• Aggregate PCPs together and potentially
with ancillary service centers
19
20. “Weaponizing the Group”
Primary Care Strategy
• Define strategy to tie PCPs and
employers
• Must have robust hospitalist program to
support PCP growth
• Must support through a marketing
strategy
20
21. “Weaponizing the Group”
Regional Specialty Strategy
• Focus on strategic specialties
– Profitable
– Differentiated capabilities
• Use employed specialty physicians to
target outlying regions
• Compensation plan needs to incent
business development
21
22. “Weaponizing the Group”
Care Process Improvement - Core Measures/Readmissions
• Employed physicians best positioned to impact
hospital care
• Define best practices within each specialty,
institutionalize with IT
• Handoffs of care also a key focus
– PCP to/from hospitalists
– PCP to/from specialists
– Standards of performance in these interactions
22
23. “Weaponizing the Group”
Clinical Integration
• Evaluate primary care models and leverage
those capabilities with employers
• Evaluate IT strategy
• Explore disease management capabilities
• Explore post-acute care relationships
• Evaluate impact of above on physician
specialty needs in employed group
• Assemble and start leveraging
• Co-management a good start 23
24. “Weaponizing the Group”
Direct Contracting / Assuming Risk
• Focus on employers, and the patients
that provide all of the profits for most
hospitals
• Self-insured employers are an untapped
market
• Ability to help lower costs will be the key
to retaining profitable commercial
volumes 24
25. “Weaponizing the Group”
Direct Contracting / Assuming Risk
• Engage and involve the physicians
– Medical directorships
– Care management opportunities
– Implement process changes
• Leverage physician expertise
• Engage employers in open dialogue
about challenges
25
27. Requirements for Success
Culture
• Everyone must understand the vision
• Benefits must be clear
• Bad actors and other roadblocks must be
eliminated…develop shared behavioral
expectations
• Focus, transparency, and accountability
are key
27
28. Requirements for Success
Leadership
• Develop a vision for what physician leadership
means
• Identify physician leaders
– Respected + capable
• Build a program with your vision in mind
– Education
– Interaction with executives
– Interaction with hospital board
• Continued planning for individual improvement 28
29. Requirements for Success
Marketing/Branding
• Leverage brand of group and hospital
– Common branding
– Not necessarily same name
• Must integrate with referral management
• Physician liaison bringing referrals to group and
hospital
• Targeting markets strategically to manage
payer mix and promote profitability
29
30. Requirements for Success
Investment
• Resources invested don’t stop at the subsidy
for the hospital
• EMR/Practice management systems
• Central billing infrastructure and personnel
• Administrative time for physicians
• Marketing
• Facilities
30
32. Case Study 1
Chronic Care Initiative
• State-led shared savings program
• Management of chronic disease
• 16 primary care physicians out of ~50 in
employed group participated
• Built NCQA-certified patient-centered
medical homes
• Increased resources for care
management within the practice 32
33. Case Study 1
Chronic Care Initiative
• Generated payments of $50,000 per
physician in year 1
• PCMH model will be expanded within
group, and within general medical staff
• Can leverage into Medicare or private
payer ACO; direct contracting
• Point of differentiation in competitive
landscape 33
34. Case Study 2
Referral Management / Quality Focus
• CEO concerned about how to get group
to pursue strategies that will make the
health system successful
• Two approaches:
– Education of the physicians concerning
reform and changing market
– Working with a physicians Advisory Board to
develop a group strategy
34
35. Case Study 2
Plan Focus
• Keeping referrals in the group to:
– Build financial strength and
– Ensure consistent care
• Begin to create a group culture
– Empower the physician board
– Begin to build common behavioral
expectations
– Create a common vision 35
36. Case Study 2
Plan Focus
• Focus on quality
– Hospital core measures
– Best practices
– Handoffs of patients
• Define the group size
– What types of physicians
– In what quantities
– Where 36
37. Case Study 2
Plan Focus
• Primary care strategy
• Direct contracting/bundled payments
• Financial reporting within the group
37
38. Case Study 3
Rate Improvement
• Hospital built groups from 30 to 300
• In process, acquired about 30% of PCPs
• Insurers fear: the hospital system would
leverage PCPs in the negotiations
• Hospital system did just that
• Able to move the physicians rates from
105% of Medicare to 135%
38
39. Case Study 3
Rate Improvement
• Made intake of new physicians much
easier
• Built in cash flow bump of about 10%-
15% on each practice required
• More in some specialties
39
TA: Responding effectively to shifting incentives from payers is currently, and will continue to be, a major strategic issue for hosptials and health systems.Overall, we are seeing CMS lead the charge, with other payers following suit, to reduce FFS payments and focus on transitioning to payments based on improving quality, improving patient satisfaction, and reducing payer cost. CMS, in particular, has a number of reforms I’m sure all of you are dealing with right now, which employed physicians can be key in heping the hospital deal with.