011 Am09 Presentations Maddux


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  • 011 Am09 Presentations Maddux

    1. 1. Leveraging Your Clinical Leadership Franklin W. Maddux, MD FACP Saturday, March 21, 2009 RPA Annual Meeting
    2. 2. Healthcare & Industry Disclosures <ul><li>Healthcare Board Affiliations </li></ul><ul><ul><li>Specialty Care Services Group </li></ul></ul><ul><ul><li>HIT Services Group </li></ul></ul><ul><ul><li>Hospital Clinical Services Group </li></ul></ul><ul><ul><li>Renal Physicians Association </li></ul></ul><ul><ul><li>Mid Atlantic Renal Coalition </li></ul></ul><ul><ul><li>Diabetes Care of America </li></ul></ul><ul><li>Industry Affiliations </li></ul><ul><ul><li>Fresenius Medical Care (Contract) </li></ul></ul><ul><ul><li>Amgen (Research sponsorship) </li></ul></ul>
    3. 3. Acknowledgements in Preparing This Presentation <ul><li>Dugan W. Maddux, MD FACP </li></ul><ul><li>Kay Lane - SCSG </li></ul><ul><li>Nancy Armistead – MARC </li></ul><ul><li>Janet Lynch – MARC </li></ul><ul><li>Terry L. Ketchersid, MD - HITSG </li></ul>
    4. 4. The Landscape of Healthcare <ul><li>National Health Expenditures & their share of gross domestic product </li></ul><ul><li>1990 $717 B 12.4% of GDP </li></ul><ul><li>2004 $1,878 B 16% of GDP </li></ul><ul><li>In 1992 women represented 36% of medical school graduates and 49% by 2007 </li></ul><ul><li>Number of patients receiving dialysis increased 55% between 1997 and 2007 </li></ul><ul><li>Since 1996, one baby boomer has turned 50 every seven seconds </li></ul><ul><li>In an AARP study, manufacturer price for 169 brand name drugs since 2001 increased by 50.5% by 2007; compared to a general inflation rate of 19% </li></ul>
    5. 5. Is Nephrology in a Period of Change? <ul><li>New Conditions for Coverage </li></ul><ul><li>Bundled ESRD Facility Payment </li></ul><ul><li>Dialysis Facility Consolidation </li></ul><ul><li>New Incentives from Payers </li></ul><ul><li>Health Information Technology </li></ul><ul><ul><li>Electronic Prescribing </li></ul></ul><ul><ul><li>Patient Safety </li></ul></ul><ul><ul><li>P4R  P4P  P4Q </li></ul></ul><ul><li>Expanding patient population at risk </li></ul><ul><li>Higher costs of running the practice </li></ul>YOU BET WE ARE!!
    6. 6. What Does the Nephrology Practice of the Future Look Like? <ul><li>What does it look like now? </li></ul><ul><li>What is driving CHANGE? </li></ul><ul><li>What will be different? </li></ul>
    7. 7. Stories Recently Heard <ul><li>The “Survival” Story </li></ul><ul><li>The “Stretched too thin” Story </li></ul><ul><li>The “Covering 18 hospitals” Story </li></ul><ul><li>The “Exhausted Heap” Story </li></ul><ul><li>Each represents a clinical reality in the life of a nephrologist </li></ul>
    8. 9. Current State What Nephrology Practice Looks Like Now
    9. 10. RPA 2007 Benchmarking Survey
    10. 11. RPA 2007 Benchmarking Survey
    11. 12. RPA 2007 Benchmarking Survey
    12. 13. RPA 2007 Benchmarking Survey
    13. 14. Nephrology SERVICES Clinic, Dialysis Unit, Hospital and … Beyond… RPA 2007 Benchmarking Survey 19% Vein Mapping 49% Hepatitis Vaccination 66% Pneumovax 77% Flu Vaccination 78% ESA Administration 81% Dialysis Education 14% Vascular Doppler 24% Renal U/S 38% Iron Administration 40% Research
    14. 15. Characteristic “DNA” of the Physician How Physicians Train?... What is Natural to Physician’s? … <ul><li>Compassion </li></ul><ul><li>Attitude of Inquiry </li></ul><ul><li>Intellectual Pursuit </li></ul><ul><li>Analytical Perspective </li></ul><ul><li>Decision Making Need </li></ul><ul><li>Desire to Control </li></ul><ul><li>Leadership by Example </li></ul>
    15. 16. What is Driving Change? <ul><li>Demand from Patients </li></ul><ul><li>Demand from Payers </li></ul><ul><li>Demand from Providers </li></ul>
    16. 17. Patient Demand in a A World of Chronic Illness USRDS, 2008 Atlas In U.S. adults, chronic kidney disease (CKD) is more prevalent than either congestive heart failure or diabetes, and the prevalence of CKD appears to have grown over a period of approximately fifteen years.
    17. 18. USRDS CKD Patient Breakdown USRDS, 2008 Atlas
    18. 19. Prevalence of GFR <60 ml/min/1.73m 2 NHANES participants age 20 & older
    19. 20. Payer Demand <ul><li>Value Based Purchasing – CMS </li></ul><ul><li>Comparative Effectiveness Research – Congress </li></ul><ul><li>Physician Quality Reporting Initiative (PQRI) – CMS </li></ul><ul><ul><li>P4R  P4P  P4Q </li></ul></ul><ul><li>HIT Adoption & Utilization Momentum - Congress </li></ul><ul><ul><li>Safe Harbor </li></ul></ul><ul><ul><li>e-Rx Incentive </li></ul></ul><ul><ul><li>Stimulus Package </li></ul></ul><ul><li>Medical Home/Neighborhood Delivery Model - ACP </li></ul>
    20. 21. The Science of Process & Outcome Measurement <ul><li>Developing processes of care for populations of patients (e.g.- Structured CKD Care) </li></ul><ul><li>Measuring & Quantifying the delivery of care </li></ul><ul><li>Determining how individual outcomes are influenced by the care processes delivered </li></ul>
    21. 22. Provider Demand <ul><li>Nephrology Workforce Changes </li></ul><ul><ul><li>Demographics </li></ul></ul><ul><ul><li>Expectations of profession </li></ul></ul><ul><ul><li>Professional Organization </li></ul></ul><ul><ul><li>Longevity expectations of practice life </li></ul></ul><ul><ul><li>Life – Work balance </li></ul></ul><ul><ul><li>Comfort with technology </li></ul></ul><ul><ul><li>Relationships with health industry </li></ul></ul>
    22. 23. Future State How Physician Leadership Must Transform the Practice of Nephrology
    23. 24. The Goddess Durga and The Practice of Nephrology A representation of the Hindu goddess depicted with multiple arms
    24. 25. The Future Nephrologist The nephrologist will need eight arms instead of two. Six of these eight arms will be from members of the clinical care team that supports a structured care approach for patients with kidney disease.
    25. 26. Transformational Leadership <ul><li>Leader sets & communicates a vision </li></ul><ul><li>Stimulates followers through mentoring and coaching </li></ul><ul><li>People oriented and participative style </li></ul><ul><li>Success comes through sustained commitment </li></ul><ul><li>Skilled at linking individual needs to organizational mission </li></ul>
    26. 27. Leading a Care Team <ul><li>Teams  A small group of people working together toward a common purpose. </li></ul><ul><li>Team work  An environment in the larger organization that creates and sustains relationships of trust, support, respect, interdependence, and collaboration. </li></ul>
    27. 28. Team Leadership <ul><li>Nephrologists lead in 3 primary care environments </li></ul><ul><ul><li>The Dialysis Facility </li></ul></ul><ul><ul><li>The Medical Practice </li></ul></ul><ul><ul><li>The Clinical Care Team </li></ul></ul><ul><ul><ul><li>Hospital </li></ul></ul></ul><ul><ul><ul><li>Vascular Access Center </li></ul></ul></ul><ul><li>Each has a different focus; but each involves extending beyond oneself </li></ul><ul><li>“ No executive has ever suffered because his subordinates were strong and effective.” --Peter Drucker </li></ul>
    28. 29. Attributes of Physician Leaders <ul><li>Exceptionally strong analytical capabilities </li></ul><ul><li>Ability to compete in a rigorous environment </li></ul><ul><li>Capacity to live & learn in a diverse community </li></ul><ul><li>Aptitude to connect theory and reality </li></ul><ul><li>Propensity to problem-solve in real time </li></ul>-- Charles Vest (MIT)
    29. 30. Rely on Authority Value Accountability Minimize Risk Accept Risks Avoid Conflict Use Conflict Make rules Break rules Tell The Vision Sell the Vision Implement Plan Details Set Direction & Vision Instruct Mentor Reorganize Reinvent Address daily issues Have a vision for the future Supervise Subordinates Nurture Followers Do things right Do the right things Managers Leaders
    30. 31. In Summary <ul><li>Nephrology practices must prepare for change in the style of care delivery and the measures of success </li></ul><ul><li>The nephrologist should avoid becoming the bottleneck to growth and development of his/her practice </li></ul><ul><li>Nephrologists are well positioned to use their leadership skills to build a robust practice in which a care team delivers chronic disease care to a larger population of kidney disease patients </li></ul>