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A HORSE OF A DIFFERENT COLOR… PHYSICIAN BUY-IN
Cheryl L. Coors, PresidentCoors Healthcare Solutions
Paul Hiltz, CEOMercy Hospital Springfield
Coors Healthcare Solutions © 2013
Create Physician Buy-In Through The Alignment Process
Coors Healthcare Solutions © 2013
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
Good Morning!
• Let’s switch seats…
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MISSION, VISION & VALUES – MAKING IT PRACTICAL
The Road Map to Creating Physician Buy-In
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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 funon the journey)
Coors Healthcare Solutions © 2013
CommunicationCreative -- Slow Start / Fast Finish
Vacillating -- TemperamentalCompetitive
ConfrontationalDirect
Results-OrientedSense of Urgency
Change Agent
Good Supporter -- Team Player -- Persistent & Cooperative -- Sensitive to Other’s Feelings
High Trust LevelNot Fearful of Change
ContractibilityRather Talk than Listen
Verbal SkillsProjects Self-Confidence
Process-OrientedQuick to Change
IndependentOptimistic
AccommodatingDislikes Confrontation
PersistentControls Emotion
AdaptableGood Listener
Product-OrientedSlow to ChangeSelf-Disciplined
Pessimistic
PreciseAccurate
Concern for QualityCritical Listener
Non-Verbal CommunicatorAttention to Detail
Organizational Strategy
Needs Assessment / Gap Analysis
Physician Strategy
Physician AlignmentContracts,
Compensation & Implementation
Physician Recruitment &
Retention
Physician Integration
Strategic Physician Solutions™
Coors Healthcare Solutions © 2013
Organizational Strategy
Strategic Physician Solutions™
Coors Healthcare Solutions © 2013
Organizational Strategy
Needs Assessment / Gap Analysis
Strategic Physician Solutions™
Coors Healthcare Solutions © 2013
Organizational Strategy
Needs Assessment / Gap Analysis
Physician Strategy
Strategic Physician Solutions™
Coors Healthcare Solutions © 2013
Organizational Strategy
Needs Assessment / Gap Analysis
Physician Strategy
Physician Alignment
Strategic Physician Solutions™
Coors Healthcare Solutions © 2013
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
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
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Healthcare Integration Trend
Source: MGMA Connexion “Medical Practice Today” July 2011
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• 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
Organizational Strategy
Needs Assessment / Gap Analysis
Physician Strategy
Physician Alignment: Physician Advisory
Council
Strategic Physician Solutions™
Coors Healthcare Solutions © 2013
Physician Engagement = Buy In
Coors Healthcare Solutions © 2013
• Getting Physicians’ Participation
• Getting Physicians’ Attention
• Getting Physicians’ Committed
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
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PHYSICIAN ADVISORY COUNCIL (P.A.C.)™
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Creating a partnership between hospital administration and medical staff.
Physician Engagement – Built Not Bought
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PAC™ Philosophy
• Physicians are a hospital's number #1 customer!
• This philosophy is the foundation to create a Physician-centric customer service model
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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
Coors Healthcare Solutions © 2013
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%
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
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Organizational Strategy
Needs Assessment / Gap Analysis
Physician Strategy
Physician Alignment: Structure Options
Strategic Physician Solutions™
Coors Healthcare Solutions © 2013
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 © 2012 Coors Healthcare Solutions © 2013
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
Coors Healthcare Solutions © 2013
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
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
Flexible Work EnvironmentThe 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
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• 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
Organizational Strategy
Needs Assessment / Gap Analysis
Physician Strategy
Physician AlignmentContracts,
Compensation & Implementation
Strategic Physician Solutions™
Coors Healthcare Solutions © 2013
CONTRACTS, COMPENSATION & IMPLEMENTATION
(STAGE 5)
Developing a collaborative working environment by establishing a cohesive
compensation program and setting performance expectations.
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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 agreementCoors Healthcare Solutions © 2013
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
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
Dashboard & Metrics Reports
• Simplicity of reports helps to create buy-in
• Example: Stop Light Reports
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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 DepartmentBudget to
ActualBudget to
ActualBudget to
Actual
WRVU'S
REVENUE
EXPENSE
Salary & Benefits
Non-Personnel
OPERATING MARGIN
TOTAL MARGIN
RESERVES
ACCOUNTS RECEIVABLE
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
Organizational Strategy
Needs Assessment / Gap Analysis
Physician Strategy
Physician AlignmentContracts,
Compensation & Implementation
Physician Recruitment
Strategic Physician Solutions™
Coors Healthcare Solutions © 2013
PHYSICIAN RECRUITMENT
Building an effective in-house training program, establishing best practices for
consistent, effective and long-term physician recruitment and retention.
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Get Your House In Order: Build Your Foundation
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Organizational Strategy
Community Need Analysis
Proof: Support for Road Map
Needs Assess /
GAPPrioritize
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 Compensation
Equality
Contracts &
Compen-sation
Physician
Recruitment & Retention
Training
Challenges Organizations Face
• Physician satisfaction scores• Physician retention• Profitability of physician practices• Physician recruitment • High use/costs of Locums
Coors Healthcare Solutions © 2013
Organizational Strategy
Needs Assessment / Gap Analysis
Physician Strategy
Physician AlignmentContracts,
Compensation & Implementation
Physician Retention Strategies
Strategic Physician Solutions™
Coors Healthcare Solutions © 2013
PHYSICIAN RETENTION
Designing comprehensive and creative programs focused on Physician-centric
customer service to attract and retain top talent.
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Physician RetentionSix most common reasons why physicians leave (MGMA Study):
1. Lack of professional interaction, support, call coverage, collegiality and camaraderie
2. Spousal and/or family dissatisfaction3. Economic dissatisfaction4. Management that does not seek or use input5. Facility, equipment, support and personnel quality issues6. Fear of loss of professional skills because of non-challenging
workload or lack of support for continuing medical education
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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
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
Coors Healthcare Solutions © 2013
Effective Retention InitiativesWhat 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
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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.
• 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
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Physician Satisfaction SurveyExample 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
Organizational Strategy
Needs Assessment / Gap Analysis
Physician Strategy
Physician AlignmentContracts,
Compensation & Implementation
Physician Recruitment &
Retention
Physician Integration
Strategic Physician Solutions™
Coors Healthcare Solutions © 2013
PHYSICIAN INTEGRATION
Completing each step of the Strategic Physician Solutions™ process creates the
platform for full integration.
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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
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Actions To Help Foster Physician Buy-in
A Case Study:Paul Hiltz, CEO
Community Mercy Health PartnersSpringfield, Ohio
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Coors Healthcare Solutions © 2013
Physicians' Perceptions of Quality of Care
Mercy Hospital Mount Airy
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Physicians' Perceptions of Patient Safety
Mercy Hospital Mount Airy
An ''Excellent'' Percentile Ranking is not available for 2004.
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Physicians' Perceptions of Administration
Mercy Hospital Mount Airy
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Physicians' Perceptions of Mission and Values
Mercy Hospital Mount Airy
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Physicians' Perceptions of Mercy Hospital Mount Airy as a Place to Practice Medicine
Mercy Hospital Mount Airy
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2006 Mercy Hospital Mount Airy(''Excellent'' Percentile Rankings)
Mercy Hospital Mount Airy
90thPercentile
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2010 Mercy Hospital Mount Airy(''Excellent'' Percentile Rankings) 2010
% Excellent90th 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
90thPercentile
Cheryl Coors, MHA – PresidentCheryl 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.
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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
Coors Healthcare Solutions © 2013