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Mapping Your Medical Staff Development: Keys to Success

Posted by Matthew Smith on Feb 26, 2013 10:21:00 PM

Medical staff development mappingTraditional medical staff development planning is no longer enough. In today’s market, hospitals need to understand the physician segments within their medical staffs and create relationship-building strategies focused on meeting physicians’ lifestyle, financial, and status needs.

In most hospitals, medical staff development planning begins and ends with the organization’s needs. The hospital determines its market requirements, prioritizes specialties for development, allocates recruitment funds, and hopes to connect with physicians interested in relocating. This level of planning is important, but it does not go far enough. In today’s tight market for physician talent, there is a big gap between what a hospital needs and what it can easily get.

Better performing hospitals and health systems create powerful physician strategies by taking staff development planning one step further. In addition to looking at their own needs, they identify the needs and aspirations of key physicians and physician groups. The resulting psychosocial “map” enables these hospitals to develop individualized strategies for building strong physician relationships.

Understand Physician Motivations

How do you map your medical staff? Start with a traditional medical staff development plan. Look at revenue and contribution margin by specialty, and overlay market share data and demographic projections. Prioritize the specialties by profitability, growth opportunity, and strategic value, and develop recruiting targets.

Now, instead of launching directly into recruiting, investigate and categorize the concerns, aspirations, and priorities of the various physicians within these target specialties. In my experience, physicians today fall within a number of different “need segments”:

Lifestyle. One segment is made up of physicians who are very interested in work/life balance. They are typically younger physicians who do not want professional demands to overwhelm their family responsibilities. This drive is most common among primary care physicians, but it is becoming more prevalent among specialty providers.

Financial. In today’s environment of declining reimbursement and rising practice costs, many physicians are very motivated by financial pressures. This includes family practitioners with lower incomes and highly trained specialists who want a greater payoff on their career investment.

Status. A third major driver among physicians today is the need for status and recognition. This need segment cuts across the entire physician spectrum, from doctors who want to be offered the opportunity to reinvent healthcare delivery to entrepreneur physicians looking for business leadership opportunities.

There is no such thing as a doctor who is focused exclusively on lifestyle issues or an MD who is motivated purely by financial concerns. Rather, physicians generally experience all these motivations in varying degrees. Underlying them all is the desire to practice medicine without distractions. The point is to understand how these motivations exist within your medical staff so you can engage physicians constructively.

Develop Alternative Solutions

After you have mapped your medical staff in terms of their motivations and aspirations, work with individual physicians and groups to develop alternative strategies for meeting their key needs.

Physicians with lifestyle priorities

Hospitals can take a variety of approaches to deliver on the needs of physicians with lifestyle priorities. For many, an employment arrangement will be the most effective means. Hospital employment can stabilize the practice environment for physicians and, within a large group, limit call demands. Well-run employed groups will also take many of the headaches of practice management away from physicians.
Physicians with financial priorities.

Hospitals are also in a good position to help physicians satisfy financial needs. The best way for primary care physicians to supplement their income is to develop sources of ancillary revenue. Hospitals can facilitate this by creating an employed multispecialty practice that incorporates both primary care and specialty physicians. CT, MRI, and other ancillary services structured within this group can increase physician income by 15 percent or more. In addition, improved practice management can lead to further improvements in billing and collections.

Procedural specialists who are focused on financial priorities often require a different approach. These physicians have many options before them, so hospitals should be willing to offer more. When working with surgical specialists, creating a joint-venture ambulatory surgical center (ASC) continues to be the best avenue. ASCs offer significant profit potential for physicians and great strategic value for hospitals.

Physicians with status needs

Hospitals can partner constructively with physicians who are focused on status by giving them opportunities for leadership. One effective approach is to establish a “center of excellence” within the hospital and appoint physicians to comanage it. For example, engage key neurosurgeons to provide leadership for a hospital spine center. You can also provide an ambitious physician with an opportunity to innovate in the area of care delivery—for instance, as medical director of a joint venture endoscopy center. Mapping your medical staff by needs and aspirations—and using the map to forge new physician connections—can help a hospital achieve a variety of financial, strategic, and marketing goals.

Case Study 1: Penetrating a New Region

A hospital in the Midwest struggled with a poor payer mix in its primary market. Recognizing the need to reduce its dependence on this market, it sought to expand into a secondary market with more favorable financial demographics. The organization identified key surgical specialties it needed to develop, then took the extra step of engaging a number of surgeons in discussions about their needs.

The talks revealed that the physicians were dissatisfied with schedule access, turnover times, and anesthesia coverage at the local hospital’s OR. In addition, the surgeons were looking for investment opportunities to supplement their income.

The hospital offered to partner with the surgeons on creation of a joint-venture ambulatory surgery center. The ASC was run using a new collaborative leadership model. A group of surgeons established the center’s direction, and day-to-day management was shared between a medical director and the OR nursing director. Through physician leadership, the ASC emphasized efficient perioperative processes and engaged a service-oriented anesthesia group. Over several years, the center provided a 68 percent annual return to the surgeon investors and created a significant new revenue base for the hospital.

Case Study 2: Protecting a Key Revenue Stream

A hospital in the Midwest depended on cardiology for more than 30 percent of its total revenue. The problem was that its cardiology staff was aging, and recruiting new providers to the community was difficult. Salary expectations exceeded local benchmarks, partly because of the age, payer mix, and seasonality of the local patient population.

Discussions with the cardiologists revealed a wide range of financial needs, many of them stemming from practice management inefficiencies. The hospital addressed these problems by partnering with the physicians to develop a cardiovascular institute.

The institute was governed by a board made up of both hospital administrators and physicians. By incorporating ancillary services and cardiac rehabilitation, the institute provided new sources of income for the physicians. Better practice management resulted in better revenue cycle performance, and improved infrastructure and IT support led to a better practice environment. Altogether, these enhancements increased physician income by approximately $100,000 per provider. The institute also provided attractive leadership opportunities for several physicians.

The improved practice environment and income potential enabled the hospital to recruit two new cardiologists within six months and stabilize its crucial cardiology market share for the long term.

Three Guidelines for Negotiation

Medical staff mapping can help healthcare leaders manage the natural conflict between hospitals and physicians—both the financial conflicts and the conflict of diverging goals. Because relationship building is at the heart of this strategy, it is important to keep in mind three negotiation parameters:

  1. Be open to working with all segments. If physicians perceive that the hospital is doing backroom deals with a select few, you will end up alienating large sections of your medical staff. Although you cannot offer the same opportunity to every physician, make it known you are willing to explore possibilities with every segment.
  2. Realize you cannot work with everyone. Although you are open to working with every member of your medical staff, understand that some physicians simply are not suitable negotiation partners. If an individual or group clings to irrational expectations or cannot display basic courtesy, you will not be able to develop a shared vision or work together constructively.
  3. Make sure every arrangement makes good business sense. Before you enter into any agreement—whether it is an employment arrangement, a joint venture, or a new program—make sure the financial or strategic benefits are in line with the costs. Identify objective measures of success, and build them into the agreement. Develop mechanisms for holding each party accountable for its responsibilities and performance.

The ultimate value of medical staff mapping is that it bridges the gap between a basic medical staff development plan and a set of strong physician relationships. Taking the time to create a shared vision and workable goals with a wide cross-section of physicians will pay off in a high degree of integration between your hospital and its medical staff.

Strategic Provider Planning, Specialty Mix

Topics: Physician Practice Solutions, Physician Recruitment, Physician Acquisition, Physician Acquisition Strategy, Medical Staff Development, Medical Staff Mapping

Top 9 Physician Recruitment Perks Offered (Other Than Salary)

Posted by Matthew Smith on Nov 29, 2012 11:05:00 AM

Physician RecruitmentSalary is the most basic component of any physician recruitment and compensation package, but what are the most common benefits outside of salary that hospitals and practices offer physicians? 

According to Merritt Hawkins' 2012 report of physician recruiting incentives, there are several primary perks, including signing bonuses and payment for continuing medical education. Here are nine of the most common benefits, based on the study's examinations of physician job searches last year.

1.    Malpractice insurance (offered in 99% of searches)
2.    Pay for continuing medical education (98%)
3.    Health insurance (97%)
4.    Relocation allowance (95%)
5.    Retirement benefits (82%)
6.    Signing bonus (80%)
7.    Disability (75%)
8.    Education forgiveness (26%)
9.    Housing allowance (5%)

Strategic Provider Planning, Specialty Mix

Topics: Employed Physicians, employed physician practices, Physician Practice Solutions, Physician Recruitment, Physician Onboarding, Physician Acquisition, Physician Acquisition Strategy, Physician Practice Acquisition, owned physician practices, Physician Employment Models

AMA Develops Guidelines for Physicians Entering Hospital Employment

Posted by Matthew Smith on Nov 13, 2012 1:00:00 PM

Hospital Physician EmploymentThe American Medical Association during its semi-annual policy meeting has adopted guidelines for physicians entering into contractual employment arrangements.

With physicians increasingly becoming hospital employees, almost a third of final year residents now list hospital employment as their first choice of practice setting, according to the association. The hospital physician employment guidelines cover such areas as conflicts of interest, advocacy, contracting, hospital-medical staff relations, performance evaluations, and compensation.

Under the conflicts of interest guidelines, for instance, employed physicians should be free to vote, speak and advocate on any matter regarding patient care interests, the profession, health care in the community and independent exercise of medical judgment, according to the association. “Employed physicians should not be deemed in breach of their employment agreements, nor be retaliated against by their employers, for asserting these interests.”

A contracting provision spells out the rights that AMA believes patients and physicians have when a physician leaves an organization, including rights to medical records:

“When a physician’s employment status is unilaterally terminated by an employer, the physician and his or her employer should notify the physician’s patients that the physician will no longer be working with the employer and should provide them with the physician’s new contact information. Patients should be given the choice to continue to be seen by the physician in his or her new practice setting or to be treated by another physician still working with the employer.

“Records for the physician’s patients should be retained for as long as they are necessary for the care of the patients or for addressing legal issues faced by the physician; records should not be destroyed without notice to the former employee. Where physician possession of all medical records of his or her patients is not already required by state law, the employment agreement should specify that the physician is entitled to copies of patient charts and records upon a specific request in writing from any patient, or when such records are necessary for the physician’s defense in malpractice actions, administrative investigations, or other proceedings against the physician.”

The employment and contractual guidelines are available here.

Strategic Provider Planning, Specialty Mix

Topics: Employed Physicians, Hospital Employment, Hospital Physician Employment, Physician Recruitment, Physician Employment Models

3 Success Factors for an Effective Physician Acquisition Strategy

Posted by Matthew Smith on Sep 5, 2012 12:15:00 PM

physician acquisitionAs hospitals and health systems prepare themselves for healthcare reform, they are considering many new physician acquisition strategies. Options include offering physicians a subsidized EHR, assisting practices with recruitment, providing access to health information exchange, and acquiring physician practices.

This article addresses the last strategy: practice acquisition and physician employment. To make a physician acquisition strategy work, hospital leaders need to carefully manage three critical key success factors:

People
As any Fortune 500 corporation that has acquired a smaller company or competitor can attest to, one of the most critical, and often overlooked, success factors is effective transition of people. Not only are financial and business systems merging, so too are the cultures and mindsets of the people running the business.

Physicians, other healthcare providers and office staff experience a significant culture shift when transitioning from an entrepreneurial business to being employees of a large hospital system. While they may not be outwardly expressing fear, anxiety or resistance, these emotions are certainly being felt internally and can have detrimental effects on the bottom line.

Hospitals would be remiss if they did not address these concerns and help physicians and staff assimilate to the new organization. Having new staff participate in an employee orientation program is an obvious strategy to ensure a smooth transition, but to have a more sustainable impact, hospitals should create a customized orientation program that meets the needs of this unique employee population. Physicians in particular should be given the opportunity to participate in customized on-boarding programs exclusive of the standard employee orientation. Give them the chance to participate in a physician advisory group or provide an opportunity to connect with colleagues who have experienced a similar transition. In general, it is important to set clear and realistic expectations for those making the transition and those managing the newly acquired practices.

Processes
As a physician practice is acquired and transitioned, its internal processes will change. This requires careful review and planning. First, the following questions should be considered when crafting a transition strategy for the physician:

  • Is the physician on staff at competing hospitals?
  • Does the physician share call coverage with physicians on staff at the employing hospital?

Who are the physician's main sources of referrals? If those sources are physicians, where are those physicians onstaff?

Second, consider needed changes to practice processes. Key questions include:

  • What changes to the operational policies and procedures should be made?
  • Will the practice’s vendors change?
  • Will the practice accept the same insurance plans?
  • How will patient service be affected?
  • Will there be a new financial policy?

Systems
During the acquisition process, review the practice’s current IT systems and determine how to transition them to the hospital systems. Systems involved may include an electronic medical record, a patient scheduling system, e-prescribing and laboratory interfaces. As these systems are reviewed, a data migration of patient medical or demographic information may be considered to save the time and money of re-entry.

Most practices have a practice management system for performing billing. Since most hospitals have their own system, the practice PM system will not be used after the transition. However, since most hospitals don’t purchase the physician's accounts receivable, the physician will be responsible for continuing to work outstanding accounts receivables and collect on outstanding claims. If the physician was hosting this system on a server in his or her office, the hospital will need to determine how to accommodate the practice’s billing needs during the system transition.

Strategic Provider Planning, Specialty Mix

Topics: Employed Physicians, employed physician practices, Physician Practice Solutions, Physician Recruitment, owned physician practices

Top 10 Challenges Facing Medical Practice Group Leaders

Posted by Matthew Smith on Sep 5, 2012 11:33:00 AM

10 ChallengesMedical practice professionals responding to MGMA-ACMPE's fifth annual medical practice survey discussed some of the most glaring issues group practices face today.

Here are the top ten challenges noted from the survey of more than 1,250 respondents.

  1. Managing finances with the uncertainty of Medicare reimbursement rates.
  2. Preparing for reimbursement models that put greater financial risk on practices.
  3. Preparing for the transition to ICD-10.
  4. Dealing with rising operating costs.
  5. Participating in CMS' electronic health record meaningful use incentive program.
  6. Understanding the total cost of an episode of care from the perspective of the payor.
  7. Collecting payment from high-deductible health plans and/or health savings account patients.
  8. Maintaining physician compensation levels.
  9. Managing group practice finances.
  10. Recruiting physicians.

In today’s challenging healthcare environment, medical practices that lack effective management controls quickly develop problems in patient service, financial performance, and physician and staff satisfaction. While they try their best to meet these practice demands, many practices simply lack adequate knowledge of their inefficiencies.

Health Directions works with physician practices so they gain control of the business side of their medical practices. By working cooperatively with providers and office staff, Health Directions enables practices to overcome difficult challenges and identify new opportunities.

The Health Directions team members rely on their hands-on experience managing both independent and hospital-owned practices. We use our practical expertise to augment current and/or provide temporary leadership in support of long-term solutions.

Specifically, Health Directions provides the following Practice Management services:

  • Practice start-up: Health Directions coordinates every aspect of practice development: staffing, technology, clinical operations, patient flow, business office processes, revenue cycle management and managed care contracting.
  • Practice turnaround: We provide the hands-on leadership needed to reduce staff turnover, improve the patient experience, boost physician satisfaction and achieve strong profitability.
  • Interim management: Our team members provide outstanding value by using interim management to address longstanding practice issues, guide organizational transitions and consolidate operational improvements.
  • Medical practice assessment: Health Directions reviews the operational and financial aspects of the practice, including staffing, workflow, systems, billing and collections. By gathering data, interviewing key staff, observing workflow and analyzing reports.
  • Practice Education: Health Directions leads and executes practice retreats and workshops aimed at improving operations, enhancing collaboration, and building market share. To augment day-to-day practice operations, Health Directions offers a range of half-day sessions pertaining to effectivepractice management.

Let Health Directions work with you to develop efficient practice operation and increased cash flow while you advance the quality care of your patients and strategically position your practice for future growth. 

Simply click on the button below to receive our complimentary Practice Pulse checkup that will deliver estimates identifying:

  • Amount of increased practice revenue per year
  • Amount of increased collections per year
  • Amount of increased patient volume
  • Amount of reduced operational costs
Strategic Provider Planning, Specialty Mix

Topics: EHR, Meaningful Use, Medicare, Reimbursement, Physician Recruitment, ICD-10, Operating Costs, Revenue Cycle

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