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2014 PracticeMAtch Educational Conference – March 2 - 5. Obtaining Buy-in from the C-Suite & situational application. 5 Key Steps to Obtain C-Suite buy-in. 3. Situations Requiring c-suite buy-in. Physician Recruitment Employing MDs – PCPs and Specialists

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situations requiring c suite buy in
Situations Requiring c-suite buy-in

Physician Recruitment

  • Employing MDs – PCPs and Specialists
  • Recruiting MDs within an Existing Practice
  • Increasing Retention
  • Formulating Compensation
  • Reducing Turnover

Physician Alignment

  • Partnering with Administrative Leadership
  • Marketing to On-Staff, Not-on-Staff, PCP, and Specialty Physicians
  • Engaging in Projects with Aligned Interests and Skills
  • Developing Performance Based Contract Terms Aligned to Strategic Goals

Behavior Change

  • Increasing Patient Satisfaction
  • Monitoring Costs Per Case – Device, Procedure, and Supply Expenses
  • Providing Dashboards and Performance Metrics
  • Establishing Productivity Standards
  • Standardizing Care Protocols

1. Identify CEO Incentives

2. Determine Pressure Points/Make Life Easier

3. Time Your Requests

4. Show the Supporting Data

5. Outline the Implementation Plan

4

do your homework

Fundraising

1. Identify why this is a worthy cause

2. Describe your needs in less than 3 minutes

3. Find out how this will benefit them

4. Uncover a way that their support can be

mutually beneficial

Do your homework

Professional Sports

1. Research your opponents

2. Know your own strengths and weaknesses

3. Know their strengths and weaknesses

4. Know who is on which team

5. Be prepared to lose for the greater good

identify c suite incentives

ACHE 2007 Compensation Factors Survey

Identify C-Suite INcentives

CEO incentive goals "are changing. They are moving toward a greater balance toward quality and safety, patient satisfaction, employee satisfaction, and finances.“

Richard Umbdenstock, CEO of the American Hospital Association, KHN June 16, 2013

Executive Employment Contracts and Performance Evaluations. CEO Circle White Paper, American College of Healthcare Executives, 2007.

identify c suite incentives1
Identify C-Suite INcentives

CEO Bonus/Incentives (2011-2012)

Profitability/Finance (7X’s)

Quality (5X’s)

Patient Satisfaction (5X’s)

Patient Safety Indicies (Blood inf., pneumonia, mortality) (2X’s)

Performance Goals (2X’s)

Strategy Initiatives

Community Service

Charity Care

Operating Goals

Revenue Growth

Employee Turnover

Expand Health System

Admissions Growth

Research Grants

Notes: [1] Total pay includes benefits unless otherwise indicated; sources include IRS filing, hospital statement, contract and/or incentive sheet. [2] Total pay is base salary and bonus; may exclude the value of benefits; [5] Total pay includes some compensation reported in previous years source: http://www.kaiserhealthnews.org/stories/2013/June/06/hospital-ceo-compensation-chart.aspx

8

physician recruitment
PHYSICIAN rECRUITMENT

Recruit Neurologist to Medical Staff

C-Suite Incentives:

Desire:

Enhance Profitability

Improve Quality

Neurosurgeon New Hire:Salary $690,548Benefits $138,110

Total compensation $828,658

Gross Receivables $2,632,463

- Reimbursement Rate @ 55% $1,447,855

Net Receivables $1,184,608

Net Income $355,950

Patient Safety Improvement:

Door-to-Needle Time in Acute Ischemic Stroke

Source: Becker’s Hospital Review May 2013

9

physician alignment behavior change

Reduce discord among Intvl. Radiologists & Neurologists

Physician alignment/Behavior change

C-Suite Incentives:

Desire:

Improve Patient Satisfaction

Improve Quality

  • Pursue Stroke Center Accreditation
  • Provide aspirational patient satisfaction and quality scores versus internal scores
  • Engage Interventional Radiologists and Neurologists in operational improvement process
  • Identify best practices and protocols
  • Determine roles and responsibilities
  • Establish timelines and critical path
  • Publicly celebrate successes and failures
standardize care protocols

Development process must be collaborative, inclusive, and multi-disciplinary

Start with benchmarking physician peers against their colleagues to identify best practices

Components may be established based on national guidelines, but adapted for the specific hospital

Requires physician input, notification, and training

Data mining – build financial and clinical care management informatics capabilities to measure performance and make changes

Standardize care protocols
source of stress
Source of stress

Climate

  • Hospital 2011 CEO turnover rate was 16%
  • The average hospital CEO tenure is under 3.5 years.
  • 56% of CEO turnovers are involuntary.
  • When a new CEO is hired, almost half of CFOs, COOs and CIOs are fired within nine months.
  • Within two months of a new CEO appointment, 87% of CMOs are replaced.

C-Suite

Stakeholders

Source: ACHE Hospital CEO Turnover 1982–2012

Becker’s Hospital Review Dec 2013

13

simplify the senior executive s day
Simplify the senior executive’s day
  • Study your boss!
    • What does she do poor poorly?
    • What does she avoid?
  • What characteristics does she possess
    • Introverted vs. extroverted
    • Risk-averse vs. risk-seeker
    • Procrastinator
    • Visionary vs. detailed oriented
  • How could you help?
  • Offer suggestions or solve the problem for them!

14

formulate the solution

Listen/read the publicly communicated

goals of the hospital, Board, and MEC

Committees

  • Draw parallels illustrating the alignment of

the proposed initiative with strategic goals

  • Identify an implementation plan of how the initiative can be

achieved

  • Determine the required resources
  • Outline the time commitment required of the Senior Executive
  • Execute the plan
Formulate the solution
physician recruitment1
PHYSICIAN rECRUITMENT

Compensation discussions with MDs

C-Suite Pressure Point:

Resolution:

Develop compensation package checklist for new hires vs. annual reviews

Establish corporate policy that involves a compensation negotiation team – attorney, CMO, Physician Recruitment Director, HR, or recruitment firm

Establish roles and responsibilities for each of the team members

Outline the timeline from offer to start date

16

physician alignment

Establishing Performance-Based Compensation

Physician alignment

C-Suite Pressure Point:

Resolution:

Research and summarize various performance-based compensation packages

Meet with attorney to rank order the most viable options given the organizational culture

Develop communications strategy with marketing to alert Medical Staff to pending compensation changes

Meet with Medical Staff to determine quality targets

Assist with compensation and performance calculations

provide dashboards and performance metrics

Performance

    • Production
    • RVU
  • Salary plus Productivity
    • RVU’s
    • % of Collections
    • % of Billings
  • Salary Plus Bonus on Quality
    • Quality / HCAHPS Core Measures
    • Incent ACOs
  • Track patient satisfaction with providers, nurse satisfaction with MDs, and overall likelihood to recommend
Provide dashboards and performance metrics

Current Productivity Metrics

Productivity Metrics Under ACA

  • Medicare Adj. Cost Per Case
  • Readmission Rates
  • Commercial Adj. Cost per Day
  • Quality/HCAHPS Core Measures
  • Two-midnight Rule
  • Medicare Physician Quality Reporting System (1.5% Medicare penalty begins in 2015)
  • Value-based purchasing
behavior change

Tracking physician performance

Behavior change

C-Suite Pressure Point:

Resolution:

Identify vendors that offer physician productivity and benchmarking software

Develop standardized reports to assess monthly/quarterly progress

Determine triggers for performance review

Establish feedback mechanism

Develop escalation procedures to minimize need for C-Suite involvement

don t focus on the battle win the war

Lessons from the home front

1. Know your opponent

2. Set the stage for a positive response

3. Time your request

4. Provide options

5. Highlight the “win” for them

6. Prepare responses for the rebuttals

7. Make it easy for them

8. Wait for the approval

9. If met with rejection, go back and revisit

at a later date

Don’t focus on the battle - win the war
analyze the environment
Analyze the environment
  • Time of year: budget season, evaluations, Board meetings, fiscal year end
  • Current issues: know the conversations your executive cares about NOW
  • Current strategies: identify the framework by which change is occurring NOW
  • State and National trends: question the future
    • What impact the ACA will have on your organization?
    • How will this impact your physician recruitment, retention and employment strategy?
    • What preparations are needed for 5, 10, and 15 years in the future as a result of payment system, federal mandate, and physician supply/demand needs?

22

it is all about the timing

Schedule a call or meeting when you know they have time to talk

Draft a succinct bulleted agenda with your request, supporting data, how it is aligned with corporate strategies, and what you believe to be the outcomes

Identify if what you are requesting is aligned with broader corporate initiatives or runs counter to them

Help them reach their goals

If you can’t get to the point in less than three minutes, you need to condense

It is all about the timing
physician recruitment2
PHYSICIAN rECRUITMENT

High MD turnover rate

Timing Issue:

Address issues:

Postpone discussions:

Loss of revenue

PCP practice aligns with competing hospital

Specialist driving out competitors in the market

OR case start times delayed

Physician satisfaction is low

Recent implementation of physician productivity-based compensation model

Implementation and adoption of EMR

Purchase of competing practice

24

physician alignment1

MD and C-Suite partnering

Physician alignment

Timing Issue:

Address issues:

Postpone discussions:

Service line planning

Facility design

Supplies and devices

Strategic planning

Quality improvements

Care redesign

Establishing protocols

Merger due diligence phase

Widespread downsizing

behavior change1

Addressing physician safety and quality issues

Behavior change

Timing Issue:

Address issues:

Postpone discussions:

High readmission rate identified

Patient “never event” occurrence

Nursing report of sentinel event

Low HCAHPS patient satisfaction scores

During Annual Review (Initial identification)

During JCAHO review

Upon discovery of state violation

show me the data

Quantify

Quantify

Quantify

Show me the data!!!!

Recruiting a New Doctor

Increasing Productivity/ Reducing Costs

Improving Safety/Quality

Improving Patient Satisfaction

physician recruitment facts
Physician recruiTMENT facts

Costly

CEO Incentives Drive Decisions

  • Attracting and retaining the right candidate is expensive
  • It can cost 2.7 times a physician’s annual salary to find a replacement when he or she leaves increasing the importance of retention. –Feb. 2008, HealthLeaders Media

CEOs who are paid bonuses based on revenue, profit, volume growth are highly motivated by the cost of an absent physician.

Scarce

  • Recruiting physicians in the proper specialties is
  • as important as sufficient MD supply
  • By 2025, a 21% increase physician supply will be needed to meet the market demand (shortage = 159,300 MDs) – 2008 AAMC Complexities of Physician Supply & Demand
  • 65% of respondents mentioned physician shortages as the

largest threat to their hospital-physician alignment strategy.

  • - September 2011, HealthLeaders Media

29

the opportunity cost of delayed hires
The opportunity cost of delayed hires

Loss in MD revenue during recruitment:

“Median annual collections on professional charges range from $390,000 for a primary care physician to $750,000 for an Orthopedist.” - November 2011, Rock Mountain Medical Search & Consulting

30

customer service quality
CUSTOMER SERVICE & QUALITY

Patient Satisfaction

CEO Incentives Drive Decisions

  • Look at comparative physician data to improve patient satisfaction
  • Review Press Ganey, Hospital Compare, and NRC/PRC scores
  • Highlight areas for improvement – “communicated well”
  • Highlight benchmarks

CEOs who are receiving bonuses based on patient satisfaction and safety are highly motivated by the stats of a careful physician.

Safety/Readmissions

  • Look at comparative physician data to improve safety
  • andoutcome scores
  • Check with Hospital Compare physician data
  • Check with your hospital Planning/Decision Support team

31

physician quality improvement
PHYSICIAN QUALITY IMPROVEMENT

Physician Mentoring Strategy. The physician with higher quality scores can work with MD having lower quality scores to develop processes and protocols that would work for the group. This improves scores while securing buy-in from entire team.

Quality/Safety

Patient Satisfaction

  • Look at comparative physician data to improve safety or outcome scores
  • Check with Hospital Compare physician data
  • Check with your hospital Planning/Decision Support team
  • Look at comparative physician data to improve patient satisfaction
  • Check with your hospital planning/Decision Support team
  • Check with your QI team

32

use physcian compare to improve quality
USE PHYSCIAN COMPARE TO IMPROVE QUALITY
  • Physician Compare contains
  • many quality measures:
  • The Physician Quality Reporting System (PQRS)
  • Group Practice Reporting Option (GPRO)
  • Accountable Care Organization (ACO)*
  • *ACO’s can be included in Group reporting if the ACO has 25+ members.
  • Downloadable files are available for 2012 performance data. Group and ACO data provided are for four Diabetes Mellitus (DM) measures and one Coronary Artery Disease (CAD) quality measure.

33

monitor device and supply expenses

Ordering & Procurement

    • Understocking/Overstocking = Additional Expenses
    • Lead time & frequency
  • Storage & Stock Control
    • Inventory management/

Quality control

    • Eliminate waste
  • Care & Maintenance
    • New vs. Old
  • Inventory Optimization Solutions
    • Purchasing group = Pricing leverage
  • Standardization of devices and implants
    • Reduction of preference variability
Monitor device and supply expenses
physician compare
PHYSICIAN COMPARE

Source: PhysicianCompare.gov

35

outline the implementation plan
Outline the implementation plan

Executive Timeline

Your Timeline

  • One page
  • High level
  • Show the goal
  • Identify participation points

… create process flowchart

… highlight problems from recent hires

… get input from key employees

… identify bottlenecks and determine how process streamlining can occur

37

outline hospital employment procedures
Outline hospital employment procedures

Map Areas Involved in Physician On-boarding

Src: NJSAMSS 19th Annual Education Conference April 12, 2012

conclusion
conclusion

5 Key Steps to Obtain CEO Buy-in Include:

39

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