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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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2014 PracticeMAtch Educational Conference – March 2 - 5

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2014 practicematch educational conference march 2 5

2014 PracticeMAtch Educational Conference – March 2 - 5


Obtaining buy in from the c suite situational application

Obtaining Buy-in from the C-Suite & situational application


5 key steps to obtain c suite buy in

5 Key Steps to Obtain C-Suite buy-in

3


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


2014 practicematch educational conference march 2 5

Identify CEO incentives


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


2014 practicematch educational conference march 2 5

Determine pressure points


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


    2014 practicematch educational conference march 2 5

    Time your requests


    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


    2014 practicematch educational conference march 2 5

    Show the supporting data


    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


    2014 practicematch educational conference march 2 5

    Outline the implementation plan


    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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