New Physician On-BoardingThe Physician Has Signed, Now What?

Sean Duffy, Director of Physician RelationsGeisinger Health System

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Geisinger Health System Snapshot Integrated health service organization in rural Pennsylvania Serve over 2.6 million people in 44 “rural” counties of PA Over 21,000 employees 1,100 member multi-specialty practice 8 hospital campuses 2 research centers 467,000 member health plan (GHP)

* Founded by Abigail Geisinger 1915 – “Make it the best”

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Successful Physician Recruitment On average, Geisinger recruits 150 new physicians every year

• Primary Care• Specialty

Each physician is categorized for ramp-up planning• Level 1 – Priority, high revenue generating specialist• Level 2 – Specialty physician, non priority• Level 3 – Non-referral base specialist• PCP

Strategies for every level

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Success in Recruitment, Failure in Productivity

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BACKGROUND/HISTORY OFGHS RAMP UP PROGRAM

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Terminology Ramp Up – On-boarding

McGladrey – scale used to track revenue produced by physicians

RVU’s – unit of revenue

60% on McGladrey – the point in which a provider is generatingenough RVU’s to pay for their total comp.

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Ramp Up – Introduction Physician Ramp Up is defined as the act of building business for

newly hired physicians to expedite their profitability for the healthsystem.

On average, Geisinger recruits 150 new physicians each year. As a result, it is important to ensure new providers are productive

and generating revenue as quickly as possible. A successful physician ramp up for a new physician is to reach the

60%ile McGladrey in 6 months or less.

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FY11- Present4

months

FY106

months=

$SAVINGS$

FY099

months

We’ve improved year-over-year

8

FY0818

months

Program started

FY11- Present

4months

FY10

6months

=$SAVINGS$

o

Impact of Successful Ramp Up - $$$$$

9

Formula:• 6 month ramp up means an

automatic cost savings to thesystem of $60k per provider

• Each month a provider rampsup prior to 6 months, equalsan additional $5k per monthon top of the $60k

Cost Savings Since FY10

• $20,600,000

What Did We Learn?New physicians weren’t seeing patientsuntil month 2 and sometimes month 3

• Templates were not open• Orientations were complex, therefore,

additional ADM time was grantedMarketing/Physician Relations strategiesoften didn’t start until month 2 or 3

• Could not market or promote without details ofpractice

Market data was not used until werecognized a slow ramp-up

• Critical mistakeNew physicians thought patients wouldsimply be knocking on the door to get in

• Lack of Engagement

Scheduling Services Issues• Unaware of new physician start

dates/locations• No authority to manipulate physician

templates• 100 page scheduling guidelines

New physicians were being utilized foroutreach locations

• Takes months to ramp up an outreach site• Some sites were an hour drive to and an hour

drive backIncorrect benchmarking of new physicians

• Incorrect ratios of research vs clinic, etcInsufficient EHR training led to encountersnot being closed

• Cannot bill for services

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Constructing A Successful Program Understand your current situation

• What and where are the shortcomings for successful ramp-up?• What is your compensation model?• How long is it currently taking you to ramp-up new physicians?• How much money are you throwing away?

Determine what resources you will need to build your program• FTE’s• Data• CFO’s confirmation of where the break even point is in the comp model• Service Line buy in• Business Development support

Draft a proposal to outline program and intended results• Show examples of how a successful ramp can save the system money• Show how much it costs to recruit new physicians

Gain approval from Executive Leadership

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It Takes a Village – Integration Recruitment Credentialing Physician Compensation

• Generate McGladrey Reports Strategy and Business Development

• Manage the Data• Construct Scorecards for Quarterly Monitoring

of all Priority Service Lines Scheduling Services

• Front door• Must be aware of new providers

Service Line Leadership• Readiness• Simplification of scheduling guidelines• Manage backlogs

Service Line Marketing• Consumer strategies

PR• News Releases• Stories

Physician Relations• Most effective tactic in new provider ramp-up

New Provider• Make sure they are engaged

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New Provider Ramp-Up Team Acts as the Quarterback Facilitates A-Z

• Receives notification of signed providers• Facilitates process

• New provider interviews• Data pulls• Plan development• Checklist management• McGladrey monitoring• Flagging and follow-up (example on Slide…)• Post Ramp-Up tracking• Data justification

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Physician accepts offerPhysician accepts offer

Marketing, Business Development,OPS leader meet

Marketing, Business Development,OPS leader meet

Marketing and Business Development callnew physician (60-120 days before start)

Marketing and Business Development callnew physician (60-120 days before start)

MarComm materialsare created

MarComm materialsare created

Physician/Liaison visitsscheduled

Physician/Liaison visitsscheduled

Physician startsPhysician starts

Marketing works with Operations team to ensure newtemplates are created, pre-employment paperwork is

complete, roadblocks are removed, schedulingservices is aware (30-60 day)

Marketing works with Operations team to ensure newtemplates are created, pre-employment paperwork is

complete, roadblocks are removed, schedulingservices is aware (30-60 day)

Marketing IDs audiences, messages,tactics, and drafts plan

Marketing IDs audiences, messages,tactics, and drafts plan

Business Development IDs marketopportunities

Business Development IDs marketopportunities

Ramp Up plan presented to Ops andBusiness Development

Ramp Up plan presented to Ops andBusiness Development

Physician SignsNow What?Physician SignsNow What?

Data

Level 1 and 2

Physician Starts, Now What?First three months are critical to meeting the 6 month target

• Month #1 – Operational Readiness is Number 1 Priority Have templates been assisted by backlogged appointments OR block time appropriate? EMR training scheduled Operational on-boarding, system orientations, physician liaison visits, deployment of PR and Marketing plan Productivity at a minimum, but templates are filling with backlogged appts.

• Month #2 Full templates, continued relationship development activities, monitoring of referral sources Productivity increasing, but not jumping off page

• Month #3 McGladrey score should see a spike, procedures in full swing First phase of official referral tracking Follow-up meeting with provider and operations to review data

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Keeping an Eye on Progress Monitor McGladrey scores monthly to assure progress

• Flag stagnant ramp-up – Contact Ops immediately to make aware/determine issues Establish check in points to review referral data/referring providers, and new

physician feedback• 90 days (end of 3rd month)

Compile referral data for review Consult with scheduling services to assure all roadblocks have been removed Review completed tactics (marketing, physician relations) Set goals for next 90 days

• End of 6 months Did we hit the 60% within this time period? Repeat referral data review to seek increased volumes and expanded list of referring physicians Determine if additional marketing and physician relations activity is needed

• End of 12 months Complete ramp-up data justification report (break out of referral volumes) Determine overall physician engagement and set expectations for next 12 months

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Ramp-Up Phase 2 – Tracking Productivity

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Physician's NameSta

rt Date

Depart

ment

Decem

ber A

ctual

Q1-Mon

th 1 A

vg

Q1-Mon

th 2 A

vg

Q1-Mon

th 3 A

vg

Q2-Mon

th 1 A

vg

Q2-Mon

th 2 A

vg

Q2-Mon

th 3 A

vg

% C

hange

Notes

FY14

Garg, Tullika 7/1/14 Urology46% 6.0% 45%* 40.0% 69.0% 59.0% 55.0% -4.0%

Hit the 60%ile in month 2 actual with 86%

Correll, Cynthia 7/7/14 Neurology92% 0.0% 0.0% 87.0% 100.0% 100.0% 100.0% 0.0%

Mehra, Vishal 7/7/14 Cardiovascular3% 18.0% 42%* 19.0% 89.0% 71.0% 44.0% -27.0%

Hit the 60%ile in month 2 actual with 61% - 1 week PTO

Ramakrishnan, Pankajavalli 7/9/14 NeurologyEndovascular GNE 100% 0.0% 0.0% 2.0% 56.0% 79.0% 86.0% 7.0%

Jones, Clayton 7/14/14 Cardiology - EP61% 0.0% 0.0% 12.0% 55.0% 45.0% 52%* 7.0%

Hit the 60%ile in month 6 actual with 61%

Buzas, Christopher 8/1/14 Colon and Rectal SurgeryGWV 20% 0.0% 0.0% 27%* 72.0% 42.0% -30.0%

Hit the 60%ile in month 2 actual with 100% - 2 weeks PTO, 3 Eddays

Rapp, Megan 8/1/14 General SurgeryTrauma 70% 35.0% 65.0% 76.0% 79.0% 74.0% -5.0%

Bell, Stephen 8/4/14 CardiovascularLewistown 58% 0.0% 18%* 63.0% 78.0% 71.0% -7.0%

Hit the 60%ile in month 2 actual with 78%

Mori, Ryan 8/4/14 Urology29% 0.0% 9.0% 28%* 34.0% 32.0% -2.0%

Hit the 60%ile in month 2 actual with 71%

Noble, Elizabeth 8/4/14 DermatologyMohs Surgery 58% 75.0% 67.0% 75.0% 84.0% 69.0% -15.0%

Shah, Nihar 8/4/14 Hepatology91% 0.0% 1.0% 3.0% 2.0% 36%* 34.0%

Hit the 60%ile in month 5 actual with 91%

Purdy, Nicholas 9/8/14ENT

50% 0.0% 0.0% 13%* 50.0% 37.0%Hit the 60%ile in month 3 actual with 63%

Harlor, Evan 9/15/14 ENTState College 79% 0.0% 16%* 21.0% 79.0% 58.0%

Hit the 60%ile in month 2 actual with 62%

Holland, Neil 10/1/14 NeurologyDirector, GNE 91% 27.0% 55%* 79.0% 24.0%

Hit the 60%ile in month 2 actual with 78%

FY14

Ramp Up – Phase Two: Mapping Productivity

• Having a clear understanding of how a providerhas ramped up will allow for ramp up strategyjustification.

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Physician's NameStart D

ate

Depa

rtmen

t

Decem

ber A

ctua

l

Q1-M

onth 1 Avg

Q1-M

onth 2 Avg

Q1-M

onth 3 Avg

Q2-M

onth 1 Avg

Q2-M

onth 2 Avg

Q2-M

onth 3 Avg

% C

hange

Notes

FY14

Buzas, Christopher 8/1/14 Colon and Rectal SurgeryGWV 20% 0.0% 0.0% 27%* 72.0% 42.0% -30.0%

Hit the 60%ile in month 2 actual with 100%

FY14

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Practice 8.1 - 11.1 11.1 - 2.13ANDRES, CHRISTOPHER D 2 0BLUM, RICHARD H 0 2Bobeck Med Assoc Sugar Notch 1 0CAMPANELLA, JOSEPH A 0 20CHILSON, TERRANCE SCOTT 2 1Cognetti & Conaboy Fam Prac Scranton 0 3COX, HOWARD J 0 1David Perrone Taylor 1 4DECKER, GARY R 0 2Endless Mtns Hlth Sys Montrose 1 1ENGLISH, RICHARD B 1 1Eugene Gorski Sugarloaf 0 1Exeter Township Med Ctr Falls 1 2Fam Prac Dallas 2 4Fam Prac Hanover 0 2Fam Prac Hazleton 1 1GALVAO, LUIZ FELIPE 0 2GERNHARDT III, ROY W 0 2Greentown Med Ctr 2 2Hart Med Ctr WB 0 1HENDERSON, DONALD WARREN 2 1Highland Phys Honesdale 3 0Hlth Ctr Shickshinny 0 1Int Med Assoc Hazleton 0 1InterMnt Med Grp Nanticoke Washington St0 2Intermountain Med Grp River St Wilkes Barre2 3Intermountain Med Grp Shavertown 2 2InterMtn Med Grp Blakeslee 13 6InterMtn Med Grp Kingston 7 3InterMtn Med Grp Nanticoke S Market St0 4InterMtn Med Grp Scott St WB 0 1InterMtn Med Grp W Pittston Luzerne Ave0 4InterMtn Med Grp W Pittston Wyoming Ave0 3Irene Lucas MtTop 1 0J Charles Lentini WB 0 1Joyce Vrabec Blakeslee 2 0Lackawanna Med Grp Scranton Smallacombe3 3LENCZEWSKI, BRIAN C 0 3LUBINSKY, CYNTHIA L 0 1LYONS, MARK J 0 1Med Assoc Pittston 5 0Med Assoc Pittston 5 2Monroe Noxen Hlth Ctr 1 4MURRAY, PATRICK M 0 2Phys Care Meshoppen 0 2Physicians Health Alliance Carbondale 0 5PRINCE, SCOTT STEVEN 1 1RICKARD, MELISSA L 2 1SAVAKINAS, SHARON M 0 1SECHERESIU, ADRIAN 1 1SHAH, GOPAL 1 2SHEERER JR, JAMES A 0 2Silvercrest Waymart 2 0STANISH, STANLEY M 3 0TAYOUN, PAUL JAMES 2 5VA MED CTR WILKES BARRE 3 3WILLIAMS, KEVIN GEORGE 0 1

Buzas 1st 90 days 2nd 90 days TotalCPSL 233 326 559Geisinger 38 84 122Non-Geisinger 74 124 198

Practice Number of ReferralsANDRES, CHRISTOPHER D 2Bobeck Med Assoc Sugar Notch 1CHILSON, TERRANCE SCOTT 2David Perrone Taylor 1Endless Mtns Hlth Sys Montrose 1ENGLISH, RICHARD B 1Exeter Tow nship Med Ctr Falls 1Fam Prac Dallas 2Fam Prac Hazleton 1Greentow n Med Ctr 2HENDERSON, DONALD WARREN 2Highland Phys Honesdale 3Int Med Assoc Hazleton 1Intermountain Med Grp River St Wilkes Barre 2Intermountain Med Grp Shavertow n 2InterMtn Med Grp Blakeslee 13InterMtn Med Grp Kingston 7Irene Lucas MtTop 1Joyce Vrabec Blakeslee 2Lackaw anna Med Grp Scranton Smallacombe 3Med Assoc Pittston 5Monroe Noxen Hlth Ctr 1PRINCE, SCOTT STEVEN 1Raphael Kon Tunkhannock 3RICKARD, MELISSA L 2SECHERESIU, ADRIAN 1SHAH, GOPAL 1Silvercrest Waymart 2STANISH, STANLEY M 3TAYOUN, PAUL JAMES 2VA MED CTR WILKES BARRE 3

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Non Geisinger Referrals by Practice

+55%

Ramp Up – Phase Two: Tracking ROI

• What is the return on investment for new patients* referred toLevel One and specific Level Two specialists from referringproviders that specialist was actively marketed to?

* New patients defined as never having been treated or not treated for 3 or moreyears at a Geisinger facility.

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Example: Christopher BuzasTotal number of new patients* from providers actively marketed to: 43ROI: $1,283,283

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