Strategic Initiatives on Physician-Hospital Alignment Fact and Fancy an Insider’s Perspective
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Transcript of Strategic Initiatives on Physician-Hospital Alignment Fact and Fancy an Insider’s Perspective
Strategic Initiatives onPhysician-Hospital Alignment
Fact and Fancyan Insider’s Perspective
Becker's Hospital Review 5th Annual Meeting
Ronald N. Riner, MDPresident and CEO
May 17, 2014
“When you come to a fork in the road – take
it.”- Yogi Berra
“You should never cease from exploration, and at the end of all exploring
you arrive where you started and know the place for the very first
time.”- Little Gidding, T.S. Eliot
2002 2005 2008 2011
100%
75%
50%
25%
0%
Source: Physician Compensation and Production Survey, Medical Group Management Association, 2011 Survey
Private versus hospital-owned practices, 2002-2011
Physicians in hospital-owned practices
Physicians in private practice
Changing Employment Dynamics
Facts
Majority of physicians and other healthcare providers are focused on delivering high quality and safe care
Despite common purposes, many healthcare systems and hospitals struggle to involve physicians in organizational leadership, strategy, quality and safety efforts
Need to get real about finances IncentivesCost of rules and regulationsFinancial metrics of acquired practices
Value – from all perspectives is not well appreciated
Rules and Regulations
Top Challenges Reported by US Physicians
91%
88%
83%
77%
90%
84%
78%
73%
Managing shifting reimbursement models with payers
Financial management of their practices
Patient engagement; spending time with patients
Dealing with the impacts of the Affordable Care Act
Keeping up with the latest research
Improving patient care
Using health information technology in the practice
Managing increasing patient volumesSource: Wolters Kluwer Health, 2013 Physician Outlook Survey
Thursday, February 13, 2014
Rationale
The Employment Carrot
Port in a storm Course of least resistance Possible coordinated care
Employed MDs
Who?
Why?
Where?
What’s it like inside the tent?
How are they doing?
Key Points
Where professionals are in their careersExit strategy for older physicians
Gender
Happiness is a “relative issue!”
Challenges to Physician Employment
Employer – employee relationship Accountability Transparency Scientific cynicism Engagement Credibility of the leadership Followership
Leadership
The Concept of Entrepreneurship
Philosophical Concerns
20132014201520162017201820192020
Short Term vs. Long Term
2013
Professional Concerns
The ability to innovate
Stifling bureaucracy
Transformation from profession to a “job”
Theory vs. pragmatism
Ideology vs. reality and experience
Loyalty
Finances: Not the glue
Key: Purposeful, Challenging Work
MissionVisionValues
Trust
Issues
Talent
Issues
“Go and do likewise.”Luke 10:37
A Calling? A Job?
Hospitals
View the world from their vantage point – still!
Bricks and mortar don’t practice medicine or deliver care
Hospital acquisitions lead to higher prices and the amalgamation of additional cultures
Clinical Integration
What’s the objective?
In many instances just buying revenue streams or attempting to guarantee a distribution channel
Nota Bene!
Hospital and medical practices are different businesses
Different metrics
“It takes an endless amount of history to make even a little
tradition.”- Henry James
Key Question
Are Mayo Clinic, Cleveland Clinic and the large staff models
applicable to your environment?
Importance of Culture
Decades to build
Often absent in small business other than in presence of founders
In established and stable systems, reflective leadership and training
Management Motif
Professional Service Firms Plant Management
Medical practice Factories
Accounting Hospitals
Law Practice Hotels
Management: Cultural Difference
Medical PracticeHospital
(Plant Management) Values autonomy, trained to
work independently and take ultimate accountability
The need for quick decision-making – sometimes life and death in the balance
Resistant to hierarchy Trained in biomedical sciences,
clinical expertise Seeks consensus in group
decisions
Trained to delegate and work in groups, embraces the collective mission
Deliberate decision-making Hierarchy is key to success Trained in management, social
sciences Respects top-down hierarchy
when making decisions
Adapted from: Nathan Laufer, MD, “The employment of doctors by hospitals-indentured servitude or practice salvation?”
Leadership Skills & Management Motifs
DifferentProfessional Service Firms Plant Management
Medical practice Factories
Accounting Hospitals
Law Practice Hotels
MedicalPractice
Hospital and Health System
Transferability
Value =Quality
Cost
Evidence-based care
Appropriate use criteria
Outcomes
Readmissions
Patient/associate/ physician satisfaction
Leadership capabilities
Current Lexicon
Value
Value =Quality
Cost
Degree of autonomy
Purposeful and meaningful work
Supportive, knowledgeable colleagues
Trustworthy systems
Quality focused knowledgeable support staff
Satisfactory compensationCredible leadership
Learning environment
Quality of life (balance)
Professional Perspective
ValuePatient’s Perspective
Value =Quality
Cost
Meeting expectations with outcomes
Physician communication
Easy access
Friendly, caring staff
Reasonable cost
ValueHospital/Health System Perspective
Value =Quality
Cost
Favorable managed care and payor relationships
Highly productive clinicians
Positive revenue streams
Coordinated (? integrated) care
Safe, quality focused care
Market leader status
“The next morning the sun was behind a cloud, but they
started on, as if they were quite sure which way they
were going.”“If we walk for enough” said Dorothy, “we shall sometime
come to some place, I am sure.”
- The Wonderful Wizard of Oz, L. Frank Baum
Fallout if Done Poorly
Fallout for Physicians
Fallout for Payors
Fallout for Hospitals
Fallout for Patients
Concerns That “You” Should Worry About Digital world realities
The importance of “thick data”
Burn out Loss of excitement and professional
satisfaction Quality
For patientsFor the institutionsFor those providing the careFor yourselves and your families
LeadershipFocusing on Results
“But you have not yet told me how to get back to Kansas.”
- Dorothy, The Wonderful Wizard of Oz
Leadership
"Do you think Oz could give me courage?“ asked the Cowardly Lion.
"Just as easily as he could give me brains,“ said the Scarecrow.
"Or give me a heart,“ said the Tin Woodman.
"Or send me back to Kansas,“ said Dorothy.
The Complexity of the Task
- L. Frank Baum The Wonderful Wizard of Oz, Author
Leadership
Adaptive leadershipFocused on building skills needed for new know howDifferent than leadership charged with
organizational challenges
The power of collaboration Long-term focused
Leadership
InnovationEvidence-based medicine
Best practices
Guidelines
Why People Fail to See the Changes Occurring
They choose to ignore or accept
changes in the external
environment
Issues
Alternative payment mechanisms Transformation of place of delivery of
health services Who should deliver care The importance of an energized,
creative, quality-focused healthcare workforce
“It was a lie but he believed in telling lies to people. Truth telling and medicine just didn’t go together except in dire emergencies, if then.” - Mario Pruzo, The Godfather
Future Think value Do you need to own all? Should you? Can you? Understand the business metrics and leadership
requirements of the different businesses The talent is the asset:
Science and businessCredibilityExperience
Leadership focusedThe power of credibility
Quality and safetyMultidimensional
The Brass Ring
The Brass Ring
Harmony
A Brief History of Medicine
2000 BC “Here, eat this root.”
1000 BC “That root is heathen, say this prayer.”
1850 AD “That prayer is superstition, drink this potion.”
1940 AD “That potion is snake oil, swallow this pill.”
1985 AD “That pill is ineffective, take this antibiotic.”
1989 AD “Managed care will correct all that ails us.”
1995 AD “Managed care could be dangerous.”
2000 AD “Antibiotics are artificial; here, eat this root.”2010 AD “Value is finally upon us . . . as are monumental rules,
regulations, requirements …”
2014 AD “Obamacare is 4 years old … here, say this prayer with this potion!”
“The comic and the tragic lie
inseparably close, like light and
shadow.” - Socrates
“In the end, only three things matter: how much you loved, how gently you lived, and how gracefully and effectively you let go of things not meant for
you.” - Buddha
Somewhere over the rainbow . . . . .
. . . . . an unending journey