What are you thankful for professionally?

By: Kimberly Buser, Partner
JHD Healthcare Partners

The other day I was stopped while walking in the Boston Public Garden by a news crew asking the typical fall question “What are you thankful for?” I answered with the cliché answer of “the opportunity to live in Boston, friends and family,” but the question has stuck with me in the form of “what am I thankful for professionally?”

As administrators of healthcare organizations, EBITDA, length of stay, staying ahead of the competition, dealing with patient complaints, keeping up-to-date on all the changes happening around us, and figuring out how to engage physicians fill our workdays … and sometimes our nights and weekends.

If we’re honest, engaging physicians is central to financial viability, ensuring positive outcomes, and having happy patients. While physicians were trained to care for patients, the business of healthcare is forcing them outside of their comfort zones – and training. All the changes and uncertainties in the industry are bogging them down, and, in some cases, discouraging them to the point where many feel they are in a “thankless” job. In fact, a 2016 Merritt Hawkins Survey for the Physicians Foundation, revealed that 49% of physicians always or often experience feelings of burnout, and 63% feel very or somewhat negative about the future of their profession.

The truth is that physicians are imperative to our livelihoods. As we enter this time of thanksgiving, let’s take some time to actually write each physician a thank you note – not send a generic email. Yes, this sounds archaic and how in the world can you write so many handwritten notes for all the physicians on your medical staff.  But, didn’t you smile and think fondly of the person who last mailed you a thank you note? Here are some tips to succeeding at thank you note writing:

  1. Set a deadline – Having the cards arrive by Thanksgiving would be ideal, but you may have to give yourself until Dec. 1, and first-class mail takes three days to arrive to its destination.
  2. Split up the work – get all the C-suite, directors and managers to take a few names of the physicians they know and work most closely with … or maybe the ones most difficult to work with. This way the message can be more personalized.
  3. Set a daily or weekly goal of how many notes you will write to meet the deadline.
  4. Have a signing day – think back to primary school days where you would have yearbook signing party at the end of the year. Bring lunch in, gather all the leadership team and start signing your name to all the notes.

Melody Beattie once said, “Gratitude turns what we have into enough, and more. It turns denial into acceptance, chaos into order, confusion into clarity … it makes sense of our past, brings peace for today, and creates a vision for tomorrow.”

A little thank you note is a big step forward to the vision of having physicians who are happier coming to work each day, more collaborative, and accepting of change.

I hope each of you has a Happy Thanksgiving!

Avoiding Data Dumptrucking, Part Two

Data CelebrationBy Cliff Gallagher, Partner, JHD Healthcare Partners

Perhaps you read my blog on data dumptrucking, and see similarities in your organization. Now, let’s look at steps you can take to steer clear of this fate.

Simply put, data dumptrucking is the process of being handicapped by the very data that is supposed to bring you clarity.  Whether it’s because of the sheer volume of data or that the same data is pulled and used differently across the organization, more data can sometimes mean more trouble. When you’re converting to a new EHR/PM system, that trickle of data suddenly becomes a waterfall of data, and you find yourself with no life preserver.

Establishing a central repository for the data is key to overcoming these issues – or one department responsible for “owning” the data (creating and pulling reports, checking for accuracy, running requested numbers, etc.).  Here are a few other tips to avoid data dumptrucking in your organization:

  • Fully understand the system’s capabilities.
  • Have a rigorous process that defines what you are looking for in your reporting.
  • Consistently ask yourself, does the data even make sense?
  • Collaborate with key stakeholders on what data is most beneficial to decision making, and how can be used effectively.
  • With the new system, clearly define 20 or 30 reports your organization needs and establish a clear process of building them and testing them. Don’t just expect the system to “go” or that the way your old system did things is easily convertible to the new system.

A few items to keep in mind during the transition:

  1. The ability to get more information out of this new system will be worth it once the system is designed the right way for your organization.
  2. The data will help to more effectively achieve the Triple Aim — reduce costs, improve quality and make patients happier.
  3. This is a change management effort, which means what might have worked before isn’t going to work in the future. This is an opportunity to evaluate what was done in the past and improve it to be better at delivering the best care possible to patients.
  4. Once it’s up and running and humming correctly, the system should easily automate functions — from data entry to data analysis, this new data will allow for faster decision-making and quicker reaction to necessary changes.

It’s also important to be critical of data in the beginning.  Once it’s accurate, it needs to be repeatable, reproducible, and pushed out often.

We have helped organizations successfully transition systems and develop the right data and reporting methodologies that mitigate losses in revenue and gaps in care. Let’s talk about how we can put our expertise to work for you.

Cliff Gallagher is a partner with JHD Healthcare Partners who leads the Practice Co-management service line. Contact JHD Healthcare Partners today to find out how you can avoid data dumptrucking in your organization.  www.jhdhp.com

‘Data-driven’ Doesn’t Mean ‘Data Dumptrucking’

By Cliff Gallagher, Partner, JHD Healthcare Partners

Healthcare organizations are undergoing extensive changes in order to compete successfully in a world driven on integration and quantitative metrics.  They have made significant investments in integrated technology systems – Cerner, Epic, etc. – and now they need to make business decisions tied to data. As data pours in from every corner, they should be able to make informed, clear decisions based on strong, empirical evidence now, right?

Perhaps you have heard the phrase: “Be careful what you wish for – you just may get it”?

In many cases, the plethora of good data becomes an albatross choking a system’s ability to use that data as it intended. Being able to discern good data from bad helps avoid the situation we call “data dumptrucking.”  Just because there is more data doesn’t mean it’s the best data.

To avoid the dreaded data dumptrucking, I recommend establishing a foreman for the data.  One team should be responsible for pulling and managing the data instead of each department running their own reports.  This department is responsible for creating, running and validating reports.  All data comes from one department. Reports should be carefully created and managed, and access to the creation of these reports should be thoughtfully determined beforehand.

Don’t let the incredible amount of new data that your system generates leave your health system gasping for air under a pile of worthless statistics.  Schedule a complimentary 30-minute consultation now to find out how you can make data work for you.

Cliff Gallagher is a partner with JHD Healthcare Partners who leads the Practice Co-management service line. Contact JHD Healthcare Partners today to find out how you can avoid data dumptrucking in your organization.  www.jhdhp.com

Medicare announces a new program to pay primary care practices for managing their own patients

On April 11, 2016 CMS announced Comprehensive Primary Care Plus (CPC+), a significant advancement of an earlier program known as CPC that was launched in 2012.

The new initiative is open to primary care practices that do not participate in other types of comprehensive care programs such as ACOs, including MSSPs.

A unique feature of CPC+ is that CMS wants to include other types of health insurance plans, in addition to Medicare, to participate so that the majority of a practice’s patients are covered.  This will reduce the complexity for participating practices and will create enough of a critical mass to make participation viable.

The CPC+ design is intended to provide partial up-front funding, added to FFS payments, and backward looking quality performance rewards to practices who actively manage the health of a panel of patients.  Many details have yet to be explained, but the Medicare component will contain two Tracks.  Track 1 is intended for practices who want to develop comprehensive care capabilities.  It is less demanding than Track 2, but also comes with lower $PMPM and performance rewards.  The prospective $PMPM will be risk stratified under both Tracks, with the methodology still to-be-determined.  As an example, under Track 1, a primary care practice with an average risk score will receive:

  • Full FFS reimbursement, billed as usual
  • Plus, a $15 PMPM, paid in advance
  • Plus, up to $2.50 PMPM based on quality performance

For a practice with 300 Medicare beneficiaries, the $PMPM payments could amount to $63,000 per year on top of any FFS dollars received.

Track 2 is designed for PCPs who are already advanced in their PHM efforts.  Compensation under Track 2 follows a similar structure, but the amounts have been increased to reflect the additional effort and resources needed.

Commercial and other health plans will need to develop their own parallel programs and coordinate with CMS so that practices can achieve economy of scale by including most, if not all, of their patients.

The next step for the CPC+ program is for CMS to receive applications for participation from insurance in order to define the participating regions.  The regions will be announced in June.  At that time practices who are in a participating region can submit their applications.   Participating practices will be announced in October.

Find out more at http://bit.ly/1sAdIfm.




Physician Revenue Cycle: A Key to Successful Integration

By Kelvin Drawdy, Director, JHD Healthcare Partners

As hospitals and health systems take steps to develop sustainable relationships with physicians, they are increasing physician practice acquisition and physician employment.  Effectively integrating the revenue cycle should be a top priority because it not only affects the financial performance of the health system, but may also affect the physicians’ compensation, and their satisfaction.

The Healthcare Financial Management Association defines revenue cycle as: “All administrative and clinical functions that contribute to the capture, management, and collection of patient revenue.” In other words, from the point of first patient contact to final payment and settlement of the claim. Each of the following functions must be performed for the revenue cycle to be effective – and must be prioritized as part of the integration of new physicians and practices.

  • Pre-Visit/Pre-Service Processes
  • Front-End Process at Time of Service
  • Encounter – Patient Services
  • Billing
  • Third Party Claims
  • Payment Processing
  • Patient Collections

There are challenges to successfully integrating the revenue cycle functions of the newly acquired practice into the health system and gaining the trust of the physician that the revenue cycle is working.   Efficiencies can be achieved working in a large health system, but if not executed well there is a risk of losing the physician’s trust and lowering the patient’s satisfaction.

If the physician revenue cycle isn’t meeting expectations, this could be an indicator the health system has issues integrating the physician revenue cycle or that it is not effectively prioritized or managed as part of the overall system.  Timely recognition and resolution of these issues will keep physicians and patients happy, and improve the health system’s financial results.

Let’s discuss how your health system is managing the challenges of your physician revenue cycle.

Kelvin Drawdy is a director with JHD Healthcare Partners.  For a complimentary assessment, please visit JHDHealthcarePartners.com.

Yes, PHM Can Get You Paid

Stethoscope and cash sm

Skip Leavitt, PA, MBA, FACMPE

The case for effective population health management couldn’t be clearer. But still there is great reticence on the side of providers and health systems, many of whom believe that adding PHM activities will threaten fee-for-service revenue. They want to be able to increase quality and lower costs for their patients, but there are some commonly held concerns that don’t have to be true:

  • Myth 1. If they are successful with their PHM, then their fee-for-service revenue will drop, and it will drop faster than value-based revenue increases.
  • Myth 2. The tech cost will be very high and they think they have to pay for the technology up-front.

Here is what organizations that have been successful at a transition to PHM have figured out: There are activities documenting a track record of increasing quality that are also reimbursable under the current fee-for-service system.

Let’s take, for example, Chronic Care Management (CCM), which Medicare has just put in place.

If a provider has a Medicare patient who meets CCM criteria, they can get paid $42 per month per person for care coordination, which can be done by non-physician staff, such as an office nurse.  For a typical internist, who has 500 Medicare patients, that’s $21,000/month for doing care coordination. And that’s just one example.

By appropriately documenting the care coordination done for those patients, providers can build their record.  Also, it’s been shown practices doing chronic care management experience a higher rate of Medicare patients coming in for annual medical evaluation — which increases the compliance with the wellness evaluation.

Many practices would like to do care coordination, but are overwhelmed by the day-to-day issues of running the practice. Becoming part of a clinically integrated network can provide the needed expertise and resources at minimal cost.

Another example to show how PHM can get you paid is closing care gaps. We know most patients don’t get the preventive care they need; typically, less than half of the patients get the recommended preventive care measures. Simply identifying those patients, bringing them into the office, and arranging for preventive care increases FFS volumes and also increases the documented improved quality of care.

PHM can be game-changing for your practice, if you’re willing to make a few changes. Don’t let the misconceptions about transitioning to value-based care hold your practice back.  Not only can you set your practice up for success in this new healthcare landscape — but also increase your revenue during the change-over.

Skip Leavitt, PA, MBA, FACMPE, has more than 25 years of healthcare management experience, including clinical and executive positions in both the provider and payor sectors. On the leadership team of JHD Healthcare Partners, Mr. Leavitt puts that expertise to work helping physicians, hospitals and health systems succeed.

Cowboys and Pit Crews: Change is Here

by John H. (Hank) Duffy, founder, JHD Healthcare Partners

shutterstock_240686083.jpg pit crewA few years ago, New Yorker magazine published a commencement address from Atul Gawande, a surgeon, writer, and public health researcher, who spoke to students at Harvard Medical School. Dr. Gawande made the very insightful remark that today’s medicine doesn’t need “cowboys,” the lone rangers who do everything themselves. Rather, in today’s medical environment, you want the patient to be surrounded by a “pit crew” — several medical professionals collaborating on how best to care for one person. Never before has the industry experienced such a dramatic shift in ideology, and culture change it requires.

The public’s experience is that while we have amazing technology and highly trained clinicians, there is little consistency with doctors and technology coming together to provide an actual system of care, from start to finish. We train, hire, and pay doctors to be cowboys. But it’s pit crews people need.

The solution to rallying the front lines around this new methodology is aligning incentives — creating frameworks for success where the physicians are incented to team, to look at clinical quality, to manage clinical costs, and to be patient-focused.

With the healthcare landscape shifting from a pay-for-service model to one based on accountable care and qualitative patient outcomes, the way physicians are incentivized and compensated needs to change in step with what the market is dictating. Physician compensation is a major issue in this transition. At one extreme, physicians are suspicious about changes in their income. At the other extreme are legal regulatory issues related to compensation.

The reality is that no matter how you configure it, any successful physician compensation plan needs to be built around 5 pillars:

  1. It (still) needs to be volume- or productivity-related. Within this are two components that must be artfully balanced: panel-sized — how many patients the physician is responsible for; and how many encounters (wRVUs) — how busy is the physician?
  2. It needs to require demonstrated clinical quality. This can be broken down into two parts. First, are the patients being given the right protocols (pap smears, vaccines for children, and best-practice processes for illnesses)? Secondly, are they staying out of the hospital and living longer?
  3. It should include clinical cost management. There is a saying that the most expensive item in healthcare today is a pen: the pen that writes multiple MRI screens, multiple pharmaceutical scripts, multiple X-rays, and more. It’s the physician’s ability to quell his or her use of the pen (or mouse) that will be the greatest impact on clinical cost. More often than not, it’s because the physicians are practicing what we call “defensive medicine”: prescribe the Z-pak, do the CT scan just to be “safe” – rather than focus on rational clinical need.
  4. It must focus on the patient experience. Enhancing the patient experience starts with opening up the schedules to get the patients cared for on a timely and convenient basis. The patient experience is knowing your patient when they come in the door, knowing what’s going on with them. It’s the antithesis of having all the patients re-do their paperwork every time they come in the door, rather than greeting them and asking if anything has changed.
  5. It has to include citizenship. It’s more than showing up at work. Citizenship is teaming with your colleagues, being a part of the group, helping to find solutions and sharing in both successes and opportunities for improvement. Being a part of the health system not only of your patients, but also your provider organization, is important in this new healthcare landscape.

There are several things that have to happen to get us from being cowboys to being well-oiled pit crews, starting with a significantly different communication process. This is not about management trying to hustle down the cost of the physician cohort; it’s about moving from fee-for-service to fee-for-value. Here’s what your communication plan needs:

  1. Education on all sides. All sides need to understand the other. You have to have an involved physician cohort in the development of your organization’s methodology; you can’t take two or three accountants and have them go in a room and develop the methodology. It’s a process that is going to take time, and you can’t do it in 3 weeks. We just completed one successfully and it took 10 months.
  2. Explain the positives. Show physicians the upside to this alignment,….how it will be good for the patients. Explain what there is to be gained and how the entire organization is going to be aligned. Otherwise, assumptions will be made that they are the ones bearing the brunt of this change. Show them the upside, which lies in tangibly demonstrating clinical quality.
  3. Data. It’s easier to say than to deliver on, but you have to give physicians data on their panel size/demographics, clinical outcomes, to the extent you can get clinical costs, and more. Also, get them comparative data, which should be blinded initially to ensure the data is correct, and then once you have enough built up to be meaningful, make it transparent to all providers. It’s the way to get us all in the same boat, and the way for us to start to feel like we’re reliant on each other, and focus more on the patient.

The reality is that change is inevitable. CMS has said it wants 70 percent of its payments under a value-based stream of contracts by 2018. Whether this happens for your organization in late 2017 or late 2018 doesn’t matter; it’s inevitable. There are going to be winners and losers, and the winners are going to be the ones who learn how to do this sooner.

Teaming — like a good pit crew.

For more information on how JHD Healthcare Partners can help your organization through this transition, please contact us at www.jhdhp.com/contact.html. For a copy of the “Cowboys and Pit Crew” commencement address, please visit newyorker.com/news/news-desk/cowboys-and-pit-crews.


Report Says Physician Engagement is Greatest Challenge for Healthcare Executives

by Skip Leavitt and Kimberly Buser, JHD Healthcare Partners

HealthLeaders recently published an insightful report on physician alignment, centering on strategies that require both risk and clinical integration. The article notes that physician engagement is the greatest need, and also the greatest challenge, for health system executives: it’s highest on the list of objectives, at 66 percent, and is most frequently cited as being the most difficult.
Some other key findings from the report include:
• The survey showed 66 percent of respondents engage physicians in quality initiatives. And, 24 percent say engagement is the most difficult part of aligning physicians. Physicians know that the goal is delivering higher-quality, lower-cost healthcare, but they are often resistant to change. A proactive change management plan is needed to help the physicians achieve their goals.
• Clinical integration is often cited as a mechanism for health systems to gain physician alignment. For employed physicians, 55 percent of health systems use clinical integration, and for independents, 52 percent, according to the HealthLeaders report. This movement can be an important way to align with physicians on common ground, but it cannot succeed in isolation.
• Executives are expecting a 48 percent growth in clinically integrated medical staff over the next three years – the same staff that are expected to provide a high level of coordination of care, but only if they are properly engaged.
The successful organizations we work with realize that to really engage physicians in the alignment effort, the entire health system needs a philosophical shift to a culture of inclusion. They also have a detailed action plan to guide the change process on all levels. We recommend that clients provide a flexible range of alignment options including employment, participation in clinically integrated networks, or through a “fabric” of supporting physician practice services.
Creating a plan for successful alignment often includes these practices:
• Implement a robust physician engagement and communication program that is bi-directional, inclusive and transparent
• Provide a robust clinical and non-clinical education program
• Establish physician support capabilities as good, or better than, what is available in the market elsewhere for them.
Lots of people talk about physician alignment. But let’s discuss how it can be one of your organization’s main strategies for success. Give JHD Healthcare Partners a call today at 972-220-0474.
To download your free copy of the HealthLeaders article, click here.

It’s Sink or Swim Time, Healthcare

Bob Dylan wrote lyrics in the 1960s that ring true, even today:


“If your time to you is worth savin’/Then you better start swimmin’/Or you’ll sink like a stone/For the times they are a-changin’.”

Dylan’s take on the turbulent social crises of the 1960s could easily apply to a number of situations.  Today’s reformation of healthcare is one of those. In these times, it is an industry that is certainly changing. The enactment of the Patient Protection and Affordable Care Act necessitates physician groups, hospitals and health systems changing their business models to succeed in the new era of promoting wellness and prevention for the populations each serves, placing greater importance on quality and managing risk-based reimbursement models.

I have the pleasure of working with a group of professionals at the JHD Group who are committed to helping organizations – especially physicians – navigate the implementation of reform while helping them stay profitable in the new model. The “sink or swim” concept that Bob Dylan talks about in his song certainly applies as we work with groups that are committed to thriving in this new healthcare landscape – not just for their businesses and their employees, but most importantly, for the patients who need them. As more patients come into the healthcare fold, and the business of healthcare continues to evolve and change, we have opportunities to show just how well we can really swim.

The JHD Group is comprised of individuals who are committed to this idea, and whoImage are educating physicians, hospitals, and health systems across the country.  As part of that commitment to education, we are launching this blog, which will feature timely thoughts from our experts in a variety of specialties.  We hope you will subscribe to our updates or check back often to get the JHD Group take on how new issues are shaping the healthcare industry. You can also find us on Facebook and @JHDGroup on twitter. Our goal is to offer you usable information and educated opinions on how reform matters to you. To that end, we would enjoy hearing your thoughts and feedback.


Hank Duffy

Founder and CEO, The JHD Group