How Much for That Physician?

Note: This is the first in a two-part series on improving profitability from the JHD Group.  Need to know how to implement these ideas?  Get started with a complimentary conversation today.

How Much for That Physician?

What does a physician cost a hospital organization per year?  Typical thinking has it somewhere between $100,000 and $200,000 per physician per year.  But it’s just that kind of “typical thinking” that has healthcare systems losing money each year. Rather than focusing on cost, smart organizations are looking at long-term value with methods that support, enrich, and enable physicians to be a profitable piece of your business.

One organization decided that it was done losing money in its large physician group and, in a period of two years, went from a loss to a profit. This physician network was completely able to reverse its group’s losses and generate a profit for the 243-member physician organization, now positioning itself as “Accountable Care Capable.”

How did this happen? Is it the kind of change you need to substantially improve profitability and operational effectiveness for your own healthcare organization?  Here is a prescription for long-term health that starts with steps any organization can take to go from seeing red to being in the black.  To start making change for your group, consider these tips:

Physician healthcare1. Take a picture.  Get a good look at your organization. Take a high assessment of the physician group — look at the financial piece and familiarize yourself with the methodology for compensating physicians. Ask yourself these questions: does it meet fair market value, is it incentive-driven so docs have skin in the game?, or are they just getting a salary.  Is there pressure on them to perform? If you’re creating an environment for physicians to focus on patient care, the expectation should be that they can do that as well as they can. 

2. Create a system of equality and transparency. Physicians have to feel like they’re being treated fairly, with ethics and integrity across the group.  Apply the same rules to everybody. For example, in regards to compensation, pay the physicians fair market value for his or her specialty. While different models can exist within the same compensation plan, special deals should not be created to recruit specific specialties. Showing favoritism toward one immediately creates tension with others — and you want all specialties to be as invested in your business as you are.

3. Carefully evaluate additions to your system. If you are considering acquiring an established practice, you really need to evaluate that practice on several fronts: How many more years do those physicians want to practice? How many patients will they be bringing with them? What is that physician’s future plans for growth? Does that physician fit well within the established group’s dynamic? Things like this need to be considered before making decisions around adding to your system.

4. Communicate, communicate, communicate. From compensation plans to growth strategies to policies and procedures, you simply can not over-communicate to physicians. Operate on the assumption that the message has not been heard by everybody, and continue communicating. Remember that they are not only on the front lines of your business, seeing patients, but are also an important part of your business’s overall strategy.

The People Side of EHR Implementation: My Night in the ER

 

Juanisha “Juan” Johnson, Senior Managing Consultant, JHD Group

As millions of people do each year, I recently found myself in need of some care. Tired, sick, and barely able to breathe with a throat so swollen, I ventured to a nearby emergency room. But this isn’t a story about overcrowding or multiple-hour waits.  I came in feeling sick but left feeling ill for people working a system that needed a remedy.

People are important. You see, they are the component that can exact change for your organization. My daily work is as a Senior Managing Consultant, guiding organizations through the process of EHR implementation and optimization.  At the JHD Group, our methodology for success as it relates to EHR Optimization consists of four pillars:

  • system set-up,
  • processes,
  • governance, and
  • you guessed it – people.

At every level of a healthcare organization are people who will make or break your EHR implementation, your patient care, your business. It also doesn’t take a neurosurgeon to know that the more people understand and feel that they can master their roles and grow into other ones makes for the kind of employees who stick around, who feel that your business is their own.  In many senses, it is.

Late this particular Thursday evening, I was relieved to find the ER waiting room blessedly uncrowded.  I was in so much pain and was having significant issues breathing. I was triaged and then, again, breathed (what little I could) a sigh of relief that I was taken to the back, where I waited. And waited. The nurse came in, did an evaluation, and then told me the doctor would be in. I waited 30 minutes. When the physician arrived, he said he wanted to order a strep test, and told me the nurse would be back in to do that. Another half-hour goes by and the nurse arrives to conduct the test. More than two hours after my visit began, the physician finally confirmed what I told them while being triaged: that I had a case of strep.

Now, I am in no way suggesting that a physician should simply take the advice of his/her patient – thorough evaluations are always necessary — but this experience was a good example of some important take-aways with EHR optimization and implementation:

  1. Staffing. The importance of enlisting the right people to your organization and its mission can not be underscored enough. Putting people in places where their skill-sets are well-used, valued, and sharpened can be key to keeping and growing them. If your healthcare institution is looking for more efficiency and streamlined processes, start with the people.
  2. Training. Was this R.N. trained in a standing order that patients presenting with my symptoms should have a strep test?  Is his office supporting him with top-of-licensure training that not only allows him to grow as a medical professional, but also encourages him to perform tasks that would free up much-needed minutes for the physicians? RNs, LPNs, medical assistants – these are all professionals who can make the daily usage of EHRs something that positively impacts patient care.
  3. Improved face-to-face time. When properly utilizing people and their interface with technology, it can actually free a physician up to get that much-needed face time. More face time improves patient satisfaction and allows the physicians to do what they are best at: treating patients. Physicians often say laptops or pads get in the way of their patient interface. Could an R.N. or medical assistant help with the technology piece so that the patient gets all the benefits of both EHR optimization and old-fashioned person-to-person interaction?
  4. People living the processes. Optimization is something that has to be practiced every day. The care teams should be able to work within a process that is streamlined for everyone’s sake. Good work flows should decrease the time physicians need to document a visit, thereby increasing productivity. Properly investing in the people who are a committed part of that efficient approach is part of what makes the practice a success.

Easy fixes like standing orders (finger pricks for diabetics, throat swabs for those with sore throats, EKGs for cardiac patients) are not only intuitive, but they also enable and empower clinical staff to perform at their best and to do the patient care that they desired to do when they made a commitment to the healthcare industry. Physicians are freed up to focus on other parts of care, and patients have shorter wait times and a more efficient visit. These are the kind of things we of the JHD Group work with clients on, as we do our “boots on the ground,” “at-the-elbow” training and process implementation.

How was my sore throat?  After a round of antibiotics and a visit to an ENT specialist, it was fine. But my visit to the ER that night confirmed what many of us preach all day long: the people component of your processes, whether it’s EHR implementation or ongoing care, is one of the most critical and important – it’s where your focus should be to effect change. Get the human part right, and ensure your machines support that.

Does your healthcare organization put its focus on people to maximize efficiency?  Tell me about it by leaving your own comment.

It’s Sink or Swim Time, Healthcare

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

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“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.

Sincerely,

Hank Duffy

Founder and CEO, The JHD Group

http://www.jhdgroup.com/leadership.html#duffy