The Top Five Animals Keeping Your Doctors Up At Night! It s a Zoo Out There! HFMA Winter Institute February 2018

Transcription

1 The Top Five Animals Keeping Your Doctors Up At Night! It s a Zoo Out There! HFMA Winter Institute February 2018 Mitali Paul MHA MBA Vice-President, Business Development Wiederhold & Associates Mitali@wiederholdassoc.com Dani Hackner MD MBA Founding Board Member Association for Leadership in Care Management Intensivist/Pulmonologist Kaiser Permanente

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3 Wiederhold & Associates Network Survey 75% E.H.R 50% Loss of autonomy 42% 25% 25% Compensation/Reimburse ment Patient Experience Burnout

4 Electronic Health Records / Interoperability

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6 System X/Dr. Boa System X has a planned electronic health record implementation. Dr. Boa has been asked to lead the implementation of the new system. The vendor discusses a menu of options during implementation including onsite technical support, training, and change management. She looks at the final price tag with all the bells and whistles and wonders how her CFO will respond. Dr. Boa reaches out to Sisters of Efficiency hospital system and asks how they rolled out. They indicated they bought the basic package out of the box with few customizations and used the EHR technical reps.

7 System X/Dr. Boa Dr. Boa reached out to Mothers of Invention hospital chain and they indicated that they heavily customized their system. Finally, she reaches out to Center of the Universe Hospital and they indicated that they didn t like the vendor s green change managers and brought on a separate consulting firm specializing in implementations. What is your advice to Dr. Boa?

8 Challenges Initial Challenges o Implementation o Interoperability Maintenance Challenges o Inadequate technical support o Complexity of systems

9 Challenges Staff impacts o Time to train, time to maintain o Care coordination challenges Upcoming hurdles o Population health requirements o Increased use of technology and devices o Device incompatibility and HIPAA Risk Investment & ongoing costs

10 Best Practices Prioritize the EHR/Revenue Cycle Rollout o Outline existing processes robustly before rollout o Give yourself sufficient time for technical build o Robust coding avoids wasted documentation o Build in real time Clinical Documentation Support

11 Best Practices Resource Training and Support Adequately o During Implementation o Simulation/training post go-live o Ongoing support Anticipate decreased productivity post go-live Support physician extenders, advanced practitioners and non-physician staff equally

12 Best Practices Design Tools for Enhanced Care o Use of point-of-care technology o Physician involvement in design, pilots and testing Develop literacy on predictive analytics o Incorporate tools for population health

13 Loss of Autonomy

14 Can loss of autonomy lead to burnout?

15 Dr. Lyons Dr. Lyons is a respected surgeon who has held positions as Secretary of Staff and Vice Chief of Staff. Peers mostly responded positively to his leadership but frequently complained that the hospital system does not speak the language of the clinicians. The administration is trying to recruit Dr. Lyons as OR medical director.

16 Dr. Lyons Dr. Lyons meets with his office manager to review his books. Costs per patient are rising, volumes of referrals have dropped, and patients are deferring surgeries. At this rate Dr. Lyons has 2 years before the practice starts to run negative. Dr. Lyons sighs, I wish I had this information before I spent all that time with administration. What do we recommend to Dr. Lyons? To the health system?

17 Challenges Market shifts o Employment and payer owned group models o Shortage of developed physician leaders o A rapid pace of change Loss of autonomy and burnout are linked o Physicians losing ownership can feel undervalued o Decision-making further away from the caregiver o Clinical-speak vs business-speak

18 Challenges Balance o Work life balance o Clinical and administrative responsibilities o Preventative and reactive medical care Increased performance measurement o Traditional quality and safety measures o Efficiency and appropriateness measures o Shift to patient outcomes

19 Best Practices Shared vision among stakeholders o Is there a clearly articulated vision among physicians? o Is there regular and dynamic outreach among physicians? Effective governance structure o Regular and structured input and engagement o Alignment and integration part of the agenda o Co-management models o Employment vs. affiliations vs. contracted

20 Best Practices Actionable data o Access made easy but protecting confidentiality o Data is validated and visualized simply o Aids with relevant, clinical decision-making Strategic use of data o Population health tools o Training on clinical documentation and risk scoring o Educated Physicians become empowered

21 Best Practices Key performance indicators reporting/dashboards o Real time and monthly o Standardization Institutional support to drive change o Cultural change with physician leadership o Adequate resource allocation o Professional developmental opportunities o Personal support services Physician health and wellness initiatives Are institutions investing in their physicians wisely?

22 Compensation- Reimbursement Models

23 Dr. Trunk Dr. Trunk, a productive interventionalist recently joined Multispecialty Group Practice. MGP provides hospitalist services, gastroenterology consultative services, and intensivist services to Mothers of Invention Hospitals and a JV surgery center.

24 Dr. Trunk Dr. Trunk has been doing a mini-mba course at the local university and is interested in the contract models. As she reviews the models with MGB s COO, she notices what appears to be a strategic problem looming between the hospital and multispecialty group ambulatory care surgery center? What problems may be coming down the road?

25 Challenges Organizations expected to dampen physician reimbursement o Expectation of higher productivity gains relative to pay o Regulatory hurdles to revenue gains: o MACRA o Stage 3 Meaningful Use o MIPS, AAPM

26 Challenges Clouding the future o Political uncertainty o Aging and tightening physician labor force o Payer market power strengthening o Pay-for-performance and shared risk models Ongoing change o Site neutral payment strategies o Aggressive prior authorization requirements by payers o Disrupted post-acute space

27 Challenges Expected to squeeze out cost and eliminate the Lemon s Market o New employer-linked entities (Berkshire/Amazon) o Tech entities entering the market (Apple) o Noninsurance provider models (Alignment Healthcare) o Consolidation of narrow networks (Kaiser and Vivity in SoCal)

28 Best Practices Physician compensation models o Employment, PHO, MSO, IPA o Clinical co-management Physician Integration o Pay-for-performance o At risk contracts o AAPM Medical Homes o Embedding behavioral health o Embedding disease management

29 Best Practices Robust administrative support o Regulatory compliance, marketing and payor negotiations support o Needs mass to be affordable Group reimbursement for extenders and APPs o RVU and reliance on billing productivity leads to MD/DO-APP conflict o Reimbursement for clinical extenders Strategies to meet shortage of Specialists

30 Patient Experience

31 Dr. Hawk Dr. Hawk is an experienced intensivist. He prides himself in his calm, interdisciplinary approach to care and a sensitive bedside manner. Recently, Dr. Hawk s mother who has multiple sclerosis was admitted to the ICU in another city. Family called Dr. Trunk repeatedly for guidance. They reported that staff were impatient with the patient s communication difficulties, assuming she was intellectually delayed.

32 Dr. Hawk Dr. Trunk speaks with multiple clinicians on the care team, that continue switching off. Dr. Hawk found himself frustrated after repeated discussions. He thinks a pulmonary embolism was probably diagnosed very late. Dr. Hawk calls up a friend in administration to discuss.

33 Challenges Patient engagement is difficult Changing family and patient attitudes and expectations Frustration with splintered communication and coordination Awareness about and anger over rising costs of care

34 Challenges Patient non-adherence is multifactorial, not simply willful noncompliance Care access issues predominate Bureaucratic regulatory, payer, and healthcare structures create hurdles to engagements Clinician communication and information transfer are paramount

35 Best Practices Communication redesign o Patient education and empowerment o Apply close loop communication at all levels o Marketing and corporate communications must be dynamic Avoid patient engagement one-off initiatives

36 Best Practices Care redesign o Start with the patient and work up o Nursing engagement o Physician perspective and support o Clinical decisions require clinicians o Operations require operator oversight Administrative / Institutional support o Allocation of human resources o Training and resources o Simplify understanding on changing regulations o Online PowerPoints and surveys are not enough

37 Polarities

38 Dr. Zed Dr. Zed is a newly hired physician advisor. She has spent ten years as a hospitalist and then obtained her MBA to learn the language of the administrators. As part of her onboarding, she meets with a former chief of staff to discuss the push and pull of the role she is beginning. What polarities does she face?

39 Challenges Clinical AND Business Independent AND Collaborative Margin AND Mission Cost AND Quality Strategic AND Tactical Patient AND Providers Fee for Service AND Managed Care

40 Leading Physicians Through Change Recognizing the polarities Speaking to the issues Admitting one s strengths and opportunities Preparing for the sociological-cultural change Physician Activation Physician Wellness Initiatives Promoting advocacy to influence change

41 Questions?