Gaining Physician Buy-In for Online Transparency Initiatives Holly C. Adams, FACHE, FACMPE Executive Director of Clinical Operations & Community Health OU Physicians, The University of Oklahoma Health Sciences Center
Webinar Objectives: Ø Provide an overview of OU Physicians and highlight the journey to improve patient experience. Ø Share the decision to adopt transparency with providerspecific patient experience data. Ø Describe the implementation & communication plans developed to transition to online provider ratings and comments & share specific project documentation and resources. Ø Highlight key strategies for gaining physician buy-in.
OU Medicine & OU Physicians Overview OU Medicine is the partnership among the University of Oklahoma College of Medicine, the OU Medical Center (including The Children s Hospital), OU Physicians, and the University Hospitals Authority and Trust, and the patient care, medical education and research programs and services they provide.
OU Physicians Overview Oklahoma City, OK 900 credentialed providers 1,100 employees 67 clinic locations 600k ambulatory visits $230M annual revenue AAAHC Accreditation NCQA PCMH Recognition Full GE Centricity EMR deployment 75k CGCAHPS surveys since July 2011 100% e-surveys July 2013
Building an Culture We are what we repeatedly do. Excellence, then, is not an act, but a habit. - Aristotle
Evidence Based Leadership Foundation Breakthrough Leader Evaluation Leader Development Must Haves SM Performance Gap Standardization Accelerators " Implement an organizationwide leadership evaluation system to hardwire objective accountability Aligned Goals Aligned Behavior Aligned Process " Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results " Must Haves " Rounding " Thank You Notes " Employee Selection " Pre and Post Phone Calls " Key Words at Key Times " Re-recruit high and middle performers " Move low performers up or out " Agendas by pillar " Peer interviewing " 30/90 day sessions " Pillar goals " Leader Eval Mgr (LEM) " Discharge Call Manager (DCM) 2008 2014
Patient Experience Improvement Milestones National Percentile Ranking AIDET Rounding EXCEL Incentive Pillar Goals & Alignment Leader Evaluation Manager Monthly Meeting Model Standards of Behavior 8 28 34 72 Accountability Matrix CPR Meetings Visit Status Boards (Early Transparency) EE Toolkit Access to Care - Referral Tracking 69 IPC / Comment Cards Clinic Visit Summary Physician Coach 71 Star Ratings & Comments Transparency Culture 78 LEAN MD Engagement Internal Transparency 88 FY 08 FY 09 FY 10 FY 11 FY 12 FY 13 FY 14 FYTD 15 * Based on Press Ganey s National Facilities Database as of 5/1/15.
CGCAHPS National Percentile Ranking 73 rd %tile 79 th %tile 80 th %tile * Based on Press Ganey s National Facilities Database as of 5/1/15.
Truth People will forget what you said, people will forget what you did, but people will never forget how you made them feel. - Maya Angelou
Patients use the Web to Find MDs Patients are demanding more transparency and searching the web for health services/information. Ø 72% look online, 77% of them use Google/Bing to start (Pew Research). Ø 59% think online ratings are important in choosing a doctor (AMA) Dozens of health websites (Healthgrades, Vitals, Angie s List, etc.) advertise physician ratings, invite consumer input and purport to provide objective patient reviews of MDs. In actuality, most ratings are based on limited, unverified or incomplete data and can provide skewed reviews of physicians. Recognizing all of these factors, other physician groups around the country are posting their own scores on their websites (Wake Forest, Utah, Piedmont, Integris, etc.).
What Patients Find on Google EXAMPLE: Dr. Gordon, Chairman, Neurology Healthgrades 4 stars, 7 reviews Vitals 4.5 stars, 2 reviews Ucomparehealthcare 2 stars, 2 reviews OU Physicians Pa>ent Survey Results 4.9 stars, 21 reviews
Why Provider Transparency & Online Reviews? 1. Controlling the Conversation With more of our patients looking to online physician reviews, we can provide valid, robust data to highlight the quality of our physicians. 2. Driving the Perception Take control of our reputation and brand in the market and drive significantly more traffic to our website where we can better manage the message. 3. Realizing Greater Utility of our Patient Satisfaction Data Leverage the thousands of returned patient experience surveys on our oumedicine.com website to provide valuable data for patients as they select a provider. 4. Fostering a Culture of Accountability Drive transparency within the organization and community around key areas of patient experience and in the future, quality of care.
Transparency Advisory Group (TAG) The (TAG) is an internal committee that will play an advisory role in the implementation of the Provider Transparency Initiative (PTI). The TAG will be charged with reviewing all comments before they are posted online to ensure they meet PTI compliance standards: No profanity, personal health information or libel/risk management issues. Appeals process: If a provider or employee believes a comment should not have been posted online, he or she may file an appeal with the TAG stating the reasoning for their objection. An appeal may be filed by sending an email to TAG@ouhsc.edu. TAG Membership: Physician leaders, clinical operations, patient safety and risk management, marketing & communications
Team Collaborations Knowledge expertise from clinical operations, office of patient experience, marketing, reporting & analytics, IT, chief medical officer, physician leadership cabinet is required. Critical Competencies: Patient survey administration, reporting, patient experience improvement, voice of the patient Marketing, web master, search engine optimization, advertising agency Digital Assent/NRC expertise Physician messaging and acceptance physician leadership Administrative sponsor/project lead Weekly meetings/conference calls helpful to ensure project remains on track with regular updates to relevant organizational committees.
Provider Star Ratings & Comments Plan OU Physicians five-star rating will be based on survey data from two CG-CAHPS survey areas: CGCAHPS: Overall physician rating CGCAHPS: Physician communication quality Comments are reviewed by the Transparency Advisory Group, a committee consisting of physician, operations, risk management and marketing representatives, to determine if it meets posting criteria. Physician ratings/comments are not posted until 30 surveys are accumulated. Comments are published (on-line), flagged (for further review/consideration, or archived (exclusion criteria was met/not posted). All comments are posted unedited, except those with profanity, PHI or libel/risk management issues. Posts updated weekly.
Implementation Timeline December, 2014 OUP Management Committee approved transparency initiative and contract executed. January May 2015 Communicate to providers with meetings, presentations and other internal communication tools. Amend patient satisfaction surveys to inform users of web use. Distribute individual patient star ratings reports to providers to help them assess their standing in advance of initiative. Provide coaching to help improve patient satisfaction scores. Update OUMedicine.com and Find a Doctor web tool to accommodate patient sat rating scores and comments. Weekly calls with our partner, National Research Corporation, to coordinate implementation. June, 2015 Providers review revised directory website to verify content and understand how ratings & comments display. July, 2015 Go live with patient satisfaction ratings/comments on OUMedicine.com
Transparency Communications Ø Transparency communication strategy/plan Ø Introductory email sent from CEO Ø Provider transparency FAQs Ø Transparency advisory group (TAG) summary Ø 1 Month out notification
Transparency Communication Examples: Communication Plan & Tactics
Transparency Communication Examples: Communication Plan & Tactics
Transparency Communication Examples: Introductory Letter from CEO
Transparency Communication Examples: FAQs
Transparency Communication Examples: TAG Summary
Transparency Communication Examples: 1 Month Prior to Publishing Star Ratings & Comments
Summary of Ratings & Comments Approximately 1,004 patient comments have been published (since notification to patients on 2/10/15): # COMMENTS BY STAR RATING 3 Stars, 25 2 Stars, 21 1 Star, 4 4 Stars, 42 5 Stars, 912
Published Comments (posted online) Dr. Coleman is a wonderful physician. He's cared for my husband as well and we both insist on him for any sports related injury due to the care he provides and the detailed information he gives on the injury and how to heal it. He even drew pictures of what he was explaining was wrong with my foot! Dr. Jenny Le is awesome, and I have recommended her to friends. She makes taking care of my health pleasant and something I want to do, rather than avoid like I did for years (When I lived elsewhere, the health care system had seemed so complex and confusing, and people in the industry did not seem to want to helpâ??which is exactly the opposite of what I have experienced with Dr. Le and OU Physicians.). I'm so happy to have found such an excellent, caring, smart, practical, down-to-earth doctor. Everyone was very nice. My biggest complaint was the wait time for my appointment, which was scheduled almost 6 weeks in advance. I doubt the employees had anything to do with the delay, but it would have been nice to have been informed ahead of time. I couldn't get test results for over 4 weeks despite multiple attempts; finally called my primary doctor to intervene for me.
Archived Comments (not posted) Provider spent first few minutes of appointment complaining about patients who "come from other countries and don't speak English and are never on time to their appointments." Spent majority of time in the room with me fussing over her computer and complaining about how she hated the technology. It was like being in a conversation with someone while they check their email- I felt secondary to the computer. I asked about a secondary (and very minor) health condition and she informed me I would need another appointment for that due to time constraints, then spent another 10 minutes fighting with her computer (so obviously there was time to interact with me instead). I will never come back and am looking into filing a complaint with medicare and medicaid. The provider is condescending. We drove for an hour to get there. We waited 2 hours. Proper care was not given. Doctor has the same condition I have and was very understanding and sympathetic.
Flagged Comments (need further review) This is the first time I felt rushed out without scripts, without answers. I still have lots of questions?!? We had discussed changing my medication as i was allergic and he decided to wait until after the blood work. When I called about the results he just said if I got tired to increase my medication and completely forgot that he was suppose to call in a different kind for me. She confused two different prescriptions in initial discussion but then returned to say she had been confused but now had names/meds straight. She did not find the heartbeat but it was not a "big deal" and the ultrasound she did to see the heartbeat was not clear and conclusive. I literally left not knowing if the baby was ok and for a patient that has had 4 miscarriages, this is a big deal!!! I do not have confidence in the care that was provided to me.
National Percentile Ranking Patient Experience Improvement Milestones AIDET Rounding EXCEL Incentive Pillar Goals & Alignment Leader Evaluation Manager Monthly Meeting Model Standards of Behavior 8 28 34 72 Accountability Matrix CPR Meetings Visit Status Boards (Early Transparency) EE Toolkit Access to Care - Referral Tracking 69 IPC / Comment Cards Clinic Visit Summary Physician Coach 71 Star Ratings & Comments Transparency Culture 78 LEAN MD Engagement Internal Transparency 88 FY 08 FY 09 FY 10 FY 11 FY 12 FY 13 FY 14 FYTD 15 * Based on Press Ganey s National Facilities Database as of 5/1/15.
Reporting Transparency - CGCAHPS
Meaningful Use Internal Transparency Report
Comments Report Internal Transparency
Transparency Advisory Group (TAG) Physician Inquiry Examples & Responses
Transparency Advisory Group (TAG) Physician Inquiry Examples & Responses
Transparency Advisory Group (TAG) Physician Inquiry Examples & Responses
Transparency Advisory Group (TAG) Physician Inquiry Examples & Responses
Transparency Advisory Group (TAG) Physician Inquiry Examples & Responses So, that s the thinking behind the project. In addition to promoting transparency in our practice and facilitating a better patient experience, we believe the initiative will help individual providers by giving patients more information. Please let me know if you have any additional questions. Sincerely, Lynn Mitchell, M.D. Chief Medical Officer
Tips for Gaining Physician Buy-in Leadership buy-in must drive the initiative. Identify a senior physician leader as champion/spokesperson. Communicate early and regularly (FAQs, monthly committee meetings, newsletters, emails, staff meetings, etc.) Consider a transparency workgroup with provider representatives. Develop a provider appeals procedure for concerns to be vetted.
Tips for Gaining Physician Buy-in Prepare a forecasted star rating and mock up web page for all providers to get a sneak peek. Identify provider coaches to help with tips to improve the patient experience. No surprises. Everything up front and in the open. Transparency is best in doses over time. Guage your organization s readiness before deciding on a go-live date.
Advice The decision to (or not to) pursue transparency must be made and led by senior physician leadership. Get organized, plan early, over communicate. Adopt important prereqs before pursuing online transparency. Don t assume providers have current data about their performance. Provide it for them. Be flexible and, Don t lose sight of the real reason for pursing transparency.
The Voice of an OU Physicians Patient
Questions? Holly Adams, FACHE, FACMPE Executive Director of Clinical Operations & Community Health OU Physicians holly-adams@ouhsc.edu (405) 271-3932