1. Physician Employment
Greenville Hospital System
University Medical Center
National Health Policy Forum Michael C. Riordan
Washington, DC President and CEO
March 25, 2011 Greenville Hospital System

2. Agenda
1. GHS Overview
• Greenville Hospital System and University
Medical Group
2. Physician Employment
• Conceptual Continuum
• Motivation
3. Quality and Operational Efficiency
• What’s the impact?
4. Summary
2

3. 1. System Overview

4. Our Vision
Transform health care for the benefit of the
people and communities we serve.
Our Mission
Heal compassionately. Teach innovatively.
Improve constantly.

5. Bird’s Eye View
• 5 Campuses
• 1,268 beds
• 11 Specialty
Hospitals
Baptist Easley
Hospital • 746 bed
Tertiary Care
Center
• More than 120
Practice Sites
(and growing)
5

6. GHS: A Critical
Community Resource
Academics
• 174 medical residents and
Data Snapshot fellows in 7 residency and 5
FY ‘10 FY ‘11 fellowship programs
Actual Budget
• Half of USC medical students
Revenue* $1,346.1 $1,397.0
receive 3rd and 4th year training
Expenses* $1,313.6 $1,376.0 at GHS
Discharges 42,570 42,259 • More than 1,350 nursing
Patient 285,871 286,487 students receive part of their
Days training at GHS each year (over
2.100 nursing student
Outpatient 2,107,575 2,367,661
encounters yearly)
Visits
*Millions • Training for multiple allied health
professions 6

7. Quick Tour

8. Greenville Memorial Medical
Campus

9. Greenville Memorial Medical
Campus
• Greenville Memorial Hospital
• GHS Children’s Hospital
• Roger C. Peace Rehabilitation Hospital
• Marshall I. Pickens Hospital
• Cancer Center
• Medical Offices
• Institute for Advancement of Health
Care

10. Patewood Medical Campus
-Outpatient Centers
-Patewood Medical Offices
-Patewood Memorial Hospital
GHS / Clemson University
Translational Research Hub

11. Greer Medical Campus
Hospital, Medical Office Buildings, and
long term care located on this site.

12. Cottages at Brushy Creek
One of just two such innovative skilled nursing facilities in the US
offering residents a unique, home like experience. National award
for providing environments conducive to quality living.

13. Simpsonville Medical Campus
• Hillcrest Memorial Hospital
• Hillcrest Medical Offices

14. North Greenville Campus
• North Greenville Hospital
- Long Term Acute Care
• North Greenville
Medical Offices

15. Baptist Easley Hospital
50/50
Ownership

16. Continuing the Tour:
University Medical Group
16

17. Employed Physicians
University Medical Group
Primary Care Physicians Specialty Physicians
Specialty # MDs Specialty # MDs
Family Practice 45 Behavioral Medicine 13
General Internal Medicine* 40
Cardiology 30
MD360 6
Hospitalists 37
OB/GYN 25
Neurology 5
Pediatrics 43 Neurosurgery 6
TOTAL 159 OB/GYN 26
Ophthalmology 1
* Includes 3
Medicine/Pediatrics Ortho/Sports Medicine 28
physicians Other Medicine Specialties 37
543 Otolaryngology
Pediatrics
6
78
Total MDs Physiatry 8
Pulmonary 16
Radiology 39
Surgery 54
Source: UMG Master Physician File, dated 3.1.11 17
NOTE: These numbers do not include 111 non-MD providers TOTAL 384

18. University Medical Group
Where Are We Now?
1994 1995 1998 2006 2007 2008 2009 2010
# of Providers 69 104 145 320 396 454 559 647
Gross Revenue $90M $200M $232M $278M $358M $503M
Gross Collection Rate 36% 43% 46% 49% 49% 48%
Net Collection Rate 63% 86% 86% 88% 89% 89%
Days in AR 168 53 47 43 37 35
% of GHS Admissions 35% 68% 82% 80% 83% 84%
Note:
In addition to the above, GHS has mutually exclusive relationships with 134
physicians providing hospital based services: anesthesiology, emergency
medicine, neonatology, and pathology.
18

19. University Medical Group
• GHSUMC has an open medical staff – 1,300 providers
• Around 1990 began employing physicians
– Medical Education
– Specialty programs (Trauma, specialty pediatrics, etc.)
– Referral network (Partners in Health)
• Organized in 7 departments – Medicine, Surgery,
Children's, Women's, Orthopaedics, and Community
Medicine, Radiology
19

20. Physician Employment
20

21. Physician Alignment Models
Fully Integrated Practice/Employment
Institute Member (Partial Employment)
Our Theory
Contract Affiliation Physician
Joint Venture Arrangement engagement
Mutual Project Development
increases as
relationships /
Supportive participation in medical
staff procedures and governance connections
Neutral medical staff participation become
Competitive position stronger.
21

22. Conceptual Continuum
“Soft” “Hard”
Affiliated Employed
Aligned Integrated
Engaged
Partner Physician Leaders
22

23. Conceptual Continuum
“Soft” “Hard”
Affiliated Employed
Partner Integrated
GHS Model
Engaged
Aligned Physician Leaders
23

24. What is motivating physician
practice acquisition at GHS
and why are physicians
interested?
24

25. There exists the opportunity for physician
groups to become part of something bigger
than they can be alone.
GHS Strategic Direction Physician Integration
25

26. Alignment
is Not Enough
The physicians and the hospital must recognize
and share interdependent well-being.
Desired state is to get physicians to see the hospital as nothing more
and nothing less than another part of their practice.
-- Spence Taylor, MD
Chair, GHS Department of Surgery
26

27. Alignment
is Not Enough
The physicians and the hospital must recognize
and share interdependent well-being.
Desired state is to get physicians to see the hospital as nothing more
and nothing less than another part of their practice.
-- Spence Taylor, MD
Chair, GHS Department of Surgery
Benefits
• Creates a structure that facilitates collaboration and
mutual commitment toward desired behaviors and
outcomes:
– Financial – cost savings as well as revenue
– Higher Quality
– Improved Patient Care and Satisfaction 27

28. It’s About Much More than
Economics...
Integrated Delivery Model –
Philosophy
Establishing a Culture of Shared Responsibility
with Engaged Physician Leadership
28

29. Why Do We Employ
Physicians?
• COMMUNITY: Fulfill our responsibilities as a Safety Net Hospital – improve
access to and quality of care available in our community.
• TEACHING: To be the core faculty for LCME and ACGME accreditation
processes
• INTEGRATION: To be known within and without the organization as the GHS
physicians responsible for development of their specialty area AND to lead our
QUALITY, PATIENT SAFETY, AND UTILIZATION INITIATIVES
• CONTRACTING: To offer a full slate of specialty physicians for third party
contracting and grant applications
• FUTURE HEALTH CARE CHANGES: To present a full service integrated
delivery system for CMS and insurers/payors involving regionalized health care
delivery and risk-sharing by providers.
29

30. Why are Physicians
Interested in Employment?
• Environment that better allows them to do the things that
led them into medicine initially
• Administrative Support = more time for patient care
• Improved / Expanded Benefits
– Lower cost of malpractice coverage
– Additional tax deferred retirement savings
• Affordable access to sophisticated EMR, billing systems
and other large scale information systems
• Improved managed care contracting
• Costs savings through vendor contracting
• Access to funding for capital purchases
• Opportunity to be part of something bigger (e.g.,
teaching, quality, highly integrated delivery system, etc.) 30

31. Impact on Quality and
Operational Efficiency
Moving from physician
employment to physician
engagement
31

32. Physician Engagement
• Board of Trustees (Physician leaders are voting members of
Board Committees)
• GHS President’s Council (Executive Team includes key
physician leaders)
• Operations Council (COO, VP Medical Services, CFO, Clinical
Chairs, Campus Presidents)
• Physician Operations Council (Physician Executives, Clinical
Chairs)
•
•
• Unit Leaders – Physician/Nurse Leader Partnership
Partnership/collaboration at all levels directed toward
clinical and operational improvements. 32

33. University HealthSystem Consortium
GHS: A Top Performer
In Readmissions
RES
ULTS
©2011
University
HealthSystem
33
Consor>um

34. University HealthSystem Consortium
GHS: Core Measures Results
Are Outstanding
RES
U LTS
AMI
HF
Pneumonia
Composite
Composite
Composite
2009
99.5%
98.0%
96.2%
2010
97.0%
96.3%
95.8%
UHC
Median
(2010)
95.8%
89.5%
83.1%
NaConal
Target
90%
90%
90%
Greenville
Rank
(2010)
31/106
13/109
11/110
©2011
University
HealthSystem
34
Consor>um

35. Physician Engagement
Examples of Physician Leader Engagement
• Supply Standardization
• Length-of-Stay – Discharge Planning Process
• Improving Operational Efficiency – Targeted DRGs
• Utilization of Inpatient Radiology Services
• Orthopaedics – Inpatient Process Improvements
• Blood Conservation Initiative
• Pharmaceutical Formulary Development
FY 2010 Result: $14 million in cost savings achieved.
35

36. University HealthSystem Consortium:
GHS Now Top 10 In Efficiency
RES
ULT
S
• Adjusted cost/discharge
declined in all major categories,
2009 to 2010
• Clinical portfolio intensification a
significant contributor
• Total cost/discharge now 17%
below UHC 25th percentile
• Supply cost/discharge now 12%
below UHC 25th percentile
• Labor cost/discharge now 8%
below UHC 25th percentile
©2011
University
HealthSystem
36
Consor>um

37. Benefits of Physician
Engagement
• Transparent and collective focus on clinical quality
through development and adoption of evidence-based
care protocols
• Collaborative/collegial opportunities to highlight
unexplained physician practice variation
• Linking a strong organization bottom line to
enhanced physician support for patient care
• Shared focus/unified goals foster relationship building
and team approach among physicians, nurses, and
administrators
• Fostering physician creativity in streamlining /
maximizing quality, safety, and operational
efficiency 37

38. Summary
38

39. Summary
• Future success for community-based academic medical
centers will depend upon prioritizing patient care and
competing by providing cost efficient, quality total health
care.
• Such care likely can only be provided by regionalized
integrated systems of health care.
• The key relationship is and will be that between the hospital
and its highly engaged/employed physicians.
• GHS is becoming progressively positioned for success in the
coming complex and tumultuous health care environment.
39

40. Summary
Our Core Belief
GHS cannot effectively take responsibility for
improved quality and reduced costs for the
governmental and private pay populations unless
all parts of the health care continuum are highly
integrated.
40

41. Summary
• GHS is becoming progressively positioned for success in the
coming complex and tumultuous health care environment….
Accountable Care Organization
• Challenges to moving toward highly integrated models
include some legal/legislative restrictions including:
• Stark Rules
• Anti-Kickback and Civil Monetary Penalty Laws
• Anti-Trust Regulations
• Tax laws for non-profits dealing with private use and private
inurement
41