Changing employed physician culture can help build market share

1. Building Market Share through Employed Physician Engagement
SHSMD
San Diego 2014
Ed Henegar, D.O.
VP Medical Affairs at OMC,
Interim President of Gainesville Community Hospital
Adrian R. Byrne
President, Lund Byrne Associates

2. What we will cover
OMC Description and Market overview
OMC medical staff
OMC challenges and strategies
EPC creation, culture and expectations
EPC evolution
Goal of 4 days to diagnosis and implications
Initial survey EPC reactions
Development of new processes
Practice style implications
Implementation challenges
“Eureka” moments
Follow up referral survey
Moving to self governance
Q&A

4. Ozarks Medical Center (OMC) in context!
OMC is a 114-bed, not-for-profit medical referral center
OMC employs approximately 1,300 people
67 local and rural physicians
One dominant and organized PCP group
Others scattered, mostly non aligned
OMC employs 40 + physicians

5. Location

6. The primary service area

7. Service area
The County market +/-89,000
Primary Service area is an 11-county area in south central Missouri and north central Arkansas that has a population of 160,000.
Average IP market share in 2008 = 46.5%
Hospital was losing basic cases to Springfield, MO and to Mountain Home, AR
Many lacked confidence in OMC specialists and ease of access to care

8. OMC strategy
Strategy:
Stop being seen as a “band-aid” station
Keep appropriate care local
Build capacity
Expand ER
Aggressively import and employ physicians
Supporting Physician Strategy:
Maintain quality
Protect and grow market share by recruiting more specialists in need areas
Create attractive working environment
Reduce leakage by owning more rural PCP practices
Improve internal referral processes

9. Recruitment
Significant success with recruitment:
Orthopedics
Cardiology
Oncology
General Surgery
Hospitalists
Family practice

10. Why Physicians sign on
0.0%
5.0%
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25.0%
30.0%
Strongly Disagree -1
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9
Stongly Agree - 10
Expectation of Cultural Fit as DeterminingFactor for Physician Employment

11. Expectations and reality
We discovered
The recruited and employed physicians were busy and productive but operated as though they were in private practice
Rapidly accepted the independent practice culture
Using W/rvuproductivity for pay incentives was working to build practice volume but did not always support hospital goals
Practice staff worked for the physicians and not for the hospital
Patient experience was at the whim of the physicians

12. True or False?
Employed Physicians can be a solution to developing new Hospital business?
Employedphysiciansneedtobeapartoftheteamandtodothattheymustbeacceptedaspartofthewholeteam!
ThetraditionalandseparateculturesofPhysicianandHospitalmustbemerged.

13. Why is “culture” important?
Culture is an expression of:
The driving values of the organization
How people work, how the priorities are set and how they are reinforced
How success is measured
How people interact within the organization
AND
“the way things are done around here”

14. How cultures can develop
What can define the behaviorsin a desired culture
Force of character of an individual
A focus on unifying goals
Leading by example
Building the company lore on getting there
Articulating the acceptable processes
Activesupport of protocols and standards of care
Communications –who/what/when/how
Being prepared to intercept and correct “undesirable” actions

15. Culture as a competitive advantage
Werecognizedthat:
Culturecancreatecompetitivedifferentiation
Agoodcultureishardtoduplicate
Also
Ifthereisafit,thenewpeoplewilleasilyadapttotheculture
Peoplewillbecomeloyaltoaculture, nottostrategies

16. Culture drives and confirms the BRAND
Richard Branson: Quote
“Brands exist as a means of communicating what to expect from a product or service.
The Virgin brand tells you that using this credit card is rather like using this airline, which, in turn, is rather like using this health club, staying in our hotels, and paying into this pension fund.
It is a guarantee you'll be treated well, get a high-quality product and get more out of your purchase than you expected.”

17. At OMC was there more than one culture?
YES!
Hospital Culture
Medical Staff Culture
Employed Physician Culture
Independent Physician Culture
Community Culture
Do they co exist?
Should they co exist?

18. Can you articulate yourculture
Definedas (E.G.)
Supported by
Rate as important in yourculture
(1 = low to 10)
Physician friendly?
Quality oriented?
Patient focused
Collegial
Profit motivated
Arealeader in services

19. What do physicians want? Not want?
19
•Respect
•Information
•Input on decisions
•Things-that-work
•Incentives
•Presence
•Freedom
•Inefficiency
•Time wasters
•“Small-mindedness”
•Bureaucracy
•No toleration for “fools”
•Slow decision making
WantNot-Want

20. Setting the framework for culture change
ClarityofVision:
Thehospitalneedstopresentphysicianswithaclearplanforitsfutureinwhichphysicianparticipationisacoreelement.
Thisisacompellingplanthatresonateswiththenewrealitiesaroundthethreebasicneedsofmanyphysicians
respect,
clinicalautonomyand
income.

21. Setting the framework for culture change
Physicianleadership:
Respected physicians with demonstrated competence as leaders and managers to play a prominent role in the employment strategy, process improvement and ongoing culture.
Brandingandmarketing:
Accesstopatientsisimportanttophysiciansandthehospital.Thehospital’sbrandingstrategyandmarketingsupporttobeseenasadifferentiatorinemployingphysicians.

22. Cultural transformation
Current Culture
2
2
Desired Culture
Time and Effort
We are here
Gap
How do we close the gap?

23. Elements of cultural transformation
Path:
Operational management and process improvement
2
3
People:
New leadership
-Change management
Plan:
Strategy - development and execution

24. Setting the Vision
Mobilizing Commitment
Sustaining Improvement
Creating the Need
Monitoring Progress
Opening people’s minds to change
2
4
Stating the “good” that will result
Bringing people along
Eliminating slippage
Confirming delivery of the “good”
Supported by a foundation of
leadership and reinforcing agreed processes
Change as a process

25. “Employed Physician Council”
10 employed physicians who are respected and interested in making a difference
Provided:
Information about changes to practice nationwide
Site visit to Geisingerandto a central scheduling program
Created sub committee to review comp. plans
Selected “areas of pain” to explore and resolve

26. “Employed Physician Council”
Early activities
The EPC set a goal of 4 days to a working diagnosis for specialty care patients
Identified the existing referral process as an impediment to speedy patient access
Initiated a survey to study the process and systems

27. Survey process
Tracked time taken to execute referrals of all types
Identified obstacles to access
1.Clinical barriers
2.Process barriers
3.Productivity barriers
Discovered there was not a global issue
Specific to Pain, Neuro and Behavioral Health

28. Pain ManagementSample Study ResultsBased on Avg. # Daily Encounters
0
5
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15
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25
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35
40
w/rvu's
Encntrs
w/rvu's
Encntrs
w/rvu's
Encntrs
w/rvu's
Encntrs
w/rvu's
Encntrs
Jan
Feb
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May
Sun
Mon
Tue
Wed
Thu
Fri
Sat

29. Next steps
EPC was shown tactics to use when working on process improvement (eg: 6 Sigma)
EPC decided to:
Revise referral protocols to the noted specialties by involving affected physicians
Recommend changes in care management to improve access to the specialist
Have clinic directors work on necessary administrative changes

30. Results
Eureka Moments
The moment the group determined some other physicians were not in support of the agreed process and decided to censure them
Changes to practice style can affect patient access and satisfaction
The discovery that the Compensation Committee needed to represent the interests of all the employed physicians.
The recognition that they needed a strong leader

31. 0.0
5.0
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25.0
30.0
35.0
40.0
Jan
Feb
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Aug
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Dec
Avg.Number of Encounters each day for Each Month FY 2013
NeuroScienceand NeuroSurgery

32. 0
1
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7
Jan
Feb
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Nov
Dec
MGMA Neuro
MGMA NSurg
Avg. Work/Rvu'sper Encounter each Month FY 2013
NeuroScienceand Neurosurgery

33. Market share
2008-2012 Inpatient Discharges
Compared to 5 Key Hospitals
% Market
Hospital
County
2008
2012
Ozarks Medical Center
HOWELL
60.3%
67.2%
OREGON
54.5%
66.8%
OZARK
20.3%
28.7%
SHANNON
26.7%
36.4%
FULTON AR
58.8%
73.5%
Total OMC
44.1%
54.5%
Source: Missouri Hospital Assoc

34. Questions