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Population Health EraMedical Staff Development Planning
March 19, 2014
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Overall Purpose
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What is Medical Staff Development Planning (“MSDP”)?
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Why is MSDP Both Necessary & Advised?
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Why is MSDP Both Necessary & Advised?
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Health ReformHealth Reform
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Evolution of Medical Staff Development Planning
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1980-90’s Late 1990’s 2004 2010 2014
IRS & “Community Need”
Rudimentary Medical Staff Development Plans
Compliance-Focused Using Dated Ratios
Oversupply Concerns (GMENAC)
Advent of ManagedCare
Stark Law Geography
Plans Still Compliance Oriented
Increasing Competition & Industry Complexity Requiring Better Solutions and Data
Affordable Care Act
Ongoing Competition, Complexity
More Sub-Specialization;Extenders;Patient Access; Changing Physician Workforce
Population Health; Clinical Integration;New Delivery Models;Value-Based;Industry Consolidation
Robust, Strategic Medical Staff Development Plans Required
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What Are a Plan’s Key Components?
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• One-on-One Interviews• Physician Survey• Patient Access Study
Local Market Reality
• Physician Supply Database• Community & Hospital Supply/Demand• Served Lives Analysis
Quantitative Results
• Synthesize All Inputs• 3-Year Recruitment Strategy• Population Health Scenarios
Recruitment Strategy
Final Medical Staff Development Plan
Steering C
omm
ittee Guidance
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Who Should Be Involved in the Planning?
Steering Committee
• President / CEO
• Chief Medical Officer
• Medical Staff Leaders
• Informal Physician Leaders
• Strategy / Development
• Physician Recruitment
• Board Member
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Local Market Reality
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How Should You Gain Medical Staff Perspective?
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Why is Senior Management Input Important?
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How Does Patient Access Impact the Plan?
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How Does Patient Access Impact the Plan?
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Quantitative Inputs
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What Should the Demand Data Include?Why Are Publicly Available Physician-to-Population Ratios Less Valuable?
GMENAC and other publicly available ratios:• Developed decades ago
• Do not adjust for age or gender make-up
• Do not account for changing utilization
• Do not account for changing practice patterns
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Robust, all-payer actuarial use rate data
Specific to populationage and gender
Broad list of adult & pediatric sub-specialties
Utilization adjustments for well-managed population
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Is There an Easy Way to Assemble Physician Supply?
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Is There an Easy Way to Assemble Physician Supply?
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Physician Practice Websites
Hospital Provider Rosters
Mailing List Data
State License
Databases
Vitals, Health-grades,
Yelp
AMA Masterfile
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Is Primary Research Necessary?
• Multiple Office Locations
• Multiple Specialties
• Productivity Adjustments
• Source Counts
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Dat
abas
e Ac
cura
cy
Number of Phone Calls
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Strategic Analysis
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What is the Purpose of a Strategic Analysis
• Identify market opportunities for services
• Customize the analysis for the institution: what are our needs?
• Integrate local market reality with the quantitative modeling
• Develop a recruitment strategy positioned for success
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Hospital Strategic Need Calculation
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Total Market Demand
Step 1:Define Strategic Service AreaUnderstand Related Age & Gender Demographics
Hospital’s Portion of Demand
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Primary Service Area
Secondary Service Area
Tertiary Service Area
Calculate Total Demand in the Market
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Total FTE Demand
40
40
40
120 FTEs
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Hospital Strategic Need Calculation
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Total Market Demand
Step 1:Define Strategic Service AreaUnderstand Related Age & Gender Demographics
Hospital’s Portion of Demand
Step 2:Determine Institutional Served LivesCurrent & Projected
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Calculate the Hospital’s Portion of the Market
• Population-based “Portion of the Market”
• Served Lives = number of residents served by the hospital
• Estimate using inpatient, outpatient, & physician market share
• Apply a set of growth targets to model future market capture
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Primary Service Area
Secondary Service Area
Tertiary Service Area
Calculate the Hospital’s Portion of the Market
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Total FTE Demand
40
40
40
120 FTEs
30
10
4
Hospital Portion: 30 + 10 + 4 = 44 FTEs
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The Portion of the Market Varies by Specialty and Geography
Primary Care Example• The hospital’s portion of the
market is heavily weighted towards the population near the hospital campus
Sub-Specialist Example• Tertiary providers draw from
a wider geography and serve a larger portion of distant population centers
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PSA
SSA
TSA
PSA
SSA
TSA
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Hospital Strategic Need Calculation
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Total Market Demand
Step 1:Define Strategic Service AreaUnderstand Related Age & Gender Demographics
Hospital’s Portion of Demand
Step 2:Determine Institutional Served LivesCurrent & Projected
Total Market Supply
Step 3:Assemble Service Area Physician Supply Data
Hospital’s Aligned Physicians
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Hospital Strategic Need Calculation
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Total Market Demand
Step 1:Define Strategic Service AreaUnderstand Related Age & Gender Demographics
Hospital’s Portion of Demand
Step 2:Determine Institutional Served LivesCurrent & Projected
Total Market Supply
Step 3:Assemble Service Area Physician Supply Data
Hospital’s Aligned Physicians
Step 4:Identify Aligned ProvidersQuantify Institutional Commitment
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Calculate Physician Commitment Levels
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1.0 1.0 1.0
100%Commitment
70%Commitment
0%Commitment
1.0
3.0 FTE Physicians in
the Market
1.7 FTE Physicians at the Hospital0.7
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Hospital Strategic Need Calculation
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Total Market Demand
Step 1:Define Strategic Service AreaUnderstand Related Age & Gender Demographics
Hospital’s Portion of Demand
Step 2:Determine Institutional Served LivesCurrent & Projected
Total Market Supply
Step 3:Assemble Service Area Physician Supply Data
Hospital’s Aligned Physicians
Step 4:Identify Aligned ProvidersQuantify Institutional Commitment
Step 5:Calculate Surplus or Deficit for the Market and Institution
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Project the Strategic Surplus/(Deficit)
Specialty Supply Demand Surplus/ (Deficit)
Family Medicine 88.1 104.7 (16.6)
Internal Medicine 31.1 62.5 (31.4)
Obstetrics & Gynecology 27.2 24.1 3.1
Pediatrics 23.0 36.6 (13.6)
Urgent Care 4.7 6.8 (2.1)
Total Primary Care 174.1 234.7 (60.6)
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Projected Surplus/(Deficit)Includes Impact of:
Total Service Area Hospital PortionProjected Retirements +Demographics & Aging
Projected Retirements +Demographics & Aging+
Targeted Strategic Growth
Supply Demand Surplus/ (Deficit)
22.1 34.3 (12.2)
14.0 20.5 (6.5)
11.0 11.9 (0.9)
10.3 11.3 (1.0)
1.9 2.3 (0.4)
59.3 80.3 (21.0)
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Segment Projected Physician Needs by Driver
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Current Gaps
Population Growth & Aging
Succession Planning
New Served Lives
Maintain Current Market Share
Capture Incremental Market Share
• Changing needs of aging patients
• Demand from new residents
• Address potential retirements
• Serve a larger portion of the population by specialty & geography
• Fill gaps in existing services
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Strategic Priority
Other Services
No Priority
Define the Hospital’s Service Line PrioritiesService Lines/Specialties
Allergy & ImmunologyBariatric SurgeryBreast SurgeryCardiac SurgeryCardiology - EPCardiology - InterventionalCardiology - MedicalColon & Rectal SurgeryDermatologyEndocrinologyFamily MedicineGastroenterologyGeneral SurgeryGynecology OncologyHematology/OncologyInfectious DiseaseInternal MedicineMaternal Fetal MedicineNephrologyNeurologyNeurosurgeryNeurosurgery - SpineObstetrics & Gynecology
SOncology SurgeryOphthalmologyOrthopedic SurgeryOrthopedic Surgery - HandOrthopedic Surgery - SpineOtolaryngologyPain ManagementPediatricsPhysical Med./RehabPlastic SurgeryPodiatryPsychiatryPulmonaryRepro. EndocrinologyRheumatologySleep MedicineSports MedicineThoracic SurgeryTransplant SurgeryUrgent CareUrologyVascular Surgery
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Develop Customized Recruitment Targets
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Local Market Reality
Hospital Strategy
SuccessionPlanning
Quantitative Results
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Quantify Recruitment Targets by Driver of Need
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Fill Current Gaps 11
Demographic Changes 2
Succession Planning 11
Market Share Targets 8
Total New Physicians 32
Summary Recruitment
Targets:
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Create the Recruitment Strategy
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Recruitment Approach• Increase alignment• Employ existing area physicians• New recruitment• Physician vs. extenders
Recruitment Vehicle• Employed network• Independent practices• Start-up practice
Budget and Cost• Recruitment expense• Independent practice support• Employed group economics
Financial Impact• Overall financial impact on the
institution given the recruitment strategy
Recruitment Strategy
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Planned Three-Year Recruitment Activity
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Total Three-Year Target:
32 Physicians
Employment:18 Physicians
Financially Assisted
Independent Recruitment:5 Physicians
Other Independent Recruitment:3 Physicians Non-Hospital
Recruitment:4 Physicians
Other Approaches:2 Physicians
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Impact of Population Health
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Population Health Scenarios
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Medicaid Expansion
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122,492
95,503
92,305
79,005
72,358
70,383
59,912
Orthopedic Surgery
Cardiology
Neurology
Primary Care
Pulmonary
Plastic Surgery
Gastroenterology
Identify Gaps to Service Existing Lives
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Number of Served Lives
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Serving Populations with an Integrated Group
How Many PCPs Needed to Support One Specialist?
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Specialty PCPsMedical Sub-SpecialtiesCardiology - Medical 16Gastroenterology 13Hematology/Oncology 20Infectious Disease 57Pulmonary 21
Surgical Sub-SpecialtiesColon & Rectal Surgery 104General Surgery 15Neurosurgery 167Orthopedic Surgery 9Urology 20
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What does “Well-Managed” Look Like?• Active use of treatment guidelines
• Physician education on ways to provide care more efficiently
• Financial incentives that reward providers for efficient utilization
• On-site utilization management of inpatient services
• The use of a primary care manager
• Integration of physician extenders
• Programs that teach populations when to seek medical assistance
• Disease management programs targeting at-risk populations
• Use of information systems that support utilization monitoring
• Active use of case managers for acute and chronically ill patients
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What is the Potential Impact on Physician Demand?
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SpecialtyUtilization % Change
from Traditional toWell-Managed
Primary Care (13%) decreaseObstetrics and Pediatrics 17% increaseCardiology (18%) decreaseInfectious Disease (11%) decreaseRheumatology (26%) decreasePsychiatry (4%) decreaseCardiac Surgery (8%) decreaseOphthalmology (18%) decreaseSpine Surgery (22%) decrease
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Tools & Analyses
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Medical Staff Development Planning Checklist
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One-on-One Interview Findings
Physician Survey Results
Patient Access Study
Physician Supply Database
Strategic Surplus/Deficit Analyses
Served Lives Analysis
Recruitment Targets
Recruitment Strategy
Population Health Scenarios
Compliance Analysis
Executive Summary Version
Scenario Planning Tools