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. ByrnePresident, Lund Byrne Associates

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

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

Location

The primary service area

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

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

Recruitment

Significant success with recruitment:

Orthopedics

Cardiology

Oncology

General Surgery

Hospitalists

Family practice

Why Physicians sign on

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%

Strongly Disagree -1

2

3

4

5

6

7

8

9

Stongly Agree - 10

Expectation of Cultural Fit as Determining Factor for Physician Employment

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/rvu productivity 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

True or False?

Employed Physicians can be a solution

to developing new Hospital business?

Employed physicians need to be a part of theteam and to do that they must be accepted aspart of the whole team!

The traditional and separate cultures ofPhysician and Hospital must be merged.

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”

How cultures can develop

What can define the behaviors in 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

Active support of protocols and standards of care

Communications – who/what/when/how

Being prepared to intercept and correct “undesirable” actions

Culture as a competitive

advantage

We recognized that:

Culture can create competitive

differentiation

A good culture is hard to duplicate

Also

If there is a fit, the new people will easily

adapt to the culture

People will become loyal to a culture,

not to strategies

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.”

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?

Can you articulate your

culture

Defined as (E.G.) Supported by

Rate as important in

your culture

(1 = low to 10)

Physician friendly?

Quality oriented?

Patient focused

Collegial

Profit motivated

Area leader in

services

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

Want Not-Want

Setting the framework for

culture change

Clarity of Vision:

The hospital needs to present physicians

with a clear plan for its future in which

physician participation is a core element.

This is a compelling plan that resonates

with the new realities around the three

basic needs of many physicians

respect,

clinical autonomy and

income.

Setting the framework for

culture change

Physician leadership:

Respected physicians with demonstrated competence as leaders and managers to play a prominent role in the employment strategy, process improvement and ongoing culture.

Branding and marketing:

Access to patients is important tophysicians and the hospital. The hospital’sbranding strategy and marketing supportto be seen as a differentiator in employingphysicians.

Cultural transformation

Current

Culture

2

2

Desired Culture

Time and Effort

We are here

Gap

How do we close the gap?

Elements of cultural

transformation

Path:

Operational management and

process improvement

2

3

People:

New leadership

- Change

management

Plan:

Strategy -

development and

execution

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

“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 Geisinger and to a central scheduling program

Created sub committee to review comp. plans

Selected “areas of pain” to explore and resolve

“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

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

Pain ManagementSample Study ResultsBased on Avg. # Daily Encounters

0

5

10

15

20

25

30

35

40

w/rvu's Encntrs w/rvu's Encntrs w/rvu's Encntrs w/rvu's Encntrs w/rvu's Encntrs

Jan Feb March April May

Sun Mon Tue Wed Thu Fri Sat

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

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

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Avg. Number of Encounters each day for Each Month FY 2013NeuroScience and NeuroSurgery

0

1

2

3

4

5

6

7

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

MGMA Neuro

MGMA NSurg

Avg. Work/Rvu's per Encounter each Month FY 2013NeuroScience and Neurosurgery

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

Questions