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TRANSCRIPT
4/20/2015
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Physician and Hospital AlignmentFrom a Physician’s
Perspective
Becker’s 6th Annual Meeting 5.8.15
Tony Tedeschi, MD
CEO Weiss Memorial Hospital
and CEO Tenet Chicago Market
Gail Peace
President Ludi Inc.
Clinical
Integration
LeadershipOpportunities
Incentives
Business Opportunities
Alignment
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PHYSICIAN AND HOSPITAL ALIGNMENT
Aligning the goals of both parties for a beneficial relationship
Healthcare Advisory Board Company describes the challenge:
� Identify the right physicians to target
� Choose the right strategy that will balance interdependence and partnership
� Engage physicians in mutual goals
� Maximize information-sharing to achieve set goals
� Engage physicians in setting goals
The challenges of alignment from hospital perspective
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WHY DO PHYSICIANS ALIGN
WITH HOSPITALS?
Physicians seek alignment models with hospitals for:� Security and sustainability� Economics� Purpose� Clinical Activity
Understand the physician’s perspective
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POSSIBLE PITFALLS
What are the perceptions of your organization?
History of distrust
and misaligned
incentives
Leadership not
following through
on the promise
Antagonistic
relationship with
administration
Turnover of
leadership team
Trust can be an
issue
Transparency builds trust
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THE SOLUTION – STRATEGIES
Medical Directorships
Committee Leadership
Bundled Payment
Co-Management Joint
Ventures
Professional Service
Agreements
Employment
Shared Savings
Build bridges through sharing the leadership role and engagement
Level of Integration
Spend
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DETERMINING THE STRATEGY
Understand all models
Determine behavior addressing
Execute on strategy
Measure and monitor success
� What are the reasons for alignment?� What is in it for the physician?
� For the organization?� How will you measure the success of the alignment?
Measure is the often forgotten step
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THE WEISS MEMORIAL HOSPITAL EXPERIENCE
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WEISS MEMORIAL HOSPITAL
� Tenet Healthcare
� Investor owned, 236-bed
healthcare facility
� Founded in 1953, adult care
� Serves diverse population of
600,00 in the city of Chicago
� Located on Lakeshore Drive
� Surgical subspecialty centers of
excellence
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WEISS SERVICE AREA MAP, CHICAGO56 acute care facilities, 5 academic centers
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WEISS EXPERIENCE
New structures- ownership and reorganize for success
Alignment of incentives – pay for performance
Clinical leadership development
Communication – key pillar
Transparency - Culture
5 keys to success
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NEW STRUCTURE DRIVES OWNERSHIP
� Appropriate way to reimburse physicians for time spent helping us manage systems/processes
� Physicians design the pathways to improve patient care and satisfaction
� Physicians like the program, it becomes theirs
� Success has been achieved when physicians change pronouns from ‘you’ to ‘we’
� The camaraderie between physicians as peers is achieved
� Able to achieve things as a team – narrowing the number of implant companies, changing OR schedule, OR start times
� Physicians are not trained in hospital management, but they are a fast study as a group, help with staffing models, business development activities and equipment
recommendations
Reorganize the structure - 4th year of Orthopedic Co-Management
Co-Management Successes
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CO-MGT ACCOMPLISHMENTS
� Increased the number of Joint University patients discharged by noon from 17 to 49%
� Achieved a PACU LOS average of 80 minutes from PACU admission to PACU discharge
� Developed and launched the Chicago Spine Center at Weiss
� Developed standardized preference cards, order sets, post-discharge instructions, and education for hand and wrist surgery to reduce variation
� Developed standardized preference cards for knee a/s, ACL reconstruction, shoulder scope with mini RCR, hip A/s, and laminectomy
� Held an average of two community events per month focused on orthopedic injuries, treatment options, and programmatic offerings
� Reduced the number of elective orthopedic surgery cancellations from 6 to 4%
� Reduced the number of primary hip and knee readmissions within 30 days from 4 to 3%
Year 3 (2013-14) Orthopedic Co-Management Accomplishments
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ALIGNMENT OF INCENTIVES ACO Strategy
Tenet owning and operating an ACO with physicians leading
Standards and agreed upon guidelines
Patient satisfaction increased
Costs changing
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LEADERSHIP DEVELOPMENT PROGRAMSSpecific programs initiated
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LEAN daily management rounding – safety huddle, walking through the workplace
Tenet Leadership Academy
Physician leadership council
Collaborative service line management
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RESULTS OF LEADERSHIP DEVELOPMENT PROGRAMS
Highly engaged and aligned physicians
Enhanced appreciation of hospital operations and goals
Physicians become very effective in managing care
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COMMUNICATION AND TRANSPARENCY
Specific examples – culture will trump strategy every day
Monthly messaging – newsletter to physicians
Provide leadership with data
Active participation in capital purchasing, operational changes and
leadership
Balanced scorecard with physicians at quarterly meetings and for
service lines
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SCORECARD EXAMPLE
*Example data does not reflect any hospital’s true performance
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LEADERSHIP TIPSAlignment is within the control of the hospital – competitive advantage
� Alignment of purpose of organization and physician
� Works economically for both
� Respectful environment and mutual respect for each other
� Environment where physician can succeed clinically and for patients
� Maintain independence in clinical decision making
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MANAGE AND MEASURE ALIGNMENT STRATEGIES
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COMPLIANCE REALITYHighly regulated environment
Office of the Inspector General
Hospital-Physician Relationships
� Anti-Kickback Statute� Stark Law� Civil Monetary Penalty� False Claims Act
Centers for Medicare & Medicaid Services
PHYSICIAN - HOSPITAL ALIGNMENT
Assess Recommend Redesign Analysis Feedback
Setup for Success Ongoing Proactive Management
� Review goals
� Identify gaps
� Identify inconsistencies
� Who
� Service lines impacted
� Clarity of goals
� Dialog with physicians
� Clarity of measures
Real-time Adjudication
Analysis
Risk Reduction
Cost Reduction
Reporting
Performance
Metrics
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SET CLEAR EXPECTATIONS
� Clearly outline duties and goals with physician
� Review work performed and score cards to assess progress
Duties:1. Attend Peer Review Committee meetings as
directed by Medical Staff By-Laws.2. Participating in long-range planning activities
as needed for the Program.3. Participate in training of staff on the unit about
clinical guidelines.4. CV Multidisciplinary Team Meetings.5. As requested by CEO or COO, accompany
facility administrative staff, attend and
participate in community outreach, including travel time to and from the communities.
Example Duties
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MEDICAL DIRECTORSHIP EXAMPLE
Time spent
Protocoldevelopment
Meetings
Training staff
Credentialing
Operationalefficiencies
$0$10,000$20,000$30,000$40,000$50,000$60,000$70,000$80,000$90,000
Investment per Month
� Review by facility, by contract, by physician
� Review detail of performance annual as
contract renews with each physician
Did we achieve what we set out to achieve?
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HOW MUCH ARE WE SPENDING?
Measure, manage and evaluate expenditures
*Source: Integrated Healthcare Strategies 2012 Medical Directorship Survey, 50th percentile yearly compensation for 10 major medical directorship specialties
Average agreement compensation
$51,000
Average agreements per hospital
60 agreements
Estimated$3,060,000
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CONTRACT INTEGRITY AND PHYSICIAN ENGAGEMENT
Time Log Automation Financial Reporting
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ADJUDICATE AND ANALYZE
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BY STRATEGY, SPEND AND SUCCESS
Medical Directorships
20%
Co-Management
41%
On-Call31%
Teaching Agreements
5%
ACO Committee Participation
3%
Expenditure
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TIPS FOR SUCCESS
1. Annual review
2. Honest review of results and spend in partnership with physician
3. Score cards
4. Use automation to track and measure
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DISCUSSION
Tony Tedeschi, [email protected]
773-564-5101
Gail [email protected]
773-866-2860