HFMA Physician Alignment - Buy in March 2013

A HORSE OF A DIFFERENT COLOR…
PHYSICIAN BUY-IN
Cheryl L. Coors, President
Coors Healthcare Solutions
Paul Hiltz, CEO
Mercy Hospital Springfield
Coors Healthcare Solutions © 2013

Create Physician
Buy-In Through The
Alignment Process

Learning Objectives
• Successfully transition practicing physicians to key leadership roles using
an assessment inventory and coaching process
• Assist physicians in transitioning to both an employee and clinical
integrated delivery model; including both monetary and non-monetary
incentives
• Use unique non-monetary physician incentives to drive the change
process while enhancing the quality of patient care
• Determine what really matters to physicians and promotes buy-in with
different delivery models, e.g. Employee physician, medical home
• Use innovative and creative solutions to promote physician buy-in

Good Morning!
• Let’s switch seats…

MISSION, VISION & VALUES –
MAKING IT PRACTICAL
The Road Map to Creating Physician Buy-In

Mission
(home = who
you are)
Strategy
(Road map =
goals,
objectives,
metrics,
dashboards)
Vision
(final
destination =
success)
The Journey
Vehicle
(Resources)
Driver
(Leadership)
Values
(who gets to
go and how
do we get there)
Culture
(did we have fun
on the journey)

Communication
Creative -- Slow Start / Fast Finish
Vacillating -- Temperamental
Competitive
Confrontational
Direct
Results-Oriented
Sense of Urgency
Change Agent
Good Supporter -- Team Player -- Persistent &
Cooperative -- Sensitive to Other’s Feelings
High Trust Level
Not Fearful of Change
Contractibility
Rather Talk than Listen
Verbal Skills
Projects Self-Confidence
Process-Oriented
Quick to Change
Independent
Optimistic
Accommodating
Dislikes Confrontation
Persistent
Controls Emotion
Adaptable
Good Listener
Product-Oriented
Slow to Change
Self-Disciplined
Pessimistic
Precise
Accurate
Concern for Quality
Critical Listener
Non-Verbal Communicator
Attention to Detail

Organizational
Strategy
Needs Assessment /
Gap Analysis
Physician Strategy
Physician Alignment
Contracts,
Compensation &
Implementation
Physician
Recruitment &
Retention
Physician
Integration
Strategic Physician
Solutions™

Organizational
Strategy
Strategic Physician
Solutions™

Organizational
Strategy
Needs Assessment /
Gap Analysis
Strategic Physician
Solutions™

Organizational
Strategy
Needs Assessment /
Gap Analysis
Physician Strategy
Strategic Physician
Solutions™

Organizational
Strategy
Needs Assessment /
Gap Analysis
Physician Strategy
Physician Alignment
Strategic Physician
Solutions™

PHYSICIAN ALIGNMENT = BUY-IN
Ensuring the current medical staff is strategically
aligned with the organizational strategy for
optimum growth and success.

Alignment Drivers – National
Perspective
• Physician Drivers:
– Reimbursement / Bundle
Payments
– Health Reform
– Administrative Complexity
– Recruitment
– Concern for Future Referrals
– Financial Security
• Hospital Drivers:
– Clinical Integration
– Health Reform
– Fear of Market Share Loss
– Competition
– Hospital Based
Reimbursement
– Committed Medical Staff

Healthcare Integration Trend
Source: MGMA Connexion “Medical Practice Today” July 2011

• Alignment of Model Options
• Health System Motivations
• Referral Sources
• Financial Security
• Governance, Term and Exit Strategy
• Health Care Reform
Top Considerations For Doctors

Organizational
Strategy
Needs Assessment /
Gap Analysis
Physician Strategy
Physician
Alignment:
Physician Advisory
Council
Strategic Physician
Solutions™

Physician Engagement = Buy In
• Getting Physicians’ Participation
• Getting Physicians’ Attention
• Getting Physicians’ Committed

Physician Leadership Attributes
• Is a global thinker
• Builds partnerships and a
network of relationships
• Creates a shared vision
• Ensures customer satisfaction
• Is technologically savvy
• Develops and empowers people
• Encourages constructive
dialogue - asks for input and
genuinely listens to others
• Has achieved personal mastery
• Demonstrates integrity with
honest and ethical behavior
• Leads change - Sees change as
an opportunity, not a problem

PHYSICIAN ADVISORY COUNCIL
(P.A.C.)™
Creating a partnership between hospital
administration and medical staff.

Physician Engagement – Built Not Bought

PAC™ Philosophy
• Physicians are a hospital's number #1 customer!
• This philosophy is the foundation to create a Physician-centric
customer service model

PAC™ Design
• TRANSPARENT COMMUNICATION – Open atmosphere
• SEAT AT THE TABLE – Physician and decision makers
• DIRECT INPUT TO CEO - Input for decisions effecting physicians
and patient care
• OPEN FORUM – Early discussion with Physicians – avoiding
crisis
• ALIGNMENT with Strategic Needs – Physician alignment with
Organization’s strategic needs

PAC™ Wins!
Northwest Medical Center
• Developed a strategic Master Plan that ensured "vested constituencies"
• Developed a 5-year physician recruitment plan (successfully recruited 23
physicians with one year)
• Increased physician satisfaction from 4th quartile to 1st quartile and
maintained 1st quartile for 3 years, until company was sold
• Increased admissions by 14% Open Heart Surgeries 72% O/P Surgeries
30% Cardiac Cath 58%

PAC™ Wins!
Gateway Regional Medical Center
• Developed a 5 year Master plan that charted the hospitals course for becoming
Surgical and cardiac based hospital verses Psychiatric
• Grew cardiac business 60% in 2012 opening hospital's 1st cardiac cath lab in 2011
• Established robotic surgery program (daVinci) - First year 140+ robotic surgeries
• Increased Physician satisfaction from 34% very satisfied in 2011 to 54% very
satisfied in 2012
• Geriatric Hospitalist program decreased readmissions by 20% in 4 months
• Successfully recruited 22 physicians as part of the succession plan without
cannibalizing existing medical staff

Organizational
Strategy
Needs Assessment /
Gap Analysis
Physician Strategy
Physician
Alignment:
Structure Options
Strategic Physician
Solutions™

Physician Alignment
• Alignment of current medical staff with organizational strategy
• Development of Physician Advisory Council (PAC)™
• Options for Physician/Hospital Alignment:
Employment Business Services Contracts
 Physician Compensation/
Productivity Models
 Single-Specialty Group
 Multi-Specialty Group
 Physician Network
Development
 Management Services
Organization (MSO)
 Practice Leasing
 Lease / Real Estate
Contracts
 I.T. Infrastructure
 Payor Contracting
Organizations
 Clinical Integration /
Physician Networks
 Physician Recruitment
 Call pay arrangements
 Medical Directorships
 Clinical co-management
arrangements
 Professional Services
Agreements
 Joint Ventures
 Practice Leasing
Coors Healthcare Solutions © 2012Coors Healthcare Solutions © 2013

Horse of a Different Color
• Physician employment requires education!
• Physicians are not accustomed to being employees
• Employment options facilitate alignment but require buy-in from
physicians
– Communication with complete transparency
– Addressing “What’s in it for me?”
– Education
– Creativity
– Trust

Physician Employee Handbook
• Mission, Vision, Values
• Governance structure
• Written code of conduct
• Workplace policies
• Operating policies for medical
practice
• Compensation/ Bonus
Distribution formula
• Benefits Program
• Billing Practice
• Hiring
• CME Requirements
• Intellectual property
• Outside income / activities

Flexible Work Environment =
Flexibility
• An increasing number of physicians are working part time
• Current data suggests that nearly 20% of physicians work part time (31 percent of
women, 8 percent of men)
• By promoting and enhancing part-time medical careers, organizations may be able
to attract and retain satisfied, healthy, capable, and connected physicians.
• Without a strategy in place, employers may find physicians either leaving for a
more flexible employment model, or “informally” cutting back either their hours or
productivity while maintaining the same salary.
• Physicians should choose how MUCH they work and how HARD they work within
standards set by the employing organization.

Flexible Work Environment
The table below provides an example of employment options for a general internal
medicine physician with productivity expectations and incentives.
0.5 FTE
• 4 sessions per week
• 2,250 work RVU/year
• $75,000 base salary
• $24 per wRVU in excess of 2,250
0.6 FTE
0.7 FTE
0.8FTE
0.9 FTE
1.0 FTE

• Relying only on financial statements
• Producing documents that are too confusing/detailed
• Not understanding what really drives the business
• Not trending data – presenting only a historical perspective
• Failing to re-design data reporting to reflect the Vision and
Strategic Plan
• Focusing solely on finances and not on operations
• Not using both internal and external benchmarks
Common Errors to Avoid

Organizational
Strategy
Needs Assessment /
Gap Analysis
Physician Strategy
Physician Alignment
Contracts,
Compensation &
Implementation
Strategic Physician
Solutions™

CONTRACTS, COMPENSATION &
IMPLEMENTATION
(STAGE 5)
Developing a collaborative working environment
by establishing a cohesive compensation
program and setting performance expectations.

Physician Contracts / Employment
Agreements
• Assess the relative productivity of each physician in order to perform
compensation and productivity analyses
• Performance measured against established industry benchmarks:
– Charges
– Collections
– Patient Encounters
– Performance/ Quality Initiatives
– Work Relative Value Units
• Fair market value compensation for each proposed agreement

• Lengthy and complex contracts
• Not building in an out-clause for multiple years
• Locking in compensation without risk for lengthy periods
• Customizing the body of the contract
• Either being too restrictive, or not restrictive enough with non-competes
• Forgetting to include non-solicitation clauses
• Forgetting to address outside income
• Not having a Code of Conduct and enforcing it

Examples of Metrics
• Physician productivity metrics
– How busy are we really?
• Ambulatory care metrics
– How efficiently do we operate?
• Staffing metrics
– Are we staffed appropriately?
• Billing office metrics
– How well do we collect the
money?
• Finance metrics
– How costly are we?
• Quality metrics
– Do we deliver great care? Are our
patients, physicians and
employees satisfied?
Keep in mind: Physicians are scientists – they think in numbers and data

Dashboard & Metrics Reports
• Simplicity of reports helps to
create buy-in
• Example: Stop Light Reports 
KEY: Red Red - Not meeting target
Variance 1.5% over/under
Yellow Yellow - Target in jeopardy
Variance 0.1% to 1.5%
Green Green - Target being met
or exceeded
Department Department Department
Budget to
Actual
Budget to
Actual
Budget to
Actual
WRVU'S
REVENUE
EXPENSE
Salary & Benefits
Non-Personnel
OPERATING MARGIN
TOTAL MARGIN
RESERVES
ACCOUNTS RECEIVABLE

Performance, Not Just Productivity
• Annual Performance Incentives reward and promote both an improved
patient care experience and specific organizational goals.
• Performance Incentive targets encourage physicians to:
– View the bigger picture by sharing in the organization’s overall strategic mission.
– Focus on quality, compliance, and patient satisfaction measures.
– Increase awareness of the cost of delivering care.
– Participate in the budgeting process.
– Respect a positive group culture.
– Value governance and citizenship contributions.
– Promote teamwork.
• Annual physician performance reviews are critical

Organizational
Strategy
Needs Assessment /
Gap Analysis
Physician Strategy
Physician Alignment
Contracts,
Compensation &
Implementation
Physician
Recruitment
Strategic Physician
Solutions™

PHYSICIAN RECRUITMENT
Building an effective in-house training program,
establishing best practices for consistent,
effective and long-term physician recruitment and
retention.

Get Your House In Order: Build Your Foundation
Organizational Strategy
Community
Need Analysis
Proof:
Support for
Road Map
Needs
Assess /
GAP
Prioritize
goals
Practice
Viability &
Due Diligence
Develop Road
Map
Physician
Strategy
Re-engage
Med Staff
Transparency
= Trust
PAC™
Alignment
Structure
Options
Physician
Alignment
Standardized
Contracts
Performance
Incentives
Create
Compensatio
n Equality
Contracts
&
Compen-
sation
Physician
Recruitment & Retention
Training

Challenges Organizations Face
• Physician satisfaction scores
• Physician retention
• Profitability of physician practices
• Physician recruitment
• High use/costs of Locums

Organizational
Strategy
Needs Assessment /
Gap Analysis
Physician Strategy
Physician Alignment
Contracts,
Compensation &
Implementation
Physician
Retention
Strategies
Strategic Physician
Solutions™

PHYSICIAN RETENTION
Designing comprehensive and creative programs
focused on Physician-centric customer service to
attract and retain top talent.

Physician Retention
Six most common reasons why physicians leave (MGMA Study):
1. Lack of professional interaction, support, call coverage, collegiality and
camaraderie
2. Spousal and/or family dissatisfaction
3. Economic dissatisfaction
4. Management that does not seek or use input
5. Facility, equipment, support and personnel quality issues
6. Fear of loss of professional skills because of non-challenging workload or lack
of support for continuing medical education

Physician Retention
• Press Ganey estimates that the replacement costs of one
physician equals $250,000 – not accounting lost revenue and
practice set up.
• All studies show that physicians are more likely to leave because
of factors related to the job itself than because of compensation
• Many studies recommended a formal mentoring program

• Failing to recognize that it’s rarely just about the money
• Not realizing that first impressions count
• Not understanding the young physician out of training and assuming “one size fits
all”
• Failing to ask for physician input to organizational priorities
• Not looking at satisfaction and morale
• Discounting life-style issues
• Forgetting that small investments in existing physicians are usually a far better
investment that costly new recruitments
• Failing to address bad behavior
• Not letting people take time off to get away

Effective Retention Initiatives
What physicians say would increase their job satisfaction:
• Desire for greater involvement in decision-making
• Greater control over work hours - increased flexibility
• Compensation plans that better recognize individual contributions
to improved patient care, productivity and profitability
• Long-term financial security – incentives to stay

Create Physician Benefit Program
– Disability – opportunity to buy into supplemental group policies
– Whole life insurance policy with vesting schedule 5 or 10 years
– SERP Program (funded through whole life policy)
– Opportunities to provide additional cash revenue service options that
support quality outcomes and increase practice revenue.

• Historically hospital administration has been more "reactive"
verses "proactive" in listening to and addressing physicians
concerns, complaints and attitudes
• Physicians are a hospital's number #1 customer!
• PAC™ uses this philosophy as the foundation in which to build
a strong, vibrant and successful physician strategy and committed
partnership
• Integral component of overall Physician Strategy, Alignment, buy-
in and retention initiatives
The PAC™ - A Retention Tool

Physician Satisfaction Survey
Example of questions to ask:
• What influenced their decision to work at your organization?
• What keeps them working here?
• What is their level of job satisfaction?
• What has happened to their satisfaction over the last 3 years?
• What would improve their job satisfaction?
• Are they considering leaving in the next 2-3 years?
• To select factors that were would influence their decision
• Which type of organization they would join if they left?
• How would they rate their satisfaction with support staff?
• Who do they respect as leaders?
• What should leadership focus on?

PHYSICIAN INTEGRATION
Completing each step of the Strategic Physician
Solutions™ process creates the platform for full
integration.

Physician Integration
• Manage employed physicians
– Operations improvement
– Coding compliance program
– Revenue cycle management
– Practice compliance & integrity programs
– Develop Primary Care feeder programs
• Involve physicians in measuring quality goals
• Clinical Integration, Co-Management, IT infrastructure

Actions To Help Foster
Physician Buy-in
A Case Study:
Paul Hiltz, CEO
Community Mercy Health Partners
Springfield, Ohio

Physicians' Perceptions of Quality of Care
Mercy Hospital Mount Airy

Physicians' Perceptions of Patient Safety
An ''Excellent'' Percentile Ranking is not available for 2004.

Physicians' Perceptions of Administration

Physicians' Perceptions of Mission and Values

Physicians' Perceptions of Mercy Hospital Mount Airy as a Place to Practice
Medicine

2006 Mercy Hospital Mount Airy
(''Excellent'' Percentile Rankings)
90th
Percentile

2010 Mercy Hospital Mount Airy
(''Excellent'' Percentile Rankings) 2010
% Excellent
90th Percentile
% Excellent
59.7% 45.5%
53.9% 44.1%
42.1% 37.1%
52.0% 49.5%
59.4% 57.6%
55.6% 55.1%
50.0% 52.0%
42.9% 48.4%
48.7% 57.4%
50.6% 58.0%
38.9% 46.1%
33.8% 42.5%
35.7% 49.4%
28.9% 43.0%
90th
Percentile

Cheryl Coors, MHA – President
Cheryl Coors has over 25 years experience in healthcare, including 15 years in healthcare
recruiting. She began her career in healthcare in nursing and progressively transitioned through
several different avenues within the industry. Her background has given Cheryl a unique
perspective in understanding the challenges facing the healthcare industry. Cheryl’s diversified
background in nursing, practice management, Biotech sales management, and executive search
lend to her expertise. Today, she has established herself as one of the top search consultants in the
recruiting industry.
In 1999, Cheryl founded Coors Healthcare Solutions to bring the highest standard of
professionalism, integrity, and personalized service to the healthcare search industry. With a
Master’s Degree in Healthcare Administration and significant experience in the field, she chose to
specialize in healthcare industry recruiting and consulting services. Cheryl has dedicated Coors
Healthcare Solutions to identifying and placing highly skilled, committed and passionate senior level
executives in healthcare organizations nationwide.

Paul Hiltz, CEO, Community Mercy Health
Partners
Paul Hiltz, MHA, FACHE, is currently the CEO of Community Mercy Health Partners, a 2 facility
system in Springfield, OH. Paul has been with Mercy Health since 1985, when he joined Mercy
Health - Clermont Hospital as an assistant administrator. In his more than 20 years with Mercy
Health, Paul has been responsible for hospital clinical and administrative operations and physician
services.
Paul holds a Master’s degree in Health Administration from Xavier University, is a Fellow in the
American College of Healthcare Executives, and has worked for Mercy in Cincinnati for more than
25 years. Over the years, Paul has held many senior roles, including heading the employed
physician organization and serving as President and CEO of Mercy Mt. Airy Hospital for many
years. Most recently Hiltz has been responsible for starting and leading Mercy Health’s Accountable
Care Organization (ACO), which is one of only 154 Medicare-approved ACOs in the United States
and has developed it to include 22,000 Medicare patients. He will continue to serve in this role with
the help of his current team.

HFMA Physician Alignment - Buy in March 2013

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HFMA Physician Alignment - Buy in March 2013