I would not characterize the go-live as a “one chance” only event. I have been through two Epic system conversions and there will be many decisions made throughout the system build that can be optimized at a later date. The key for us was finding well respected physician champions who could help keep the project moving along. The Epic implementation team also has best practice recommendations for many of the decisions that need to be made. Delays are costly and perfection impossible.
Our physicians are paid 90% on volume of wRVUs and 10% on quality/performance measures; I don’t think 10% is enough. One of the performance measures for our outpatient clinics is controllable cost (staff, supplies, Rx, facility) per Total RVU. This is a cost per unit of service measure that we set goals for. We aren’t prescriptive in communication regarding more volume or less cost, however, we do expect departments to manage their cost per TRVU.
I think that there is a total cost-of-care argument to make to the payer(s). If your outcomes are better you should see lower readmission and complication rates. I would show this information to the payers.
We brought two equal-sized organizations together 6 years ago; with two very different cultures (physician led and non-physician led). During the merger we focused on building a new culture by introducing “lean” management/organization principles and four core pillars/priorities for the new organizaiton. By introducing something new, I think it allowed employees to let go of the old cultures and focus on the new priorities and goals of the newly created organization.
We implemented a dyad model approximatley 5-6 years ago in an attempt to improve physician engagement and to help identify future physician leaders. Similar to above comments, some dyads work very well together and some do not. When we originally rolled this out, clear expectations were not set and we ran into similar issues with who was the final decision maker and lines of authority. Over the years we’ve done better at clarify roles and responsibilites, providing training to the dyad partnerships, and setting specific targets and goals for service lines.
Our physician compensation model is based on median compensation for median productivity (per a few different compensation surveys). For departments who take call, we’ve offered to reduce the productivity pay component and create a call pool that the department can use to pay for call. Median compensation in the surveys is total pay (including call pay). This is a way to pay for call (which is becoming very difficult to avoid) but be budget neutral.