I suggest we acknowledge that times are changing and will never be the same. Don’t spend too much time trying to bring it back, but focus on how to make the current and future environments more optimal for everyone. We’ve moved all of our PC docs to 100% outpatient and employ a full hospitalist model, plus ED, adding Ortho and maybe Laborists in the near future. Allowing providers to focus in one area should be beneficial to them and the patients, if you have you right resources,structure and tools in place to promote the same, or better communication than the days of old. As scale continues to change the market and communities continue to grow outward from any centrally located hospital, we must encourage and design technology and programs that narrow the time and distance challenges of the new markets. Population health strategies are already driving these demands and it’s gaining momentum.
Keys for us include:
– Optimization of EHR
– Usage of portals and secure messaging tools for providers
– Quartely provider socials, away from work
– Regular MD leadership events for edcuating and aligning
– Monthly Section Head meetings that inlcude inpatient and outpatient MD leaders
There are multiple components to any financial equation…revenue and expense. The suggestion to know, understand and appropriately document for appropriate coding is a valuable one. That is one way to potentially increase the revenue side of the equation. As you know for inpatients, the MD’s documentation can impact hospital revenue too.
More and more these days, payor contracts have risk and value associated with them, so it’s important for Docs and hospitals to find common ground on the opportunities of focus and develop a compensation plan to incorporates and shares risks and reward with the docs too. For the docs, in some situations they may have the leverage to negotiate departmental goals with the hospital where they can achieve cost savings that puts more money towards the bottom line, and in return is shared with the docs. MDs also have power in negotiating implant pricing and creating standardization across care plans and programs which typically lower costs.
Hospitals aren’t usually making higher profits just to pay their administrators more, they simply have to balance the books to keep the organization growing, because scale in the key to their future, and the MDs. Look for ways to help them achieve their goals (reduce costs/waste) and any good organization will do the same for you.
We’ve been on the pay for performance journey for many years now, both pay for the providers and by the insurance companies. Even on the straight wRVU model, we instituted a “withhold” that protected the provider and organization from under-performance. We also have value-based metrics as a % of the total comp that can be earned or lost based on individual and departmental metrics. The % of these VBM vary and are becoming greater as we move more toward value contracts. Our Primary Care service has their own comp model with weighted emphasis on production, panel size and quality outcomes (as usually rewarded by the payors). The better we can track, measure and reward individuals for their outcomes across all these measures the more palatable the changes have become for the MDs.
It’s important for the organization to realize that population management done right doesn’t usually equate to lower expenses, but investing in the right resources and processes can yield significant ROI if designed and aligned properly. I believe the components of comp plans will always be evolving it to meet the new demands of the environment and letting the MDs know that is part of it from the beginning can minimize distrust and frustration.
We’ve see our dyads grow stronger the more we align the performance and incentive goals.