Massachusetts General Physicians Organization

1. Massachusetts General Physicians Organization November 16, 2004 James Heffernan

2. What is MGPO?MGPO Mission Statement The Massachusetts General Physician Organization is a multi-specialty medical group dedicated to excellence and innovation in patient care, teaching and research

3. What is MGPO?About the MGPO • The physician practice of Mass General Hospital • Formed by Mass General Hospital physicians in 1994 • Self governing • 501-C-3 Charitable Corporation

4. Raju Kucherlapti, PhD Genomics Gary Gottlieb, MD, MBA BW/F President Peter Slavin MD MGH President George Thibault, MD Clinical Affairs Robin Jacoby, PhD Chief of Staff Thomas Lee, MD PCHI Network President Gary Gottlieb, MD, MBA Psych & Mental Health Robert Norton NSMC President Thomas Glynn, PhD COO* Eugene Braunwald, MD Academic Affairs Alan Ezekowitz, MD Pediatrics Partners Entity Management James Mongan, MD CEO & President David Storto Non-Acute Care Gary Gottlieb MD, BWH President David Trull, Faulkner President Troy Brennan MD, BWPO President Bruce Cohen MD, McLean President Peter Slavin MD,GH President David Torchiana MD, MGPO President Ann Caldwell, MGH Institute President Michael Jellinek, MD NWH President

5. MGPO is Self Governing

6. M G P O O R G A N I Z A T I O N CHAIRMAN & CEO David Torchiana, MD CHIEFS OF SERVICE* Robert Colvin, MD John Parrish, MD Andrew Warshaw,MD Alan Ezekowitz, MD Anne Young, MD James Thrall, MD Jay Loeffler, MD Robert Martuza, MD Harry Rubash, MD Leonard Kaban, MD Alasdair Conn. MD Isaac Schiff, MD Kurt Isselbacher, MD Warren Zapol, MD Dennis Ausiello, MD Walter Frontera, MD Patricia Donahoe, MD W. Scott McDougal, MD Jerrold Rosenbaum, MD Medical Director Gregg Meyer, MD President & COO Daniel Ginsburg Clinical Care Mgmt. Unit Elizabeth Mort, MD* Patient Care Services Jeanette Ives-Erickson* Primary Care and International Brit Nicholson, MD* Legal Susan Williams** Physician Office Lab Dom Misiano Specialty Care Jeffrey Weilburg, MD Specialty Care Development John Stakes, MD Mass General West Greg Pauly Internal Audit Robert Damiano** Primary Care TBD Managed Care Contracting & Marketing Anne Dubitzky* Physician Practice Mgmt and Service Improvement Nancy Gagliano, MD* Medicine, Cancer TBD* Human Resources Jeff Davis** Information Systems Jim Noga** Finance Jim Heffernan Drug Therapy Harry Demonaco* Quality Cy Hopkins, MD Marketing Peter Braumlea Physician Compensation & Benefits Tom Moore** Surgical services Anesthesia, Cardiac program Ann Prestipino* Service Improvement TBD Professional Billing Brad Osgood Physician Advisory Committee John Levinson, MD Executive Registry Marianne Gibbons Practice Support Francine Kaiser Neurology, Neurosurgery, Psychiatry, Pediatrics Joan Sapir* Professional Billing Compliance John Belknap* Generalist Support * IDX Systems Cole Dowaliby Program Development TBD Service MGH Mary Cunningham Professional Staff Benefits Mark Grubbs Managed Care Operations & Analysis Susan Zackon Budgeting & Financial Reporting Peter Gouws Radiology, Pathology Jean Elrick, MD* Ambulatory Consulting Christine Primiano Deferred Physician Compensation Kathleen Ryan Communications Jennifer Wells Payment Analysis Nan Jones Referral Service Hilda Wiggins * Joint GH ** Joint to Partners *** Joint to BWPO Rev. 02/03 af

7. What is MGPO?Partner in Leading the Institution • CEO is partner with hospital president in leading the institution • MGPO has three seats on MGH Board, MGH President sits on MGPO Board • MGPO is well represented on all key Partners committees

8. What is MGPO?About the MGPO • Largest multispecialty physician group practice in New England • Affiliated with 7,900 Physicians in Partners • 1,216 Massachusetts General Physicians Org. • 539 Brigham and Women’s Physicians Org. • 1,080 Partners Community HealthCare, Inc. • With more than 2,200 FTEs • Operates a consolidated physician billing office that is one of the country’s largest

9. What is MGPO?About the MGPO (continued) • Nonprofit organization with revenues of $365 million • Represents over 1,800 participating physicians for managed care contracting • Nearly all of its physicians are on the faculty of Harvard Medical School

11. Patient Volumes FY04 YTD Visits/Encounters Actual Budget PY Inpatient / Hospital 306,303 258,259 255,942 Outpatient / Office 499,099 428,533 441,129 Ancillary 2,445,966 2,396,406 2,343,035 Surgery / Procedure 206,953 171,899 186,889 Total Visits / Encounters 3,458,321 3,255,097 3,226,995 RVU September YTD FY'04 559,116 6,941,915 FY'03 495,720 6,161,566 RVU Change 63,396 780,349 % Change 12.8% 12.7%

12. How is the MGPO funded?Internal Funding • Administrative cost – 4% of costs • Compliance – 0.5% of costs • Billing – 7% of cash collections varies by practice

13. What is MGPO?Vision Statement The MGPO will be one of the premier multi-specialty physician group practices in the world. Working in partnership with the Massachusetts General Hospital and in cooperation with Partners HealthCare System, the MGPO will build on the synergies among clinical practice, research and teaching to improve our patietns’ well-being and the professional lives of our physicians and staff.

14. Where does the MGPO focus its efforts?MGPO TWO TO THREE YEAR GOALS • Close the compensation gap A. Contracting B. Advocacy C. Revenue cycle D. Compensation plans for more practices 2. Lead the nation in health care quality & safety 3. Develop and begin implementing MGPO growth strategy 4. Improve working lives of physicians

15. LEAD THE NATION IN HEALTH CARE QUALITY AND SAFETY MGPO taking the lead role in the Partners Signature Initiative on improving medication safety. MGPO/MGH strategic planning process has a Quality and Safety Team focused on quality measurement, culture, and education. Site visits have been made to other leading institutions and leaders have been sent to national forums. Quality measurement dashboard has been developed and is now being more widely disseminated among PO physicians with plans to migrate it to the web this year. Information Systems oversight has been restructured to increase clinical input and quality focus. Clinical Performance Management (CPM) program structure increasing focus on quality. Joint quality board committee playing an active role. Joint MGPO/MGH trustee departmental review committee established to support the departmental review process.

16. IMPROVE WORKING LIVESOF PHYSICIANS Work force task force has developed “tool box” of over 100 ideas to improve the work lives of physicians and staff. Task force is also looking at recognition, training, and the challenges of working off campus. Partners Physician Survey underscored the need for recognition. MGPO is holding focus groups later this month to get direction on how best to proceed. Initial planning underway for a 2004 physician recognition event. Physician Leadership Development program receiving positive feedback. Thirty physicians currently involved.

17. Physicians are squeezed by the combined impactof inflation and payment decreasesPhysician Compensation Per Unit For a Major Payer Declined 36 (47 Percent Decline Adjusted For Inflation) Percent Between 1992 and 2000 Physician practice revenue based on BCBS fee updates from 1992 to present. Office expense as a ratio of total practice expense in 1992 inflated using the CPI indicator. • Office Expenses include: • salaries and benefits for • secretaries, nurses, etc. • furniture and equipment • supplies--office and medical • rent, utilities • computers • malpractice insurance Sources: Ratio of office expenses to revenues for 1992 is from the AMA Socioeconomic Characteristics of Medical Practice 1994. Office expense data is trended forward from 1992 by the CPI-U., all items less medical for the Boston area from the Bureau of Labor Statistics. Physician Reimbursement is based on the payer fee update aggregate percentage changes from 1992 to the present as indicated by payer communications.

18. Massachusetts physicians have lagged behind their counterparts • Focused on capitation and risk contracting • Failed to recognize that Fee for Service payments were falling below costs • Allowed billing systems to slide when insurers were installing code editing software to increase denials

19. MGPO’s own experience is that Net Patient Revenue per RVU is Below National Benchmarks

20. A similar comparison of cost per RVU indicates financial survival requires keeping costs even lower relative to benchmarks

21. Productivity Benchmarks are often difficult to obtain, however detailed practice analysis shows high productivity in the example academic service

22. Despite higher productivity, total compensation is below benchmarks as a result of overall payments

23. Physician practices need to make a better case that government payers are not paying their fair share • In contrast to hospitals, Medicare pays below cost for many specialties • Medicaid pays below Medicare even though the fees were once pegged to be similar • State employee plan rates are similarly low • The of covering cost falls on self pay and those paying for indemnity insurance

24. Medicare and Medicaid payments don’t cover MGPO costs, that are below MGMA benchmarks

25. Put the focus back on providing highquality health care • Be a little more guarded about advocating in general and look out for the real value to patients • Do patients have access? - Not if hospitals and physician practices close • Is the care necessary? - New definition! Does the latest alternative health benefit provide greater value than the cost patients or employers may pay?

26. Be much more persuasive explaining the real cost of providing quality HC • Physicians or their practice managers need a crash course to catch-up and better understand their practice costs • Learn and understand productivity analysis. Don’t stop with a tool to count patient through put. A better tool can explain the value of a longer cognitive visit • Remember covering cost is the first step to assuring access

27. Get on with administrative simplification • If insurers really intend to distinguish themselves with a role of organizing quality care • And if providers really intend to provide quality care • Why is it so hard and why is each payer developing their own proprietary systems to access the data needed to process services? Membership, referrals, claims, remittances

28. Thank you for your attentionI look forward to your questions and comments