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Welcome!. Session
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1. Medical Staff Planning and Physician Community Need Assessments
November 17, 2004
2. Welcome! Session #3 – 9:30 – 10:00 A.M.
Community Need Assessments
John Harris
3. Physician Manpower Trends and Issues Future of National Workforce
Status of the Regional Physician Workforce
Implications for Hospitals and Health Systems
4. The Future of the National Workforce Plethora of recent research on physician supply and demand
COGME (2000)
Escarce, et. al. (2000)
Cooper, et. al. (2003)
Solucient (2003)
Weiner (2004)
5. COGME
6. COGME
7. COGME
8. Escarce et. al. (2000)
9. Cooper et. al. (2003)
10. Solucient (2003)
11. Weiner (2004)
12. So what is the consensus on the physician workforce of the future?
13. So what is the consensus on the physician workforce of the future?
14. So what is the consensus on the physician workforce of the future?
15. What about the impact of major industry trends?
16. Medical Education Resources
National
Medical schools continue to train at same rate
Regional
No reported shrinkage of residency training slots
17. Regional Developments Decentralization of tertiary services to suburbs
Shortages of hospital beds
Employment of specialists
Large single-specialty groups
18. What is happening to the physician supply in our region?
19. Regional Physician Workforce In Perspective Short term – shortages within selected subspecialties likely to continue in next 3-5 years
Long term – possibility that the supply of graduates and an improved practice environment may restore balance to physician need/supply
20. Implications for Hospitals and Health Systems Careful and thoughtful strategic planning must be implemented
Program and service development often dependent upon physician resources
New hospital/physician relationship models
Allocation of capital resources between facility, technology, and manpower requirements
21. What are the implications for physicians in our region?
22. HOSPITAL IMPERATIVE:Medical staff planning and community need assessments Medical staff planning and development
Quantifies and prioritizes physician resource needs
Identifies competitive opportunities in market area
Provides process for maintaining continuity and control over resource allocation process
Community need assessments
Supports innovation in physician relationship models
Mitigates regulatory/compliance issues
23. MEDICAL STAFF DEVELOPMENT PLANS
24. Definition of a MSDPWhat is it? Five Year Future Assessment of the Institution’s Need for Physician Manpower
Identify Physician Shortages in the Community
Meet Key Strategic Initiatives
Replace Departing/Retiring Physicians
Strengthen Core Programs and Services
Add New Business Lines and Ventures
Address Competitor Challenges
“Right-Size” the Medical Staff
PHO/IDS Service Requirements
Facilitate Medical Staff Organization/Affairs
Balance Politics of Conflicting Interests
25. Importance of a MSDP Strategic Planning Has Changed
Driven by Financial Realities
Operating Margins Continue to Narrow
Capital Investments Growing Larger
Debt Capacity is Limited
Focus is on Revenue Growth Initiatives
New Technology Acquisition
Alternative Delivery Models/Sites
Service Line Development/Integration
High Margin Services are Specialty Driven
Need Referral Networks and Physician Loyalty
MSDP MUST be Linked to Key Strategy and Financial Parameters
26. Key Issue – Institutional Need vs. Community Need
27. MSDP Process Step 1 – Define Service Area & Profile Demographics
Geographic Draw
85% of Annual Admissions/Discharges
Use Sub-Areas, if Necessary
Population Growth
5-10 Years
By Age Cohort (0-14, 15-64 and 65+)
Key Demographics
Age Distribution
Race/Ethnicity Mix
Seasonal Factors (Employment/Recreation)
Environmental Factors
Malpractice Situation
Level of Managed Care Penetration
28. MSDP Process Step 2 – Compile Physician Supply (In FTE’s)
Develop Initial Inventory
Medical Staff Rosters
Proprietary Databases (AMI, ABMS)
Public Databases (Telephone Directory, MCO Directory)
Determine Supply Adjustments
Physician Age and Practice Levels (65)
Multi-Office Locations (in/out of Service Area)
Non-Clinical (AS&T Activity)
Finalize Physician Supply
29. MSDP Process Step 3 – Estimate Demand of Physicians (In FTE’s)
Interview Key Physicians and Senior Management
Department/Specialty Needs
Referral Patterns/Activity Levels
Strategic Initiatives
Apply Industry Planning Standards and Methodologies
Physician-to-Population Ratios
Use Rate Productivity Models
National Supply Benchmarks
Estimate Demand of Physicians (Use Range)
30. MSDP Process Step 4 – Compare Supply to Need
F O R M U L A
31. MSDP Process Step 5 – Integrate Strategic Plan Initiatives
Impact on Service Area Definition
Changes in Service Delivery Requirements
Technology and Practice Model Shifts
Inter/Intra-Organizational Changes
32. MSDP Process Step 6 – Prepare Implementation Plan
Clarify Policy and Procedural Issues
Establish Priorities
To Meet Current Demand
To Accommodate Projected Demand
Define Physician Retention/Recruitment Packages
Hospital Supported and Funded
Non-Hospital Related Support
Prepare Five Year Budget Estimate
Include Performance Metrics
Identify Leadership and Coordination
Physician Liaison Representative
Reporting (Board, Admin, and Medical Staff)
33. Winthrop University Hospital – A Case Study In Medical Staff Planning WUH Background
Founded in 1896 – Long Island’s First Non-Profit Hospital
Mission Statement – Comprehensive Health Care Services in a Teaching and Research Environment – “Care Without Compromise”
591 Bed University-Affiliated Medical Center(SUNY@Stony Brook School of Medicine)
Full Service Medical Center
Six Major Institutes (Cancer, Digestive Disorders, Heart, Neurosciences, Lung and Family Care)
Level I Trauma Center
Major Pediatric Referral Center
34. WUH Background (continued)
Voluntary Attending Medical Staff of 1,250
Medical Education Profile
21 Accredited Residency and Fellowship Programs
16 Independently Accredited
5 Integrated
200 Residents and Fellows
150 Full Time Faculty and Clinical Investigators
Operational Profile (2002)
32,200 Admissions
45,500 ER Visits
18,000 Surgical Procedures (820 Open Heart)
4,600 Deliveries
35. WUH Strategic Profile
Service Area Definition
Covers 43 Zip Codes in Nassau, Suffolk and Queens Counties
Sub-Divided into Five Core Areas (87% of Discharges)
Stable Population of 1.1 Million
Physician Inventory of +/- 3,500 Physicians
Many with Multiple Offices and Medical Staff Appointments
Many Over 65 Years, but Still Practicing
Many with Non-Clinical Activities
Major Competitor
Large Multi-Hospital System (10 Hospitals & 4,000 Beds)
Two University-Affiliated Medical Centers
Some Medical Staff Overlap
Winthrop University Hospital – A Case Study In Medical Staff Planning
36. WUH Objectives for MSDP
Develop Physician Resource Requirements for Clinical Departments and Specialties
Sustain Strategic Initiatives
Maintain Clinical Education Program
Balance Interests Between Voluntary and Faculty Physicians
Provide Legal Basis to Close Departments/Sections
Project Range of Primary Care and Specialty Physicians to Meet Future Community Needs
Identify Specific Demand in Each Core Area
Build Reliable Physician Supply Database
Identify Implementation Strategies, Priorities and Actions
Winthrop University Hospital – A Case Study In Medical Staff Planning
37. Results of MSDP
Community-Based Physician Demand
Primary Care (IM/FP)
Practice Patterns in Long Island Market Reflect IM Dominance
Net Demand of 30 Physicians in Total Service Area
One Core Area need for 60 Physicians
Specialists
Modest Deficit for Cardiac, Thoracic and ENT Surgeons
Nominal Deficit or Excess in Rest of Subspecialties Winthrop University Hospital – A Case Study In Medical Staff Planning
38. Results of MSDP
Medical Center Physician Needs
Voluntary Attending Staff
Generally Sufficient to Meet WUH Needs (Cardiac Surgery Need Due to Recent Defections)
Some Specialists are Splitters – Loyalty Issue (Nephrology, Cardiology, Hematology/Oncology, GI)
Large Number of Inactive Physicians
Faculty Staff
Clinical Workloads Indicate Needs in Cardiology, Infectious Diseases and GI
Non-Clinical (AS&T) Need Not Quantified Winthrop University Hospital – A Case Study In Medical Staff Planning
39. Key Recommendations
Selectively Recruit Primary Care Physicians into Underserved Core Areas
Develop Program to Enhance Physician Loyalty to WUH
Voluntary Staff Too Large and Unwieldy
Purge all Inactive Physicians From Roster
Establish Minimum Standards (Admissions, Procedures, Meeting Attendance) to Retain Appointment
Consider Closing Departments/Sections with Significant Oversupply of Physicians Winthrop University Hospital – A Case Study In Medical Staff Planning
40. Key Recommendations (continued)
Use Voluntary Staff to Augment Faculty Needs
Improve Integration and Communication Between Voluntary and Faculty Staffs
Replace or Strengthen Physician Leadership in Two Clinical Departments Winthrop University Hospital – A Case Study In Medical Staff Planning
41. Additional MSDP Considerations Use Appropriate Legal Support
Legal and Regulatory Concerns
Antitrust
Fraud and Abuse
Corporate Practice of Medicine
Fee-Splitting
Managed Care Contracting
42. Securing Physician Buy-In Is Important
Participation in MSDP Process
Use Task Force/Steering Committee Representation
Physician Surveys and Interviews
Frequent, Ongoing Communication
Medical Staff Meetings
Electronic/Written Updates
Information and Data Objectivity
Use Industry-Accepted Methods and Standards
Independence of MSDP Resources Additional MSDP Considerations
43. Keys to Implementation Success
Embrace Key Medical Staff Constituencies
Senior Physicians with Peer Respect
Younger Practitioners with Long Term Future at Stake
Attributes of Loyalty, Wisdom and Objectivity
Recognize Process Issues
Establish “Ground Rules” Early
Innovation Creates Risk Exposure
Sound Planning Mitigates Risk Additional MSDP Considerations
44. Keys to Implementation Success (cont.)
Assure Proper Organization, Leadership and Oversight
Must Start at the Governance Level
Function Must be Clearly Defined Within the Organization
Must be Adequately Funded
Must Have “Rapid Response” Capability
Must be Regularly Reviewed and Adjusted Additional MSDP Considerations
45. COMMUNITY NEED ASSESSMENTS
46. What is a community need assessment? One-time determination of community need for a specific physician specialty
Supports physician recruitment and remuneration package
Provides documentation for regulatory compliance
47. Comparison of MSDP and CNA
48. The process of completing a community need assessment is made up of five steps Define the service area
Enumerate physician supply and make appropriate adjustments
Estimate physician demand based on planning standards and market forces
Calculate deficit or surplus
Issue opinion letter or memo to file
49. Define the Service Area Stark II provisions
Fewest contiguous zips w/75% of IP business
For determining “relocation” of practice
Maintaining consistency with hospital’s MSDP service area is preferable, but not required
Tertiary or quaternary programs may have unique service areas
50. Determine Physician Supply Start with MSDP data
Check for recent practice additions
Contact individual practices by phone
Multiple practice locations
Work effort level
AS&T
Pending retirements or relocations
51. Numerous adjustments are made to accurately assess physician supply within designated service area
52. Apply DGA Planning Standards Compiled from several sources
Weiner (2004)
U.S. Supply (Weiner 2004)
Solucient (2003)
Longshore + Simmons (1995)
Specialty board studies
Expressed as a range
Refined to address subtleties
Detailed subspecialty categories
Internal medicine/family practice
Hospitalists
53. Adjust Planning Standards for Unique Market Forces Apply planning standard (per 100,000 population) to service area population
Adjust for variations from national norm
Utilization management intensity
Demographics
Hospitalists
Physician extenders
Technology
54. Calculate Excess or Deficit of Physicians(Deficit = Community Need)
55. Closing Thoughts One-time determination of community need for a specific physician specialty
More narrowly focused than a Medical Staff Development Plan
Supports physician recruitment and remuneration package
Provides documentation for regulatory compliance