2014 PracticeMAtch Educational Conference – March 2 - 5

1. 2014 PracticeMAtch Educational Conference – March 2 - 5

2. Obtaining Buy-in from the C-Suite & situational application

3. 5 Key Steps to Obtain C-Suite buy-in 3

4. Situations Requiring c-suite buy-in Physician Recruitment • Employing MDs – PCPs and Specialists • Recruiting MDs within an Existing Practice • Increasing Retention • Formulating Compensation • Reducing Turnover Physician Alignment • Partnering with Administrative Leadership • Marketing to On-Staff, Not-on-Staff, PCP, and Specialty Physicians • Engaging in Projects with Aligned Interests and Skills • Developing Performance Based Contract Terms Aligned to Strategic Goals Behavior Change • Increasing Patient Satisfaction • Monitoring Costs Per Case – Device, Procedure, and Supply Expenses • Providing Dashboards and Performance Metrics • Establishing Productivity Standards • Standardizing Care Protocols 1. Identify CEO Incentives 2. Determine Pressure Points/Make Life Easier 3. Time Your Requests 4. Show the Supporting Data 5. Outline the Implementation Plan 4

5. Identify CEO incentives

6. Fundraising 1. Identify why this is a worthy cause 2. Describe your needs in less than 3 minutes 3. Find out how this will benefit them 4. Uncover a way that their support can be mutually beneficial Do your homework Professional Sports 1. Research your opponents 2. Know your own strengths and weaknesses 3. Know their strengths and weaknesses 4. Know who is on which team 5. Be prepared to lose for the greater good

7. ACHE 2007 Compensation Factors Survey Identify C-Suite INcentives CEO incentive goals "are changing. They are moving toward a greater balance toward quality and safety, patient satisfaction, employee satisfaction, and finances.“ Richard Umbdenstock, CEO of the American Hospital Association, KHN June 16, 2013 Executive Employment Contracts and Performance Evaluations. CEO Circle White Paper, American College of Healthcare Executives, 2007.

8. Identify C-Suite INcentives CEO Bonus/Incentives (2011-2012) Profitability/Finance (7X’s) Quality (5X’s) Patient Satisfaction (5X’s) Patient Safety Indicies (Blood inf., pneumonia, mortality) (2X’s) Performance Goals (2X’s) Strategy Initiatives Community Service Charity Care Operating Goals Revenue Growth Employee Turnover Expand Health System Admissions Growth Research Grants Notes: [1] Total pay includes benefits unless otherwise indicated; sources include IRS filing, hospital statement, contract and/or incentive sheet. [2] Total pay is base salary and bonus; may exclude the value of benefits; [5] Total pay includes some compensation reported in previous years source: http://www.kaiserhealthnews.org/stories/2013/June/06/hospital-ceo-compensation-chart.aspx 8

9. PHYSICIAN rECRUITMENT Recruit Neurologist to Medical Staff C-Suite Incentives: Desire: Enhance Profitability Improve Quality Neurosurgeon New Hire:Salary $690,548Benefits $138,110 Total compensation $828,658 Gross Receivables $2,632,463 - Reimbursement Rate @ 55% $1,447,855 Net Receivables $1,184,608 Net Income $355,950 Patient Safety Improvement: Door-to-Needle Time in Acute Ischemic Stroke Source: Becker’s Hospital Review May 2013 9

10. Reduce discord among Intvl. Radiologists & Neurologists Physician alignment/Behavior change C-Suite Incentives: Desire: Improve Patient Satisfaction Improve Quality • Pursue Stroke Center Accreditation • Provide aspirational patient satisfaction and quality scores versus internal scores • Engage Interventional Radiologists and Neurologists in operational improvement process • Identify best practices and protocols • Determine roles and responsibilities • Establish timelines and critical path • Publicly celebrate successes and failures

11. Development process must be collaborative, inclusive, and multi-disciplinary Start with benchmarking physician peers against their colleagues to identify best practices Components may be established based on national guidelines, but adapted for the specific hospital Requires physician input, notification, and training Data mining – build financial and clinical care management informatics capabilities to measure performance and make changes Standardize care protocols

12. Determine pressure points

13. Source of stress Climate • Hospital 2011 CEO turnover rate was 16% • The average hospital CEO tenure is under 3.5 years. • 56% of CEO turnovers are involuntary. • When a new CEO is hired, almost half of CFOs, COOs and CIOs are fired within nine months. • Within two months of a new CEO appointment, 87% of CMOs are replaced. C-Suite Stakeholders Source: ACHE Hospital CEO Turnover 1982–2012 Becker’s Hospital Review Dec 2013 13

14. Simplify the senior executive’s day • Study your boss! • What does she do poor poorly? • What does she avoid? • What characteristics does she possess • Introverted vs. extroverted • Risk-averse vs. risk-seeker • Procrastinator • Visionary vs. detailed oriented • How could you help? • Offer suggestions or solve the problem for them! 14

15. Listen/read the publicly communicated goals of the hospital, Board, and MEC Committees • Draw parallels illustrating the alignment of the proposed initiative with strategic goals • Identify an implementation plan of how the initiative can be achieved • Determine the required resources • Outline the time commitment required of the Senior Executive • Execute the plan Formulate the solution

16. PHYSICIAN rECRUITMENT Compensation discussions with MDs C-Suite Pressure Point: Resolution: Develop compensation package checklist for new hires vs. annual reviews Establish corporate policy that involves a compensation negotiation team – attorney, CMO, Physician Recruitment Director, HR, or recruitment firm Establish roles and responsibilities for each of the team members Outline the timeline from offer to start date 16

17. Establishing Performance-Based Compensation Physician alignment C-Suite Pressure Point: Resolution: Research and summarize various performance-based compensation packages Meet with attorney to rank order the most viable options given the organizational culture Develop communications strategy with marketing to alert Medical Staff to pending compensation changes Meet with Medical Staff to determine quality targets Assist with compensation and performance calculations

18. Performance • Production • RVU • Salary plus Productivity • RVU’s • % of Collections • % of Billings • Salary Plus Bonus on Quality • Quality / HCAHPS Core Measures • Incent ACOs • Track patient satisfaction with providers, nurse satisfaction with MDs, and overall likelihood to recommend Provide dashboards and performance metrics Current Productivity Metrics Productivity Metrics Under ACA • Medicare Adj. Cost Per Case • Readmission Rates • Commercial Adj. Cost per Day • Quality/HCAHPS Core Measures • Two-midnight Rule • Medicare Physician Quality Reporting System (1.5% Medicare penalty begins in 2015) • Value-based purchasing

19. Tracking physician performance Behavior change C-Suite Pressure Point: Resolution: Identify vendors that offer physician productivity and benchmarking software Develop standardized reports to assess monthly/quarterly progress Determine triggers for performance review Establish feedback mechanism Develop escalation procedures to minimize need for C-Suite involvement

20. Time your requests

21. Lessons from the home front 1. Know your opponent 2. Set the stage for a positive response 3. Time your request 4. Provide options 5. Highlight the “win” for them 6. Prepare responses for the rebuttals 7. Make it easy for them 8. Wait for the approval 9. If met with rejection, go back and revisit at a later date Don’t focus on the battle - win the war

22. Analyze the environment • Time of year: budget season, evaluations, Board meetings, fiscal year end • Current issues: know the conversations your executive cares about NOW • Current strategies: identify the framework by which change is occurring NOW • State and National trends: question the future • What impact the ACA will have on your organization? • How will this impact your physician recruitment, retention and employment strategy? • What preparations are needed for 5, 10, and 15 years in the future as a result of payment system, federal mandate, and physician supply/demand needs? 22

23. Schedule a call or meeting when you know they have time to talk Draft a succinct bulleted agenda with your request, supporting data, how it is aligned with corporate strategies, and what you believe to be the outcomes Identify if what you are requesting is aligned with broader corporate initiatives or runs counter to them Help them reach their goals If you can’t get to the point in less than three minutes, you need to condense It is all about the timing

24. PHYSICIAN rECRUITMENT High MD turnover rate Timing Issue: Address issues: Postpone discussions: Loss of revenue PCP practice aligns with competing hospital Specialist driving out competitors in the market OR case start times delayed Physician satisfaction is low Recent implementation of physician productivity-based compensation model Implementation and adoption of EMR Purchase of competing practice 24

25. MD and C-Suite partnering Physician alignment Timing Issue: Address issues: Postpone discussions: Service line planning Facility design Supplies and devices Strategic planning Quality improvements Care redesign Establishing protocols Merger due diligence phase Widespread downsizing

26. Addressing physician safety and quality issues Behavior change Timing Issue: Address issues: Postpone discussions: High readmission rate identified Patient “never event” occurrence Nursing report of sentinel event Low HCAHPS patient satisfaction scores During Annual Review (Initial identification) During JCAHO review Upon discovery of state violation

27. Show the supporting data

28. Quantify Quantify Quantify Show me the data!!!! Recruiting a New Doctor Increasing Productivity/ Reducing Costs Improving Safety/Quality Improving Patient Satisfaction

29. Physician recruiTMENT facts Costly CEO Incentives Drive Decisions • Attracting and retaining the right candidate is expensive • It can cost 2.7 times a physician’s annual salary to find a replacement when he or she leaves increasing the importance of retention. –Feb. 2008, HealthLeaders Media CEOs who are paid bonuses based on revenue, profit, volume growth are highly motivated by the cost of an absent physician. Scarce • Recruiting physicians in the proper specialties is • as important as sufficient MD supply • By 2025, a 21% increase physician supply will be needed to meet the market demand (shortage = 159,300 MDs) – 2008 AAMC Complexities of Physician Supply & Demand • 65% of respondents mentioned physician shortages as the largest threat to their hospital-physician alignment strategy. • - September 2011, HealthLeaders Media 29

30. The opportunity cost of delayed hires Loss in MD revenue during recruitment: “Median annual collections on professional charges range from $390,000 for a primary care physician to $750,000 for an Orthopedist.” - November 2011, Rock Mountain Medical Search & Consulting 30

31. CUSTOMER SERVICE & QUALITY Patient Satisfaction CEO Incentives Drive Decisions • Look at comparative physician data to improve patient satisfaction • Review Press Ganey, Hospital Compare, and NRC/PRC scores • Highlight areas for improvement – “communicated well” • Highlight benchmarks CEOs who are receiving bonuses based on patient satisfaction and safety are highly motivated by the stats of a careful physician. Safety/Readmissions • Look at comparative physician data to improve safety • andoutcome scores • Check with Hospital Compare physician data • Check with your hospital Planning/Decision Support team 31

32. PHYSICIAN QUALITY IMPROVEMENT Physician Mentoring Strategy. The physician with higher quality scores can work with MD having lower quality scores to develop processes and protocols that would work for the group. This improves scores while securing buy-in from entire team. Quality/Safety Patient Satisfaction • Look at comparative physician data to improve safety or outcome scores • Check with Hospital Compare physician data • Check with your hospital Planning/Decision Support team • Look at comparative physician data to improve patient satisfaction • Check with your hospital planning/Decision Support team • Check with your QI team 32

33. USE PHYSCIAN COMPARE TO IMPROVE QUALITY • Physician Compare contains • many quality measures: • The Physician Quality Reporting System (PQRS) • Group Practice Reporting Option (GPRO) • Accountable Care Organization (ACO)* • *ACO’s can be included in Group reporting if the ACO has 25+ members. • Downloadable files are available for 2012 performance data. Group and ACO data provided are for four Diabetes Mellitus (DM) measures and one Coronary Artery Disease (CAD) quality measure. 33

34. Ordering & Procurement • Understocking/Overstocking = Additional Expenses • Lead time & frequency • Storage & Stock Control • Inventory management/ Quality control • Eliminate waste • Care & Maintenance • New vs. Old • Inventory Optimization Solutions • Purchasing group = Pricing leverage • Standardization of devices and implants • Reduction of preference variability Monitor device and supply expenses

35. PHYSICIAN COMPARE Source: PhysicianCompare.gov 35

36. Outline the implementation plan

37. Outline the implementation plan Executive Timeline Your Timeline • One page • High level • Show the goal • Identify participation points … create process flowchart … highlight problems from recent hires … get input from key employees … identify bottlenecks and determine how process streamlining can occur 37

38. Outline hospital employment procedures Map Areas Involved in Physician On-boarding Src: NJSAMSS 19th Annual Education Conference April 12, 2012

39. conclusion 5 Key Steps to Obtain CEO Buy-in Include: 39