Identifying the MVPs: 9 steps for recruiting physicians for your value analysis team

The realities of healthcare reform — including the departure from fee-for-service models of care, shrinking reimbursement and higher quality standards — means the impetus for collaboration around cost, quality and outcomes is only going to grow.

However, traditional paradigms in hospitals are not conducive to the type of cross-sectional collaboration required to make the shift to value-based care effective. No longer can physicians and hospital administrators function in silos as opposing forces. They must find ways to build positive, symbiotic relationships that enable understanding and the sharing of ideas, according to Kristin Boehm, MD, senior advisor at Nexera, a healthcare consulting firm specializing in operations improvement and supply chain management.

"The overuse of healthcare services most likely costs hundreds of billions of dollars each year out of the approximate $3 trillion Americans spend on healthcare," Dr. Boehm said in an Oct. 29 webinar sponsored by Nexera. "Successful hospitals must adapt to remain financially viable."

Hospitals have suffered declining Medicare margins since 2002, averaging -5.4 percent in 2013, -6 percent in 2014 and -9 percent in 2015, according to a Crain's Detroit Business report cited in the webinar. The average hospital has a 2.2 percent operating margin, but in the face of reimbursement cuts, the average margin will fall to -16.8 percent, Dr. Boehm explained, citing data from the Studer Group. "Margins are predicted to decline this year, even for hospitals that are deemed efficient."

Such predictions substantiate the need for business-minded hospital administrators and clinical experts to work together to devise ways to drive value, eliminate waste and engage physicians. However, somewhat opposing characteristics of each may make this a challenging goal, according to Dr. Boehm. For instance, administrators often think in a large-scale setting. They are used to working in groups, accustomed to delegating responsibilities and think in terms of the long-term future. Physicians, on the other hand, are used to working as solo practitioners or in small teams. They focus on individual patients, rarely relinquish authority and think in terms of getting each patient through an episode of care. 

At the same time, physicians and finance managers share a handful of traits. These include precision in their work, a reliance on data absolutes and objectivity, a logical problem-solving approach, a competitive edge, desire to succeed and a propensity for a type-A personality. While all physicians and administrators may not be compatible partners, it is possible to identify a few "champions" to serve as influencers and leaders in a collaboration effort.

"These physician leaders are the ones to lead quality improvement teams that establish evidence-based protocols and routine order sets that reduce variability and improve clinical outcomes," said Dr. Boehm.

There are a number of factors that may inhibit physician engagement in change efforts designed to increase value and cut unnecessary spending, according to Dr. Boehm.

  • Time constraints
  • Lack of defined common purpose
  • Scarce leadership support
  • Scant data
  • Poor communication

To stave off these barriers and effectively engage physicians, Dr. Boehm provided nine key tips for those in hospital administration.

1. Have a presence in the clinical settings — show that you value physicians' time. When administrators are present in the clinical setting, they will gain a better understanding of what it is physicians do on a daily basis. Visiting the emergency department, catheterization lab, ICU, a medical staff meeting or even the physicians' lounge demonstrates willingness among finance managers to get out of their comfort zone and build new bridges with clinicians, according to Dr. Boehm.

2. Invite physicians to financial meetings. By the same token, it is beneficial for physicians to gain insight into the conversations among financial managers. "Many physicians are interested in hospital financials and joining the C-suite," said Dr. Boehm. Including physicians with a demonstrated interest in the financial complexities of an institution in financial meetings can deepen their understanding of billing and account receivable and give physicians real perspective on budget balancing and budget variance.

3. Involve your physicians prudently. "Not every initiative requires physician input," said Dr. Boehm. "Recruit physician support only when necessary so you don't dilute their enthusiasm in the process overall." In those initiatives that would benefit from physician input, involve them at the onset — don't just solicit their feedback midway through or at the end.

"Forcing them to adopt something without their input reduces buy-in," said Dr. Boehm. "Inviting relevant end-users to lead the decision making process augments the likelihood it will be accepted throughout the department."

4. Clearly define a culture core value system wherein executives and physicians are partners devoted to quality and safety. It is critical for physicians to shoulder responsibility for the institution's outcomes, not just their own personal performance. Cultivating a culture in which administrators and physicians believe in a shared purpose stimulates physician buy-in, especially when the purpose is centered on providing higher quality care. Dr. Boehm notes it is important to address the process, not necessarily the individual, when things go wrong. Singling out a physician can lead to resentment and disengagement. 

5. Communicate candidly. When issues arise, address them at the onset. "A lack of candid communication makes physicians less likely to collaborate," said Dr. Boehm. "Divisive issues can actually bolster engagement when facts around them are delivered promptly and thoroughly."

6. Recognize the educational road to becoming an MD. All of the work required to becoming a physician — the prerequisites in college, medical school, residencies and fellowships — have made them accustomed to delayed gratification. Showing appreciation of this process generates a new level of respect among physicians for administrators, and will increase the likelihood physicians will willingly enter into relationships with their financial counterparts, according to Dr. Boehm.

7. Speak a common language. Physicians gravitate toward the language of biological systems, not macroeconomics, which is why it is crucial for all conversations to focus on improving outcomes and patient care, not cutting costs, according to Dr. Boehm. "Physicians want to know how changing products or processes will impact their clinical outcomes or decrease wasted time," she said. "Emphasize the metrics of increased face-to-face time with patients, improved patient care and doctor satisfaction, not just costs."

8. Educate physicians on the cost impact of clinical decisions. Physicians are typically unaware of the costs of procedures performed, supplies used, drugs prescribed and tests that are ordered, according to Dr. Boehm. However, a simply solution exists. The financial department can share this information with the clinicians as it relates to supply costs and utilization patterns.

9. Use incentive-based programs. In addition to their focus on the patient's wellbeing, physicians care about their reputation. There are numerous ways to motivate physicians to buy-in to initiatives designed to increase value. For instance, annual look-backs linked to a financial reward can be used to assess performance and demonstrations of collaboration.

Additionally, Dr. Boehm pointed out physicians are more effectively moved by loss aversion — having something be taken away — than gaining a reward. "Physicians are more likely to change their behavior when they are threatened to lose just 1 percent of their income," said Dr. Boehm. Nonfinancial rewards, such as positive feedback and respect from colleagues, can also go a long way. Publishing individual physicians' performance alongside their peers' can spur significant changes in behavior.

How to identify a physician champion. Not all physicians are suited for this role. It is imperative to select physician champions who are respected among their peers, have demonstrated strong clinical competency and are natural leaders and influencers. Dr. Boehm noted additional characteristics of a physician champion:

  • Someone who operates as a democratic manager
  • Someone who is satisfied with being an influencer among his or her colleagues rather than a renowned leader in a particular specialty
  • Someone who is respected by his or her peers, not only for clinical acumen but for diplomacy and willingness to listen
  • Someone who enjoys working with peers, within and across specialties
  • Someone who is a team player
  • Someone who is assertive, not authoritarian
  • Someone with charisma and the ability to effectively implement practice pattern changes

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