By Andis Robeznieks<\/i>
\nChanging physician behavior is an interesting art, according to David Fairchild, M.D., a director with healthcare consultants BDC Advisors.
\n\u201cIt\u2019s not necessarily about financial incentives \u2014 though people think if you pay doctors to do X, doctors will do X,\u201d Fairchild explained. \u201cBut there also has to be alignment with doing the right thing for patients and ease of workflow.\u201d<\/p>\nIf financial incentives, workflow, and patient interests line up, \u201cyou can achieve remarkable things,\u201d Fairchild said, adding that one way to achieve this is through an annual goal-setting process with input from all stakeholders.<\/h2>\n
Setting goals requires learning how doctors think and how to motivate them, Fairchild said. Also, doctors are experiencing a loss of control that makes them feel like just a cog in some vast machine, but the goal-setting process gives them back some of this control, he added.
\nHealthcare consultants Integrated Healthcare Strategies developed a list of the 50 best governance practices for medical groups. Numbers 29 to 33 fall under the heading \u201cSetting Strategic Direction.\u201d
\nThese include: setting priorities and approving the strategic plan, adopting policies and procedures spelling out how strategic plans are developed and updated (including time frames, plus who is involved and what they should do), adopting criteria for evaluating proposed new programs and services, and ensuring that plans are specific and measurable with accountability for implementation clearly identified.
\nDrawn from research by the Governance Institute of Hospitals and Health Systems and a study commissioned by the American Medical Group Association, IHS emphasized in best practice #34 that an annual goal-setting process should be treated as a top priority of a medical group board.
\nAlso, #30 on the list states that \u201cThe board discusses the needs of all key stakeholders served by the group when setting the long-range direction for the organization.\u201d But this is one best practice that is not always followed.
\nWith mergers and the proportion of employed physicians on the rise, IHS Managing Director and Senior Medical Advisor William Jessee, M.D., noted during a presentation at the AMGA\u2019s 2015 annual conference that, along with these mergers, there were also \u201cmany failures or dissolutions due to culture clashes.\u201d Also, many organizations were struggling to integrate physicians into their enterprise.
\n\u201cShared goals become critical if you\u2019re talking about hospital-physician integration,\u201d said Jessee in an interview. \u201cOne of the things I see a lot of is hospitals never getting the physician groups they now own involved in the goal-setting process.\u201d
\nJessee said he has one client where the physicians in the hospital-owned group say they\u2019ve been with the system for five years and have no idea what its strategy is or what its goals are. \u201cThe physicians say \u2018They\u2019ve never talked to me,\u201d Jessee said.<\/p>\n
Healthcare systems need to find a mechanism to get doctors involved in the process, Jessee said, adding that doing things like scheduling 11:30 a.m. goal-setting meetings \u2014 when physicians are in the middle of seeing patients \u2014 is one way to ensure that they won\u2019t participate in the proceedings.
\n\u201cEarly evening meetings \u2014 where you feed people \u2014 are still the bread and butter of this process,\u201d Jessee said, but morning meetings don\u2019t work for night staff who are tired and just want to go home. \u201cIf it were easy, people would be doing a better job of it.\u201d
\nDudley Morris, the senior advisor with BDC Advisors, noted that \u201cnot enough CEOs spend time in the trenches\u201d with their physicians, which is vital to aligning physician incentives and benchmarks with system strategies on efficiency, customer alignment, and other priorities.
\nHealthcare faces much uncertainty over its near future with talk of repealing and replacing the Affordable Care Act, but Morris said annual goal-setting still has value.
\nInstead of replacement, Morris predicted \u201cmodification\u201d of the ACA is more likely and that it\u2019s unlikely the movement away from fee-for-service is over.<\/p>\n
Jessee agreed and said that goal-setting for value-based payments includes making decisions about where to invest limited resources. Priorities need to be set concerning buying software, hiring staff, and the remodeling of existing facilities or the building of new ones to accommodate new models of care.
\n\u201cExecution of goals is more important than goal-setting,\u201d Jessee said. \u201cIf you alienate people you need support from, it isn\u2019t going to work.\u201d
\nFor example, it\u2019s common for groups starting an accountable care organization to require their employees to seek care within the ACO. But if the ACO is not ready and staff finds the service below par, people who would have been strong advocates for the effort are now recommending friends and associates to steer clear, Jessee said.
\nFairchild agreed and noted that \u201cgetting it right is important.\u201d
\nHe told of how, when he was an executive with a large medical group, the annual goal-setting process would include developing practice metrics that would be tested over a year but would not have any dollar values attached to them.
\n\u201cThat turned out to be a brilliant strategy,\u201d Fairchild said. \u201cIf there are any flaws, you haven\u2019t hurt anybody by it.\u201d
\nHe added that \u201cyou have to be careful what you incent \u2014 because you\u2019ll get it.\u201d<\/p>\n
Fairchild explained that poorly developed incentives could lead to physicians gaming the system \u2014 especially with targets that are productivity based. For example, if you encourage population health or care-coordination efforts but don\u2019t reimburse physicians for the time spent on the telephone performing these tasks, they\u2019re tempted just to schedule people for office visits to create a Relative Value Unit (RVU).
\nGroup Health Cooperative, a Seattle-based healthcare provider and health plan, uniquely posts its goals on the internet for public consumption. It also puts forth its strategies for reaching those goals and even offers a frank assessment where goals have fallen short.
\n\u201cWe believe that we lost some discipline and focus on our reliable application of care processes that drive quality improvement,\u201d the document stated. \u201cThis is primarily due to a focus on cost containment strategies across the Enterprise, resulting in staff reductions combined with a restructuring of leadership within the Group Practice, leading to the majority of operational positions with new leaders in those roles.\u201d
\nIn the document, Group Health goes on to state that its overall goals include consistently providing Group Health members the best care, information, expert advice, and support; outstanding service every time; and value that exceeds needs and expectations.
\nIt spells out a strategy of using information technology \u201cto make the right thing the easy thing to do, with activated patients and clinicians.\u201d This includes \u201copportunistic care\u201d that anticipates all patient needs and to deliver them when they come in for a scheduled appointment.
\n\u201cOur goal is that the majority of our patients finish their visit with us with all their clinical needs having been recognized,\u201d the document states.<\/p>\n
He explained that, in this new age where consumers do comparison shopping for healthcare services, a healthcare organization doesn\u2019t have to put its quality goals on a billboard. They can post them on their websites and, if their competitors aren\u2019t doing the same, smart shoppers will find them lacking and choose a more transparent provider.
\nOne of Group Health\u2019s announced goals for 2016 was to reduce variation in clinical quality. Fairchild said this is a common goal, but it\u2019s also one that can provide tension within a group. It requires transparent data to show who in practice is getting it right and tact to address those who aren\u2019t.
\n\u201cYou find out that the doctor who thought he was great is on the bottom,\u201d he said. \u201cThen there\u2019s pressure on that guy or woman to change their practice.\u201d
\nThe answer is to \u201cdig in and look at workflows\u201d to see how the top performers are achieving the goal and help the others adopt those practices, Fairchild said.
\n\u201cDoctors are competitive \u2014 no one wants to be at the bottom of the list,\u201d he explained.
\nDoctors like being paid to provide high-quality care rather than just a high volume of care, Fairchild said, though the systems for doing so are far from perfect, so an annual review is helpful.
\n\u201cThere\u2019s always a quest to get incentive plans to get closer and closer to what represents true quality,\u201d Fairchild said. \u201cWe\u2019ll never get there, but it\u2019s worth the effort.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"
By Andis Robeznieks Changing physician behavior is an interesting art, according to David Fairchild, M.D., a director with healthcare consultants BDC Advisors. \u201cIt\u2019s not necessarily about financial incentives \u2014 though people think if you pay doctors to do X, doctors will do X,\u201d Fairchild explained. \u201cBut there also has to be alignment with doing the […]<\/p>\n","protected":false},"author":1,"featured_media":43652,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,69],"tags":[370,371,372,373,374,375,376,377,378],"class_list":["post-18000","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-growth","category-show","tag-american-medical-group-association","tag-amga","tag-goal-setting","tag-governance-institute-of-hospitals-and-health-systems","tag-governance-practices-for-medical-groups","tag-hospital-physician-integration","tag-ihs","tag-setting-strategic-direction","tag-workflow"],"yoast_head":"\n