Physician Management

Evolving medical group models need special leadership skills for success

By Robin W. Singleton, C.H.C., C.H.E.

 

Leadership in today's evolving physician group practice organizations requires a diverse array of skills and experience, especially as hospitals return to the business of purchasing physician practices in order to further their integration strategies. Many of these organizations are being newly launched or expanded by most hospitals and hospital systems and are less traditional and predictable than in the past. For today's dynamic and rapidly expanding physician organizations, this means quickly finding cutting-edge leaders who have considerable knowledge in multiple disciplines and not just the hospital provider side; thus, the process may be extremely challenging.


LET’S START WITH THE BASICS

Finding the right individual to lead your physician organization or employed physician group must start with determining the answers to some basic questions: What type of organization or practice model will the individual be leading? How will this affect the type of person selected to lead the organization? How knowledgeable is the individual regarding the needs of today’s generation of physicians and the paradigm shift that has led to greater demands for a work/life balance that has not existed in the past?

  • Hands-on operations experience. Most of the group practice leadership positions today are a result of acquisitions and newly created strategies for physician integration, accountability and improved patient care and delivery. The ideal candidate needs hands-on group practice operations and development experience, since he/she is ultimately responsible for providing all of the key business services necessary to retain the physician customer by ensuring both the provider’s and hospital’s profitability.
  • Financial and accounting expertise, plus good, solid, general business acumen, including knowledge of revenue generation options, fee establishment, coding, billing, accounts receivables management, information technology/EMR assistance, scheduling, and staffing, just to name a few. All are different in a physician practice than in a hospital setting, so again having a practice management executive is a must.
  • Understanding the significance of Evidence Based Medicine and its implementation. Group practice leaders must thoroughly understand the concept of “Evidence Based Medicine” and its role in today’s physician-hospital relationship. The ability to work with physicians and the hospital to implement a usable and effective strategy that binds physicians and hospitals together to seek out the greatest outcome for the patient while working to control costs will be a central role in today’s managed practice environment.
  • Understanding of the possible impact of Accountable Care Organizational structure and the role this will play in the delivery of healthcare, should this become a reality in 2014.
  • Strategic planning, business development, and marketing skills.
  • Knowledge of staffing and human resource functions, including policies, procedures, training and mentoring.
  • Managed care contracting experience and knowledge of current industry and regional trends around practice and referral patterns.

THOUGHT LEADERSHIP

  • Information systems and vendor relations to either lead a conversion or select a new system as the organization grows and attempts to integrate smoothly with the variety of hospital and other group practices’ systems that are not likely to speak to each other currently.
  • Training and experience and the ability to implement these programs.
  • Data tracking, analysis, and implementation (clinical pathways, care/case management, and outcomes measures, again specific to the variety of specialties being recruited is another essential component).
  • Strong physician relations skills and an ability to educated physicians and develop rapport with them, as well as to develop both formal and informal physician leaders for the long haul.
  • Effective communication skills at all levels and the proven ability to use metrics/data to implement meaningful physician behavior changes.
  • Strong negotiation, facilitation and collaboration skills.
  • Entrepreneurial, decisive, and a risk taker.
  • Continual learner who stays abreast of marketplace changes.

When talking with candidates, ask for specific accomplishments in each area. Seek details and examples of accomplishments that provide a clear picture of his/her understanding of various practice and specialty situations, but also past successes from which he/she can draw.

Learning about the candidates’ basic expertise can build a solid foundation for secondarily determining who has the best chemistry with the existing physicians and administrative team. Check references to verify these attributes.


IDENTIFYING SPECIAL SKILLS

The general leadership skills and core competencies outlined above are the undergirding of any good practice management executive, regardless of the practice model. However, today's organizations require a second tier of specific leadership skills, depending on which kind of practice they will be managing.

Specific multi-specialty group practices need a strong practice leader who is a self-starter with a full understanding of physician referral and practice patterns, physician compensation issues, contract negotiation, personnel management, IT and political savvy, goal-setting, and an entrepreneurial approach.

The group practice leader must be able to "do it all"—to be equally as good at strategizing as at implementing—usually with minimal staff support and resources. He/she must like autonomy and be an independent thinker who will not be swayed easily by individual physicians while simultaneously working across today’s highly matrixed systems.

He/she must also be able to build consensus among physicians and enlist support to help the practice move toward its mutual goals and merge them with those of the hospital and/or system. This individual may have never set foot in a hospital or corporation, but he/she probably has 5 to 10 years or more of hands-on practice management experience. Some practices are finding that either a Certified Public Accountant or a Master’s in Business Administration often makes an excellent fit in terms of additional specialized credentials.

For any entity purchasing physician practices the incoming executive must be able to help blend the independent practice mentality with the new "leaner/meaner" corporate style that results in profitability for all parties and ultra-efficient, high quality, documentable and accountable patient care.

A leader in this setting must readily command respect and engender trust across a wide range of areas and be proven to manage multiple sites from afar.

An excellent choice in this type of leadership role is someone with a strong general business background, one who is a systems thinker and can see how pieces can fit together without duplication, and who has the ability to see beyond—but not overlook—the day-to-day details is.

 

MISCONCEPTIONS AND PITFALLS TO AVOID

Unfortunately, in most new medical group models it is common to see mistakes that could be avoided with the right individual at the helm.

Assuming that systems are interchangeable. Thinking that group practices can always be run with hospital or other pre-existing information systems and the like.

Example: A large hospital in the Midwest purchased multisite, specialty physician practices, took the personal computers that were working fine out of the physicians' offices, brought in new computers, and provided no training to office personnel. One rural practice alone dropped more than $30,000 in lost billings in the first quarter because of coding errors, lost files, etc.

Under-hiring. Promoting from within for the sake of 'politics" rather than seeking qualified candidates with specific and proven, group practice, business, leadership, and financial experience.

Example: An independent group practice in the South that grew from seven to more than 20 members in a two year period promoted an office manager to group practice leader. The office manager had no managed-care experience, no strategic planning skills, nor systems integration orientation to reposition the group for growth. As a result, the group's competitors partnered with the only local hospital, nearly putting the group out of business. In fact, the group was acquired by the larger group, but only after all of the physicians' incomes fell more than 40%.

Rushing the process. Focusing on bringing in more practices before the initial planning, analysis, or structural foundations are in place.
Example: A for-profit hospital system started buying practices before appropriate valuations were complete. The corporate executives had the independent hospital executives telling them which practices to buy. Therefore, the corporate office inherited too many unprofitable and diverse practices with diverse practice styles, hampering its ability to effectively blend or successfully manage them.

Too much attention to sheer numbers. Total bottom-line orientation.
Example: A PHO director, who was asked to be the interim manager for an MSO until an MSO director could be hired, was enrolling physicians in too many plans too quickly, resulting in so much red tape for the physicians that several of them needed to take an entire extra day off to keep up with the avalanche of increased paperwork for the providers. Because they were salaried, the physicians now only worked a three-day week, and the MSO was losing both patients and money.
In all of these examples, serious mistakes and many turn-around situations could have been avoided by finding the right leader early on before so much long-term damage was allowed to occur.

 

CONCLUSION

You can develop your own physician organization leader if you have the option of a longer learning curve, but this takes time in a market characterized by immediacy and an often overwhelming potential to lose large amounts of market share and money quickly.

Success in finding the best leader to come in from the outside for your physician organization can be achieved by realizing that very few candidates have all the skills and experience necessary to effectively lead today's practices, and the competition for these individuals is fierce. These candidates are in great demand from not only the competitors in your own segment of the market, but also from other independent groups in the marketplace.

A nontraditional approach to seeking leaders—doing your due diligence by looking outside the traditional hospital environment for a candidate with an entrepreneurial spirit, strong physician relations skills, analyzing your specific model needs, determining your growth objectives at the outset, and being willing to explore individuals with transportable skills may result in your making the correct decision initially and, therefore, avoiding monumental financial and integration obstacles down the road.

Case Studies | December, 2012