Jennifer Moody - Lonestar HFMA

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Succession Success
— Real-Time Strategies
Date
for an Aging Physician Workforce
HFMA Winter Institute
Dallas, Texas
January 29, 2016
Agenda
I. Session Objectives
II. National Workforce Demographics
III. Risk Assessment
IV. Challenges and Solutions
V. Key Takeaways
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I. Session Objectives
In this session, we will:
» Evaluate age cohort–related challenges to the
physician workforce.
» Examine the strategies that organizations are
utilizing to address succession risks and
transition physician practices.
» Learn how to create risk assessment models
and plan for changes to medical staffs.
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Healthcare
organizations are
preparing for a
tidal wave of
change as a large
segment of the
physician
workforce
prepares for
retirement.
2
II. National Workforce Demographics
The national physician workforce is more diverse than ever, particularly in regard
to age.
The veterans (born before 1945) have largely retired.
The older baby boomers (born between 1945 and 1964) are
rapidly changing their practice styles.
Younger physicians are aligning with
hospitals and health systems.
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II. National Workforce Demographics
Physician Workforce Distribution
Summary Specialty
<35
35–44
45–54
55–64
65+
Primary Care
11%
25%
25%
25%
14%
Capacity-/Hospital-Based
11%
26%
28%
24%
11%
Medical Subspecialty
7%
23%
25%
26%
19%
Surgical Subspecialty
8%
24%
25%
25%
18%
Pediatric Subspecialty
11%
27%
26%
22%
14%
Women's Health
10%
24%
25%
25%
16%
Mental/Behavioral Health
7%
16%
24%
26%
28%
Other
5%
23%
23%
29%
19%
Total Workforce
9%
24%
25%
25%
16%
Source: Infogroup USA, 2016.
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Over 41% of the nation’s physician workforce is
age 55 or older. The percentages for
mental/behavioral health, medical subspecialties,
surgical subspecialties, and women’s health are
even higher.
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II. National Workforce Demographics
Oldest Specialty Cohorts (Nationally)
Source: Infogroup USA, 2016
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Rank
Specialty
Percentage
Age 55+
1
Nuclear Medicine
62%
2
Occupational Medicine
59%
3
Medical Genetics
58%
4
Pathology
58%
5
Allergy/Immunology
54%
6
Psychiatry
53%
7
Cardiac Surgery
51%
5
III. Risk Assessment
Succession is no longer just about retirement planning; it requires navigating
various components of physician practice.
Changes to hospital inpatient
and emergency coverage
Limitations in practice
style, which can include
subspecialization
Control over patient
access for financial
and/or lifestyle reasons
Preparation for untimely
departures or impairment
challenges
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III. Risk Assessment
Overview
» Verify physician and
advanced practice provider
workforce.
» Solicit physician input.
» Evaluate staff demographics.
» Quantify current physician
needs in the market.
» Identify strategies for hospitalspecific and regional needs.
» Review plans with physicians,
and adjust as necessary.
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DATA
GATHERING
RISK
ASSESSMENT
SUCCESSION
PLANS
PHYSICIAN
INVOLVEMENT
» Assess community
demographics.
» Consider the ambulatory
experience.
» Review community
expectations.
» Consider current physician
supply trends.
» Discuss future plans with
existing provider groups.
» Engage medical executive
committee as advocates.
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III. Risk Assessment
Service Area Physician Inventory
Create a provider database
utilizing multiple sources such
as:
Conduct any additional research
necessary to fully profile all
providers, including:
» Purchased data.
» State licensure.
» Hospital staff listings in
region.
» Vitals, Healthgrades, and the
NPI lookup tool.
» Yellow Pages directories.
» Other online practice listings.
» Other area sources.
DATABASE
CREATION
PHYSICIAN
VERIFICATION
DATA
REVIEW
Conduct research through
various methods, such as
phone calls, to determine:
Review the profile for any errors
such as:
» Practice locations and FTEs.
» Inappropriate classification of
specialty and FTE.
» Specialty/subspecialty.
» Acceptance of new patients.
» Wait time for new patient
appointments.
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ADDITIONAL
RESEARCH
» Misrepresented data.
» Qualitative concerns (call or
consulting coverage).
» Missing physicians.
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III. Risk Assessment
Sample Service Area Physician Inventory
Primary
Market FTE
Secondary
Market FTE
Accepts
New
Patients?
Physician A
-
0.9
Yes
Yes
No
21
Male
Physician B
1.0
-
Yes
Yes
Yes
30
Male
Physician C
-
0.5
Yes
Yes
No
45
Female
Physician
Staff Status
Accepts
New
Medicare?
Accepts
New
Medicaid?
Days Wait for
New Patient
Appointment
Age
Gender
Physician D
Active
0.8
-
Yes
Yes
Yes
30
70
Male
Physician E
Active
0.8
-
Yes
Yes
Yes
30
37
Male
Physician F
Courtesy
1.0
-
Yes
Yes
No
30
60
Male
-
1.0
Yes
Yes
No
30
1.0
-
Yes
Yes
No
30
Physician I
-
0.6
Yes
Yes
No
14
Female
Physician J
1.0
-
Yes
Yes
Yes
30
Male
Physician K
-
1.0
Yes
Yes
No
30
Male
30
Physician G
Physician H
Courtesy
Physician L
Active
0.6
-
Yes
Yes
Yes
Physician M
On Leave
0.2
-
No
No
No
Physician N
Active
1.0
-
Yes
Yes
No
30
-
1.0
Yes
Yes
No
30
7.4
5.0
93%
93%
33%
29
Physician O
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Female
74
Male
72
Male
37
Female
61
Male
Male
59
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III. Risk Assessment
Sample Service Area Physician Inventory — Hospital Coverage Changes
Primary
Market FTE
Secondary
Market FTE
Accepts
New
Patients?
Physician A
-
0.9
Yes
Yes
No
21
Male
Physician B
1.0
-
Yes
Yes
Yes
30
Male
Physician C
-
0.5
Yes
Yes
No
45
Female
Physician
Staff Status
Accepts
New
Medicare?
Accepts
New
Medicaid?
Days Wait for
New Patient
Appointment
Age
Gender
Physician D
Active
0.8
-
Yes
Yes
Yes
30
70
Male
Physician E
Active
0.8
-
Yes
Yes
Yes
30
37
Male
Physician F
Courtesy
1.0
-
Yes
Yes
No
30
60
Male
-
1.0
Yes
Yes
No
30
1.0
-
Yes
Yes
No
30
Physician I
-
0.6
Yes
Yes
No
14
Female
Physician J
1.0
-
Yes
Yes
Yes
30
Male
Physician K
-
1.0
Yes
Yes
No
30
Male
30
Physician G
Physician H
Courtesy
Physician L
Active
0.6
-
Yes
Yes
Yes
Physician M
On Leave
0.2
-
No
No
No
Physician N
Active
1.0
-
Yes
Yes
No
30
-
1.0
Yes
Yes
No
30
7.4
5.0
93%
93%
33%
29
Physician O
Female
74
Male
72
Male
37
Female
61
Male
Male
59
» The hospital has seven physicians on staff but three of them are not taking call. This puts a strain on the other four
physicians, only one of whom is practicing at a full-time FTE.
» The physician on leave is expected to return to work part time in 6 months.
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III. Risk Assessment
Sample Service Area Physician Inventory — Practice Limitations
Primary
Market FTE
Secondary
Market FTE
Accepts
New
Patients?
Physician A
-
0.9
Yes
Yes
No
21
Male
Physician B
1.0
-
Yes
Yes
Yes
30
Male
Physician C
-
0.5
Yes
Yes
No
45
Female
Physician
Staff Status
Accepts
New
Medicare?
Accepts
New
Medicaid?
Days Wait for
New Patient
Appointment
Age
Gender
Physician D
Active
0.8
-
Yes
Yes
Yes
30
70
Male
Physician E
Active
0.8
-
Yes
Yes
Yes
30
37
Male
Physician F
Courtesy
1.0
-
Yes
Yes
No
30
60
Male
-
1.0
Yes
Yes
No
30
1.0
-
Yes
Yes
No
30
Physician I
-
0.6
Yes
Yes
No
14
Female
Physician J
1.0
-
Yes
Yes
Yes
30
Male
Physician K
-
1.0
Yes
Yes
No
30
Male
30
Physician G
Physician H
Courtesy
Physician L
Active
0.6
-
Yes
Yes
Yes
Physician M
On Leave
0.2
-
No
No
No
Physician N
Active
1.0
-
Yes
Yes
No
30
-
1.0
Yes
Yes
No
30
7.4
5.0
93%
93%
33%
29
Physician O
Female
74
Male
72
Male
37
Female
61
Male
Male
59
Only five physicians are generalists while the remainder subspecialize. Loss of generalists may create difficult vacancies to
recruit for. In addition, older subspecialized physicians may be carving procedures away from other physicians in the community.
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III. Risk Assessment
Sample Service Area Physician Inventory — Access Limitations
Primary
Market FTE
Secondary
Market FTE
Accepts
New
Patients?
Physician A
-
0.9
Yes
Yes
No
21
Male
Physician B
1.0
-
Yes
Yes
Yes
30
Male
Physician C
-
0.5
Yes
Yes
No
45
Female
Physician
Staff Status
Accepts
Accepts
New
New
Medicare? Medicaid?
Days Wait for
New Patient
Appointment
Age
Gender
Physician D
Active
0.8
-
Yes
Yes
Yes
30
70
Male
Physician E
Active
0.8
-
Yes
Yes
Yes
30
37
Male
Physician F
Courtesy
1.0
-
Yes
Yes
No
30
60
Male
-
1.0
Yes
Yes
No
30
1.0
-
Yes
Yes
No
30
Physician I
-
0.6
Yes
Yes
No
14
Female
Physician J
1.0
-
Yes
Yes
Yes
30
Male
Physician K
-
1.0
Yes
Yes
No
30
Male
30
Physician G
Physician H
Courtesy
Physician L
Active
0.6
-
Yes
Yes
Yes
Physician M
On Leave
0.2
-
No
No
No
Physician N
Active
1.0
-
Yes
Yes
No
30
-
1.0
Yes
Yes
No
30
7.4
5.0
93%
93%
33%
29
Physician O
Female
74
Male
72
Male
37
Female
61
Male
Male
59
» The data above represents many brewing access issues—from physicians working at less than a full-time FTE to payor
limitations and lengthy new appointment wait times.
» Of the five physicians accepting new Medicaid patients, two are over the age of 70.
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III. Risk Assessment
Physician Involvement
POSITIVE ENGAGEMENT
» Encourage planning dialogue
through a medical staff
development committee.
» Regularly include succession as
part of service line and medical
group strategic planning
processes.
» Provide opportunities for
physicians to express succession
concerns, such as medical staff
surveys, focus groups, or town
halls.
» Maintain a positive approach—
succession is a normal part of
the labor cycle.
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IV. Challenges and Solutions
“Should we recruit to the existing
group practice?”
The most recent physician needs assessment
showed a healthy supply of general surgeons in the market.
However, referring physicians are complaining about
access to the group, as most physicians have decided to
narrow their procedural range, and several older physicians
have recently stopped taking call. The group has
approached the hospital for assistance with recruitment.
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IV. Challenges and Solutions
Recruit to Existing Practices
Evaluate market need, including the physician-to-population ratio, to determine if
market need exists.
Is there a need
for additional
providers at the
present time?
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Do needs exist
solely due to
payor issues in
the market?
Do special
markets (such
as HPSAs or
MUAs) drive
recruiting?
Does projected
demand match
physician
resources?
15
IV. Challenges and Solutions
Physician Needs Assessment and Geographic Segmentation
Distribution for the total market area
highlights overall needs as compared to
market demographics.
Payor acceptance and patient wait times may
influence qualitative needs.
1
Local practice distribution should be considered.
This distribution should then be compared to
residential and employment patterns and
evaluated alongside market supply,
demographics, and specific demand influences.
2
3
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IV. Challenges and Solutions
Understanding Geographic Segmentation
Physician-to-Population Density Heat Map
The market assessment identified
shortages in primary care. Recruitment
was occurring in the dense (blue)
markets near established practices.
In one of the red (underserved) ZIP
codes, 60620, there were 5.6 primary
care FTEs but only one physician for
every 12,750 patients.
Only 33% of the physicians in 60620
were accepting new Medicare patients
and 50% were accepting new Medicaid
patients. The average wait for an
appointment was 13 days, and the
average physician in the market was 59
years old.
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IV. Challenges and Solutions
“Why aren’t they doing what we
are paying them to do?”
The hospital has been aggressive in offering competitive
compensation packages to the physicians recruited to its
employed practice, several of whom are physicians in their
late years of practice. Since the hospital acquired several
small community practices, productivity has decreased,
wait times have increased, and more cases are being
referred to other hospitals. It seems that physicians are
struggling to adapt to an employment model.
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IV. Challenges and Solutions
Review of Group Structure
Example Clinic
Provider Schedule
Daily
Schedule
Provider 1
Provider 2
Provider 3
7 a.m.
8 a.m.
9 a.m.
10 a.m.
11 a.m.
12 p.m.
Meal
Meal
1 p.m.
2 p.m.
3 p.m.
4 p.m.
5 p.m.
6 p.m.
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Meal
» The staggering of provider shifts
expands clinic hours throughout the
early morning, over lunch, and into the
evening.
› Patients often want the option to
see a provider outside of the
traditional 8 a.m. to 4:30 p.m.
hours.
» Shift staggering can also offer
convenience to providers and staff
who may have personal obligations
during these time frames by giving
them the flexibility to manage their
blocks in the clinic.
» Ensuring that provider patient care
hours are consistent and meet
minimum standards will also increase
patient access.
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IV. Challenges and Solutions
Practice Operations Assessment
To ease patient scheduling, two common types of templates are often utilized.
Sample Scheduling Template
Daily Schedule
Appointments
8:00
New Patient
8:20
New Patient
8:40
Open
9:00
Follow-Up
9:20
Open
9:40
New Patient
10:00
Follow-Up
10:20
Open
10:40
Hospital Rounds
11:00
Hospital Rounds
11:20
Hospital Rounds
11:40
Hospital Rounds
12:00
1:00
1:20
1:40
2:00
2:20
2:40
3:00
3:20
3:40
4:00
4:20
4:40
Meal
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
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Hybrid Template
» Eliminate individual scheduling rules and allow providers to automate
preferences into templates with defined parameters.
› Acceptable — No more than three new patients in a row, unless the slot
goes unfilled
› Unacceptable — No more than two workers’ compensation cases in the
same day
» Designate a percentage of each provider’s template to be held for specific
visit types using descriptors (e.g., ED/hospital follow-up, surgery follow-up,
casting).
› Build templates so that descriptors are released in a timely manner if
they are not filled.
» Ensure that template holds are approved and built into the schedule.
Open Template
» As providers become more comfortable with scheduling
changes, an open template model should be considered.
» Open templates are devoid of descriptors and holds.
» Scheduling rules are agreed upon by each specialty and built
into the templates (e.g., no more than five new patients in the
morning).
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IV. Challenges and Solutions
Compensation Assessment
Incorporating a scorecard as a component of the physician compensation plan can
address clinical productivity, financial sustainability, and provider accountability.
Compensation Plan Key Performance Indicators
Percentage of Organizations
2011
2012
2013
2014
WRVUs
76%
81%
74%
88%
Quality
27%
37%
52%
54%
Patient Satisfaction
20%
33%
29%
38%
Provider Profitability
14%
23%
26%
13%
Net Professional Collections
24%
21%
23%
13%
Organization Profitability
14%
19%
10%
8%
Panel Size
N/A
N/A
10%
4%
Attribute
Source: ECG National Provider Compensation, Production, and Benefits Survey, year 2014 based on 2013 data.
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IV. Challenges and Solutions
Evaluate Alternative Arrangements
Some short-range succession issues can be addressed through strategic planning for
physician coverage through alternative arrangements.
» Incentive based call and/or consulting coverage can help expand the
capability of the hospital to provide services when physicians are no
longer willing to practice in their current style.
» Utilization of locum tenens providers can not only allow for temporary or
part-time coverage but can serve as a placeholder for a practice if
unanticipated changes in coverage occur.
» Telehealth may also be an important tool for expanding provider
capabilities or filling future voids.
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IV. Challenges and Solutions
Work With Legal Counsel
When devising succession plans, it is best practice to work with legal counsel
and/or a professional with expertise in this area.
» Succession planning, if executed incorrectly, can be seen as age
discrimination. Therefore, appropriate evaluation and documentation is
critical.
» Physician impairment is a sensitive subject and should be appropriately
addressed through peer review and medical staff policies.
» When practices close or physicians retire, change practices, or make
other changes that affect patient care, transition protocols should be
followed.
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V. Key Takeaways
» Succession risk is unavoidable. No one works forever, and succession is a
natural part of the workforce cycle. Succession planning is a perpetual process,
not a onetime activity.
» It is important to evaluate succession in the greater context of community
need. One-to-one replacement is not the best practice for long-term succession
planning. Healthcare organizations should regularly assess their workforce
supply and project both organizational and community needs. Succession
planning should be one element of that assessment process.
» Succession and retirement shouldn’t be synonyms. Physician transitions
today look different than they did a decade ago. Practicing at full capacity until
retirement is less common. A decade (or more) of slow transition is more likely,
and succession planning methodologies need to account for this.
» Early planning yields smooth transitions. The best succession plan is the one
that identifies and addresses risks before they become a reality.
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Questions
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& Discussion
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About ECG
» ECG is a national consulting firm focused on offering strategic,
management, and financial advice to healthcare providers.
» Known for our expertise in strategy, hospital/physician relationships,
business planning, and program development, we focus on creating
customized, implementable solutions to meet our clients’ specific
challenges, in both community-based and academic settings.
» We have approximately 190 consultants nationwide.
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About ECG
We’re leading healthcare forward,
one organization at a time.
STRATEGY
FINANCE
Tackling today’s complex and
interconnected healthcare problems
requires knowledge and expertise across
multiple disciplines, and that’s what ECG
delivers to our clients every day. With four
core competencies of strategy, finance,
operations, and technology, we provide
smart counsel and sustainable solutions
OPERATIONS
0100.015\353422(pptx)-E2
TECHNOLOGY
that are transforming healthcare delivery.
27
Meet Our Presenter
Jennifer Moody
Senior Manager
jmoody@ecgmc.com
469-729-2600
0100.015\353422(pptx)-E2
Jennifer is a dynamic healthcare strategist with a wide-ranging
knowledge of physician workforce planning, medical staff
development, and provider practice trends. ECG clients value
her guidance on health system market planning and physician
staffing issues, and they appreciate the insightful, pragmatic
approach she brings to all of her engagements. Prior to joining
ECG, Jennifer helped found AmeriMed Consulting and served
as the firm’s Managing Principal for 15 years. With AmeriMed,
she brought extensive expertise and hands-on management to
an array of projects for more than 300 health systems,
hospitals, and physician organizations, helping them define
goals and craft implementable solutions to challenges in
physician recruitment, market development, strategic planning,
managed care, and physician clinical operations. Jennifer has
worked closely with leadership to position their organizations for
success in an evolving healthcare landscape.
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