Veterans Day reminds me of my father. In WWII, he landed on Omaha Beach on D-Day.

As Steven Ambrose details in his book “D-Day,” the Allies planned the Normandy invasion for three years, but as soon as our troops hit the beaches, the plans went out the window. To the ‘man on the ground,’ NOTHING was as planned. And on the beaches, formal leaders were dead or not available. Survival and progress to save the free world depended on rapid learning and action, i.e., adaptive leadership. Our troops felt empowered to act, German forces felt compelled to wait for Hitler’s direction. The rest of this leadership story, as they say, is history.

Despite asserting to my Dad, in my youth, the growing impact of technology, e.g., pilotless planes, long-range capabilities, etc., he remained convicted of the mantra “the ultimate weapon is the man on the ground.”* My Dad and his colleagues, some of whom made it past D-Day, are heroes. I have since learned that there were others “on the ground” back in the U.S. who heroically enabled these heroes. During the planning for the largest invasion in modern history, a significant challenge was figuring out how to get our troops from ‘ship-to-shore.’ The U.S. federal government knew how make large ships to get our troops across the English Channel, but they could not get our troops to the shore. Enter Andrew Jackson Higgins, who was described by Dwight D. Eisenhower in 1964 as “the man who won the war for us.” (Read Full Article)

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A physician who I greatly admire and respect once took a job as a hospitalist in a small town. She was told that she would have a guaranteed salary. But she did not read the fine print in her employment contract. The guarantee was actually an advance against future production, or collections. She was required to meet a certain level of collections to support her salary. If she did not meet that level of collections, she had to pay back the deficit. There was a hospitalist outside of and competing with her group. One of the emergency department physicians really liked this hospitalist. If he determined that the patient had good insurance, he called the outside hospitalist to do the admission. If he determined that the patient did not have good insurance, he called my friend’s hospitalist group. They were providing a tremendous amount of care to the patients in the hospital. They were just not getting paid. The longer she worked there, the deeper in debt she was getting. One of her partners did the math and simply left. My friend stayed out of a sense of integrity and fairness to give them time to find her replacement. She was not repaid in kind. And who was going to come and take over for such a terrible deal? She ended up in court and had to pay everything that the hospital was demanding of her. The judge said that it was a terrible contract, but a legally binding one and that she was a big girl and should have read the contract. Her partner who left early made the right decision in that she paid much less to the hospital.

When I was in medical school, we had a medical legal course which consisted of about 10 hours of lectures. One of the things that we were told was to read very carefully anything that we put our signature to. We were particularly cautioned to read employment contracts. I have followed this advice, and it has served me very well. I know of some stories where physicians were badly injured for not having read their employment contracts.

The first question is, “Will I be paid as an employee or as a contractor?” If an employee, then the employer pays half of the Social Security and Medicare taxes. If a contractor, then you pay all of the Social Security and Medicare taxes. If paid a salary, you will get a set amount of money, usually every two weeks or every month. Most people who are paid a salary are expected to work significantly more than 40 hours per week, because there is no additional cost to the employer for extra hours that you work. Many job offers will sound like salaried positions, but close examination of the contract will reveal that all or a significant portion of the payment offered is contingent upon one or more performance metrics. These metrics may include collections, relative value units (RVU’s), quality & efficiency. These may be based on individual performance, group performance or some combination of both. Collections is how much was actually paid for the care you delivered. Usually, a percentage of your collections is paid to the group or hospital for overhead. RVU payment is based not on collections, but on billing. This system is often used by organizations that serve the underserved as it encourages physicians to deliver care regardless of an individual’s ability to pay. Increasingly large portions of physicians’ compensation packages are only paid if the individual and/or group meet certain quality and efficiency metrics. Whether you are actually in control of a metric, the manner in which the metric is tracked & calculated and the thresholds to qualify for the metric all can have significant impact on your actual compensation. Benefit packages can also have significant impact.

In such a short article, I cannot tell you everything to look for. I would advise you to look closely at the exit clauses. When you go to work for a new employer, you have great hopes and even expectations that things are going to go very well. But they may not. I heard of a physician who, within two months of joining a new group, learned that his partners were engaged in and engaging him in activity of questionable legality. The exit clauses in his contract were onerous, and it was very costly for him to leave so early. Issues that may hit you with early separation can include repayment of sign-on bonuses, repayment of moving stipends and noncompete clauses. I was once invited to sign a contract that said I could not work for two years in any hospital anywhere in the United States owned by any company or organization that had a contract with this large physician staffing company (which had hospital contracts in many states).

So how do you go about reading an employment contract? Of course, you are not going to receive a copy of the contract until after you have been given an offer of employment. The contract is usually sent as a PDF. You can either print it out and use a highlighter and an ink pen or, if you can get it into an editable format on your computer, you can go through the document using track changes. You are now going to sit down and read every single word of the document: slowly, carefully and thoughtfully. You will go online and look up the definitions of any legal terms that you do not understand. You can write those definitions in the margins. You can make notes about things that you understand and want addressed and about things that you do not understand. After fully digesting the document, you will either decide to walk away from this job or you will think that this might be doable if the potential employer is agreeable to reasonable changes.

If you wish to go forward, you will now hire an experienced physician employment attorney and will send him or her a copy of your highlighted document with all its notations. You will discuss your concerns. Your attorney will review your document and schedule a follow-up discussion. Your attorney may advise you simply to walk away. Or he may give you a list of items that need clarification or correction. Some issues you identify and some of your attorney’s recommendations will be deal breakers meaning either these changes are made, or you refuse the offer of employment. Others may be that it would be nice if you could get them, but are not that important. With the help of your attorney and your spouse or significant other, if there is one, you will formulate a plan for seeking necessary and desired changes in your employment contract that are reasonable and fair to both parties. Your attorney will help you express your concerns in a language that resonates with the attorney working for your potential employer who will have to give the final approval on any changes to the employment contract.

I will walk you through how I approach these negotiations. I schedule a phone meeting with the individual designated by the potential employer to be their face for the negotiations. My tone is very pleasant and reasonable. I start by saying that my wife and I have carefully read the contract. I have sought the advice of a very competent attorney experienced in physician employment contracts. From these discussions, the following concerns have arisen. If the concern is coming from me, I do not hesitate to say so, but I consider it a good strategy to point out when the concern is coming from my wife or from the advice of my attorney. This is called an appeal to higher authority. It may seem like weakness, but it is a very powerful tool. Used properly, it can tremendously strengthen your position as nothing they say to persuade me will have any impact on how my wife feels about it, especially when it is an issue that is recognized as a reasonable concern for the employee’s wife. When appropriate, I ask for clarification of language in the contract rather than outright changes. Everything that I am asking for needs to be laid out in this first meeting. If you keep coming back with new demands, they may tire very quickly and look for another candidate.

You likely will not get everything you ask for. Just make sure that you get everything you need.

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Why is it that too much of something becomes a bad thing? We have all heard that phrase, “too much of a good thing.” And while we might not like to admit it, it is true. I have a weakness for sugar, but if I eat it too often, I gain weight. This causes a chain reaction because being fit is also important to me. So, I compensate for this love of sugar by increasing my hours in the gym. As I increase my hours in the gym, I forgo time at home with my wife and family. Life is full of balancing acts like this one.

Another such balancing act is needed between confidence and arrogance. As an executive transition coach, I work with clients on confidence frequently. Although, it should be noted that even though I have been in the healthcare business for 30 years, I can name only 10 people I thought were truly arrogant. Most people in healthcare seem to be somewhat humble, but when that is overstated it too can become a negative.

What is arrogance? Somebody once said to me “confidence becomes arrogance when performance dips.” At what point does confidence become too much? When does arrogance come into play, and how can you strike a balance between the two? The answer lies in humility ...or rather in your ability to be humble.

Urban Dictionary states that, “To be humble is to have a realistic appreciation of your great strengths, but also of your weaknesses.”

Your confidence level is absolutely essential in securing your next position. Sometimes the client is overly afraid of coming across as cocky, other times the client is already so cocky, we have to work on humility and self-awareness. Whatever side of the spectrum the client falls on, we talk about ways to meet in the middle and find their sweet spot.

How to find your confidence sweet spot:

1. Take an inventory of your professional accomplishments. Be honest with yourself. Be proud of yourself. Self-awareness is the first step in identifying whether you fall on the arrogant or the self-deprecatory side of the spectrum.
2. Record yourself talking about your accomplishments. Then play it back so you can hear how you are coming across. Does it sound like bragging to you? Or perhaps you are actually downplaying the work you put into a project? Neither scenario is ideal, but if you are able to identify it, you can modify your message and practice a new approach to telling your story. One that is genuine and strikes a healthy balance between what you accomplished, while giving credit where due.
3. Observe others. Seek out and observe people with the right level of confidence and write down your observations. It always helps in defining what the right level of confidence is for you.
4. Ask a friend or two to be candid with you. Look at yourself through their eyes. Put your pride to the side and take note of any areas they identify where you could make improvements. This is sometimes very difficult and hard to hear, but if you really listen, it can be invaluable feedback.
5. Be willing to take responsibility, but not too much. Arrogant people don’t like to take any responsibility, while confident people admit their error, and create an action plan to remedy the error.

Above all, be genuine and honest with not only everyone else, but perhaps most importantly -- to yourself. When you are able to see yourself objectively, both the positive and the negative, then you can speak confidently -- and with the right amount of humility -- during your next interview or conversation with a recruiter.

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“This article originally appeared on www.stout.com.”

Ensure accurate coding and billing by reviewing the coding and compliance policies woven into a health system’s revenue cycle.

Because coding can be confusing and laborious it can often be overlooked and potentially not recognized as part of the revenue cycle process. Now more than ever before, coding reviews are an important component of a health system’s overall "value”-based payment continuum, due to continued scrutiny by Medicare/Medicaid and commercial payers. Health system executives are tasked with optimizing performance of and maximizing efficiency of the coding stage in the revenue cycle. Accurate coding leads to clean claims, which results in prompt reimbursement, and that’s why coding has a direct impact on the bottom line.

Coding is a moving target for many providers. Omnipresent and at times inconvenient and confusing, the ever-changing demands coupled with the risk of inaccuracy constantly challenges providers. With severity of care levels and clinical outcomes increasingly tied to “value,” reimbursements will inextricably link with accurate disease-state coding and documentation. Also, with provider compensation woven tightly to provider production (with emerging compensation models embracing quality and efficiency components, as well), accurate coding confirms both proper reimbursement to the system and accurate compensation for those providers on productivity models.

Educating providers mitigates downside risk to health systems and hospitals and offers leadership (the C-suite along with the physician executive team) the prophylactic of ongoing monitoring ensuring that the administrative/physician partnerships are cemented in a compliant manner.

Coding Compliance

A successful coding review and compliance plan should be crafted to define the hospital or health system’s investment and belief in coding compliance. A memorialization of the processes and procedures undertaken in a coding review enshrines that all constituents clearly understand the goals, objectives, and expectations of the hospital/system. Coding/compliance plans cannot be one-dimensional relying solely on documentation of services or an information technology solution. For instance, in a vacuum a provider can “pass” a coding assessment with proper documentation which generates work relative value units (wRVU). However, sometimes that productivity can be overly, and erroneously, robust given clinic hours, patient facing time, provider schedules, etc. Since most employed providers have a component of their compensation driven, at least in part, from a wRVU model, ensuring precise claim level of billing (e.g. a level 3 versus a level 5) offers physicians and health system leadership peace in the knowledge that claims, charges, and subsequent revenue are accurate.

Additionally, until block chain, “machine learning,” and other IT initiatives like artificial intelligence (AI) have firmly taken hold to “solve” coding and compliance issues, human-intervention will be required to certify that coding documentation aligns with patient facing time, required coding elements, and charting. EHRs can be dangerous when a user simply hap-hazardly “carries forward” a note which can offer a false sense of accuracy. Providers (physicians and APPs) must fully understand the rules and regulations of coding, especially in the critical nature of pay for value initiatives that are evolving over time. Additionally, and tangentially, carrying notes forward has potential med/mal exposure. All of that said, accurate coding is essential relative to severity of disease state, etc.

A Coding and Compliance Program - The "3 F's"

Frequency

Delineate a program of ongoing review and analysis. It should have well-defined expectations. The program should be structured with defined timelines, be diligent, and guarantee random sampling and a rotating sequence of providers (depending on group size) for review. In program development “acceptable” parameters should be constructed indicating varying rates of post-review monitoring and education. The program should be “owned” by a staff member (with backup) to ensure it is perpetual and robust.

Feedback

After reviews are performed, an expedient and concise feedback loop should be deployed displaying to providers deficiencies and providing education. For instance, if a provider “fails” 80% of his or her coding reviews for accuracy, he or she should be placed on a more frequent review process (every quarter?) as defined in the compliance plan to document a remediation process and catalogue improvement in accuracy.

The feedback loop should contain educational opportunities that celebrate successes and elucidate challenges. Providers should be counseled and offered “real time” assistance if coding issues or questions arise during the day.

Follow-up

The coding review should carry with it a robust follow-up plan ensuring that team members (from front desk to providers) understand that the plan is deployed and in force infusing into the culture a sense that the system or hospital takes, and will continue to take, coding compliance seriously. That is not to say that staff members should know that Dr. X failed his or her coding review. Instead, the message to staff should be that the system views coding compliance as a system-wide obligation and focus.

Stout’s coding/compliance leadership ties coding together with one point of contact to manage all aspects of review and education. Our seamless coding and compliance team delivers a variety of solutions based on client need. Stout associates manage outpatient, “pro fee” evaluation and management (E&M) and risk adjusted coding assessments and education, while deftly handling Ambulatory Payment Classification (APC), Diagnosis Resource Group (DRG), and Clinical Documentation Improvement (CDI) coding initiatives for inpatient coding. Additionally, we are adept at hospice and home care coding analyses. Our “borderless” approach empowers our team to rapidly address client needs by removing artificial “silos” that inhibit fluidity on multi-faceted projects running between health system, inpatient work and ambulatory reviews. Stout associates understand the congruency of in and outpatient facilities and can deliver reviews and offer a coding/compliance partner.

* To read more about Stout’s experience and how we provided a 15 to 1 return on a client’s initial investment by helping them improve on their revenuecycle, download our case study now.

Physician Compensation Value-Based Care Initiatives Bring Disruption

a href=http://www.wiederholdassoc.com/blog/2018/10/19/physician-executives-are-you-utilizing-their-talent>Physician Executives – Are You Utilizing Their Talent?

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Everyone knows that the foundation of a good healthcare marketing plan is a focus on where an organization is trying to maintain and grow market share, and where the opportunities lie for expanding reach and volume. And, hopefully, it is based on a solid strategic plan with immediate and long-term goals. But often, there are a number of key sections that are left out—overlooked elements that can move a good marketing plan to excellence, taking advantage of all the layers of outreach in a healthcare marketer’s virtual toolkit. I offer six to consider below.

Six Sections Often Left Out of a Healthcare Marketing Plan

1. Internal Communications. First off, internal audiences can help reinforce your key messages and themes. But only if you take the time to engage them. Employees, physicians, and volunteers want to “get it” and be included. Include a section that focuses on doing just that.
2. Media Relations. Why not strategically incorporate earned media into your plan to help reinforce your key themes in an instantly credible way? Take control of your media outreach so that it supports what you’re working to achieve through paid channels.
3. Community Outreach and Sponsorships. Your organization probably does a lot to give back to the community and support important local initiatives. Some of this can be incorporated into your plan to support service line and program messaging. Think about how to promote your outreach while promoting your key marketing goals, without being too self-serving. It can be very powerful.
4. Payer Strategy. Healthcare marketers don’t often think about payers, but we should. As the major conduit for reimbursement, you want payers to know your organization has a positive reputation and strong consumer demand. This can be leveraged during contract negotiations. Consider how to target payers with your messaging in ways that are relevant and memorable.
5. Niche Targeting. Depending on your market, you may have the opportunity to message to a number of cultural niche audiences—Hispanic, African American, Asian, etc. Where appropriate, in-language marketing can be very favorably received. Experiential marketing can be incorporated to engage these audiences in ways that are meaningful to them, bringing them closer to your brand.
6. Consumer Engagement. Lastly, think of how you can engage consumers when they aren’t in need of your services. Done well, these efforts can actually build your brand much more effectively than a multi-media service line or image campaign. Think of how you can interact with consumers in ways that support your brand and provide value—outside the typical provider-patient relationship.

Take out your marketing plan and reflect on whether any of these sections are missing, and how you might incorporate them to bring greater value to your organization. As marketers, that’s our responsibility. I’d love to hear from you on how you utilize these ideas, as well as any additional thoughts you might have.

Read other posts by Janice:

Process Transformation: a Way to Reduce Cost, Improve Quality, etc. etc. etc.

Your Healthcare Marketing Plan: What’s Missing?

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When I was in college, the church that I attended had a booth every year at the local fair. We made a pastry called an elephant ear. I have seen at fairs funnel cakes which are made by pouring a liquid batter into hot oil and frying it. The elephant ear dough was mixed in a huge mixer. It had eggs in it. The dough was allowed to rise. It was then punched down, weighed out into balls and set on large cookie sheets to rise again. Volunteers sitting at tables would pat the balls into flat disks. These were fried in hot peanut oil and then covered with cinnamon sugar or powdered sugar. In the mid-1980s we sold these for two dollars apiece. They sold like, well, hotcakes. Many people would pay to get in the fair solely to buy elephant ears. There was always a line. If people saw that the line had gotten short, they would run to get in the line. We could sell as many as we could make.

I was in the booth one Saturday morning patting out elephant ears when I noticed Brother “Jones” handling sales. He was a very kind and pleasant man but age was upon him, and he was absolutely overwhelmed with the task. He had before him a line of people who were eager to get elephant ears and behind him stacks of elephant ears growing cold. I spoke to the team leader and asked him if he could arrange for Brother “Jones” and I to exchange positions, of course, handling it in a way that was not hurtful to Brother “Jones’s” feelings. The team leader declined to have us exchange positions but asked me to assist Brother “Jones” with sales.

We began to quickly make sales, and the stacks of unsold elephant ears got much shorter. Soon Brother “Jones” was at one of the tables patting out elephant ears. This was not a terrible place to be. There was always lively and pleasant conversation at the tables, and the task was ideally suited to his capabilities. I now had helping me another brother who was young, like I was, and energetic. We found ourselves waiting for elephant ears to be produced so we could sell them.

A new problem became apparent. The elephant ears were coming out of the vat and were stacking up waiting to have cinnamon sugar or powdered sugar applied. I spoke to the team leader who moved someone to assist with this task. Each time product piled up at a certain point in the process, I would ask the team leader to add or exchange human resources to speed the flow of product through the production chain.

The following day was Sunday. It was announced in church that the elephant ear booth averaged about $11,000 per year in sales, yet the day before we had sold $4000 in elephant ears. The fair would run each year for 11 days. We were not open on Sundays so we would run our booth for nine days each year. This gives us a daily average just over $1200. While Saturdays had more people at the fair than weekdays, demand always exceeded supply even on weekdays. We had tripled our sales that day by simply using our available resources more efficiently.

Several years later while in college, I read The Goal by Eliyahu M. Goldratt and Jeff Cox. This book is a business novel that describes the same process I did in the elephant ear booth but done in an air conditioner manufacturing plant. The protagonist identifies bottlenecks in the production stream by where product in process piles up and then eliminates the bottleneck by moving resources to that step. I highly recommend this book for business leaders.

The ideal value strategy requires no additional investment of resources but uses the current resources more efficiently to deliver quantity and quality, such as: a faster moving line delivering more and hotter elephant ears. We must not be afraid to make small investments when we know that there will be substantial return on investment. Large investments may be necessary and wise, but the larger the investment, the greater we risk, and the higher returns that are necessary to create a value result.

Read previous articles related to this topic:

Article 1: Your business’ future lies in an abundant strategy – not in scarcity

Article 2: Maximum Wow Strategies Lead to Scarcity

Article 3: Fat cutting from an organization can be taken too far – Are you starving your organization?

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A maximum value strategy may involve cutting the fat from an organization, but a maximum economy strategy will cut the meat and bone. A maximum economy strategy has an excessive emphasis on cost-cutting so that it starves the organization of the resources it needs to sustain and thrive.

I will tell you the true story of the only hospital in a town of less than 100,000 people. I will not tell you the name of the hospital or the town to protect the innocent and the guilty. This hospital was sold to a national, for-profit hospital chain. Their emphasis was to pull out as much of the hospital’s gross income for corporate profits as possible. This left very little operating capital to run the hospital. They underpaid their doctors and treated them with contempt. They did not buy necessary equipment and supplies. Deferred maintenance on the building piled up. Many of the doctors moved away including surgeons who were very important to the hospital’s revenue. People in the community began driving to other towns to use the hospitals there. The average number of patients in the hospital each day fell from 75 to less than 10. They wanted it all and slowly they killed the goose that was laying the golden eggs. They wanted everything and ended up with a little bit higher percentage of much, much less.

They saw their market as static and limited. They saw increasing profit opportunities in decreasing their investments in people, operations and infrastructure. They took on a scarcity mindset. They starved the hospital of the resources it needed to thrive or even sustain itself. The hospital wasted away under this neglect and abuse.

Stephen Covey told a similar story in The Seven Habits of Highly Successful People. A restaurant sold a delicious clam chowder that people lined up to buy. The restaurant was sold. The new owners were given all the recipes. They decided that they could make more money if they used cheaper ingredients. Over time people realized that the clam chowder was no longer as good. The lines got shorter and shorter. When the new owners realized their mistake, they tried to go back to the original recipe, but it was too late. The restaurant closed. They bought a maximum value organization and tried to convert it into a maximum economy organization. They shifted from abundance to scarcity and failed.

I am not saying that cost savings and efficiency are bad. If the restaurant owners were paying $3/pound for butter and found the same quality butter for $2/pound from a supplier who was just as reliable, that would be value neutral for the customers and value positive for the owners. But if they instead bought margarine for $1.50/pound, that would be value negative for the customers who are still paying the same price for a bowl of clam chowder. Now the question is, “How would buying cheaper margarine affect the value equation for the owners?” The new owners thought it would be value positive. They figured that they would pay less for margarine and get the same price for a bowl of clam chowder. But the customers stopped buying the clam chowder. The little bit extra profit they made buying cheaper ingredients was small compared to the income they lost from reduced sales. It was also value negative from the owners.

Here is an important take away. Be very careful about changes that you suppose will increase your value results while reducing the value results for your customers and other stakeholders. That is seeing your customers and important stakeholders as members of the opposing team instead of being on your team. And when they realize that you are not on their team, they will abandon you as soon as a viable alternative presents itself. Where the value equation really counts is in what you deliver to your customers and other important stakeholders.

A maximum economy strategy is a scarcity strategy. It is driven by pessimism and lacks vision. It is excessively focused on cost reduction without weighing the impact on quality. It will fail to deliver value (quality divided by cost) and will likely lead to weakness and failure.

Read previous articles related to this topic:

Article #1: Maximum Wow Strategies Lead to Scarcity

Article #2: Your business’ future lies in an abundant strategy – not in scarcity

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A recent survey of 146 CEOs by the Advisory Board (1), the CEOs voted that “sustainable cost control” was the number one priority. This is an imperative that every hospital in America must be doing in the current health care environment. Net revenue is tightening up. Smaller and smaller increases from government programs are the trend and health plans are taking the position that any new net revenue be tied to improving quality or costs. The routine annual increases are not routine anymore.

What CEOs should be focusing on is collecting all net revenue. What is the best that can be expected in net revenue collections from the revenue cycle area? Is it 90% of expected? 93%? 96%? What is preventing your organization from collecting closer to 100% of expected revenue?

We know that nothing ever happens at 100% in any field, endeavor or undertaking. Asking the question of “why not 100%” is the start of reviewing what is preventing your organization from improving on net collections. If your organization is at 91% net collections (including vendor fees, etc. from handing off old accounts), that’s pretty good. But can your organization get to 95%? Or 97%? Or 98%? What steps can be taken internally to earn an extra 3-7% of net revenue? That extra money could be the difference in meeting budget or bond market targets.

How to find your 3-7% extra net revenue:

1. Adoption of a new attitude. Policies and procedures have been adopted over time that balance the effort and expense of collecting versus the return. Making policies that allow for write offs of cases under $500 or $300 creates the mindset that it is ok to “just write it off.” If $500 is ok to write off, then why not the $15 co-pay? The concept is to reinforce the attitude that NOTHING is written off without a “good” reason. Hospital revenue cycle leaders get under pressure to lower A/R and it is too easy to compromise on small amounts that can add up. But when its ok to write off $15 it becomes easier to write off larger amounts. Additionally, reinforcing the attitude of no write off without a good reason helps support collection efforts of the front offices as well as in the back end
2. Trend analysis needs to be refined and acted upon more quickly. The new analysis is one plus one equals a trend. Reporting in revenue cycle often trends towards financial statistics and contractuals. Reporting needs to get more granular and specific to highlight trends in more real time. The best way to get real time information is to educate and empower your skilled staff.
3. The staff need to understand that when they see something happen twice – sound the alarm. Getting a denial or a rejection you don’t understand once happens. But twice is a trend. You do not need to wait until 10 or 50 or 100 examples occur to request an investigation, create a report and send to a payer. Health plan payment systems are very precise and anything unusual needs to be acted upon immediately.
4. Get better at reporting and documentation – fast. To support the staff, create rigor in the documentation of issues with plans. Nothing helps contract discussions for the managed care lead than starting off with how difficult the health plan is administratively. Reporting also needs to be detailed and refined in new ways to spot trends and support the managed care staff.
5. Establish new interactions with payers – set expectations and standards. Monthly meetings with payers need to reframed. The managed care lead needs to get agreement on performance and service expectations of the health plan. Simple expectations of responsiveness, service turnaround, etc. is imperative and needs to be enforced with the health plans.
6. Use process improvement techniques – be rigorous. Collecting the last few percentage points of revenue requires focus and discipline. Using process improvement techniques and their rigor is a must to gain and sustain results.

Hospitals need to ask the question: what more can be done to gain net revenue? Re-evaluating the revenue cycle and creating a “need attitude” is key. Adding a new focus and training for staff will create the ability to approach payers in a new way for new results.

(1) 2018 Advisory Board Research Annual Health Care CEO Survey conducted between December 2017 and March 2018.

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In Abundance: The Future is Better Than You Think by Peter H. Diamandis and Steven Kotler, the authors make the point that technological developments and continuing innovation will bring to the world a future of abundance rather than scarcity, of increasing prosperity rather than increasing poverty. I believe that they are right so long as we can maintain freedom in general, free markets in particular, reasonable levels of taxation and relative peace throughout the world. As I pondered on the ideas they presented, it occurred to me that a business leader needs to have an abundance mindset in strategic development. An overall scarcity strategy cannot bring a strong and bright future to an organization. We cannot simply cut and slash our way into growth and prosperity. Nor can we simply spend our way into growth and prosperity. An abundance strategy is one of tremendous value generation.

My wife and I built a home using a general contractor who builds custom, luxury homes. I commented to him one day that it had occurred to me that there are three types of people who buy a custom home:

1. Maximum WOW! These buyers do not care how much it cost. They want to upstage everyone else at any cost.
2. Maximum value. Value is defined as quality divided by cost. These buyers are willing to spend more money if they get a good return on their investment relative to their experience living in the home and to their resale value.
3. Maximum value. Value is defined as quality divided by cost. These buyers are willing to spend more money if they get a good return on their investment relative to their experience living in the home and to their resale value.

I told him that I thought that he could build homes for wow buyers and value buyers, but he could not build a home for an economy buyer to which he agreed.

At first glance we may be tempted to see a maximum wow strategy as an abundance strategy, but maximum wow and maximum economy are both scarcity strategies. Both strategies are low value generation strategies, and low value generation will sooner or later lead to scarcity. In maximum wow the cost is too high relative to the quality generated. In maximum economy the cost is low, but the quality generated is too low relative to that cost. The abundance future is in high value generation that comes in a maximum value strategy.

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Is the perspective on retirement amongst healthcare professionals different than in other industries?

As a Retirement and Career-transition coach, I work to stay abreast of the issues and challenges that are evolving in these two areas. Combined with my 18 years of experience as an executive recruiter in healthcare, I’ve been able to gain insight into some of the retirement and career transition issues that are unique to healthcare executives.

Is there life after a healthcare career?

A Beckers Hospital Review article reports that the average healthcare CEO is 57 and plans to retire at 65 and that 61% do not plan to work beyond 65.

Online nursing forums indicate that most nurses expect to retire in their fifties and nurse executives in their early sixties, understandable considering the combined effect of the physical and psychological demands of the profession.

Does this indicate that healthcare executives are no more aware of the evolving retirement scene than executives in other industries? Is there still a prevailing 20th century mindset when it comes to retirement, one based on the three-stage linear life plan with its artificial finish line of 65 and “withdrawal into isolation?” A model that, for more than a half-century, has advocated an off-the-cliff move from labor-to-leisure, vocation-to-vacation.

Graphically, that 20th century model and its life-span altering consequences look like this:

We’re at a place we’ve never been before. A place that renders this model irrelevant and potentially dangerous - physically, mentally, socially and spiritually.

The new reality is that we are living longer and healthier. We’re experiencing a “longevity bonus”, potentially as much as 30 years beyond the traditional retirement age.

When the arbitrary, politically-inspired retirement age of 65 was established decades ago, the average life span was around 55 and the old model made some sense. Guideposts weren’t important – few people lived to 65. But today, with lifespans for many stretching into 80’s, 90’s and beyond, the game has changed. We’re in unfamiliar territory with outdated institutions and policies and limited guardrails to keep us realistic about the new face of retirement.

But we instinctively know that thirty years of golf, travel, canasta and/or mah-jong just doesn’t make sense, nor can it be healthy.

A new retirement perspective is emerging, one that eschews tacking that longevity bonus onto the end and simply extending a period of “old age.”

Instead it proposes an alternative model where that bonus is recognized as a period of productivity and purpose that can be interspersed with pleasure. A model that might look like this in the second half/third stage.

Under this model, there is no wasting of accumulated experience, skills and passions. Learning continues as does meaningful, purposeful work along with a broadening and deepening of social relationships. Combined, this increases chances to not only live longer but to die shorter by maintaining vitality, vigor and verve up to the end. And society gains as acquired skills, experience, wisdom and passions are redeployed and not squandered.

The dark side of retirement

As a society in general - and likely amongst healthcare professionals - we don’t appear to be making this transition to a new retirement mentality very effectively.

We are experiencing an unprecedented “dark side” component to retirement. It stems from (1) failure to acknowledge and plan for this extended life space and (2) a retirement planning process that is almost entirely dedicated to financial or “hard side” elements and with little or no attention to non-financial, “soft side” components.

We know that 2 of 3 retirees have gone into their retirement with no semblance of a non-financial plan.

Here are just a few sobering facts that speak to the affects of an unplanned retirement:

• By 2020, the number of retirees with alcohol and other drug problems will leap 150%.
• The NIH reports that, of the 35 million Americans age 65 or older, nearly 2 million suffer from full-blown depression. Another 5 million suffer from less severe forms of the illness.
• Depression is the single most significant risk factor for suicide among the elderly. The CDC recently showed a dramatic spike in suicides among middle-aged people.
• The overall, national rate of divorce in the United States is trending down. Except for one group: the 50-plusers, who have seen their rate of divorce surge 50% in the past 20 years. In fact, one in four couples divorce after age 50.

Is it the same for retiring healthcare professionals?

I don’t see healthcare pros being as susceptible to these issues or devolving into “roleless roles” and sinking deep into a lounger upon retirement because of the intensity of career roles already performed and the energy and commitment necessary to fulfill those roles.

However, this is also a group whose “nose to the grindstone and shoulder to the wheel” dedication doing such meaningful, purposeful work may shield them from the aforementioned issues. Retirement planning beyond the financial may be no more present than with the general population because of this.

As a retirement coach, I encourage pre-retirees and early retirees to put as much emphasis on non-financial planning as on the financial planning. Don’t expect that assistance from your financial planner. They are trained to advise on, and sell, financial products and most do an excellent job in helping their clients in that regard. However, they are not trained or equipped to dispense advice on life-planning issues.

Beware the retirement honeymoon

Research has shown that retirees experience a “retirement honeymoon” period of 1-3 years after which the realities of existence within a traditional retirement model sinks in. These post-honeymoon years of retirement can be disappointing, contentious and wasted if pre- or early-retirement planning doesn’t take place.

Here are some of the issues that often surface:

• Overcoming a loss of identity.
• Divergent post-retirement interests (career or personal) between spouses.
• Boredom and stagnation – even narcissism - due to a lack of challenge and social engagement.
• Depression and physical deterioration because of reduced activity and social interaction and lack of a sense of purpose.

Retiring healthcare professionals can rock the world – on their terms

Personally, I feel that healthcare professionals can rock the world in the new version of retirement. Drawn to the healthcare profession out of a desire to help, having flourished in a life-and-death environment and seen and experienced real-life issues on a deeper level than people in other professions, there is a wonderful, unique and powerful foundation on which to build to the continued benefit of our society.

Consider the freedom to impact and serve in a very unique, personal way without the restrictions of politics, bureaucracy, government controls. Equipped with a longevity bonus and a background unparalleled in touching lives, the possibilities are restricted only by one’s thinking and creativity.

I fear that the persistent pull of the 20th century retirement model will suppress that creative thinking and waste a pool of incredible talent and problem solving.

There is life after healthcare – don’t panic

Those are the words of a new friend of mine, one of a number of retired friends who are integrating their essential selves, passions and their natural and acquired skills and leveraging them back into the marketplace where they will continue to do good.

A recently retired hospital CEO in Missouri, this new friend has chosen to pursue things that interest him. He has chosen to broaden and deepen his passion for civic and community involvement through volunteer board-level positions, paying forward his executive administrative experience as well as satisfying a passion to serve. He balances that with deepened family involvement, by immersing himself in learning a second language and by building black-powder, muzzle-loader rifles as a stress relieving hobby. My sense is that he has never operated at a higher energy and enthusiasm level.

For a retired CNO/CNE friend, it’s taking her doctorate in nursing and decades of top-level nurse management experience back into the marketplace to help nurse leaders cope with the pressures of today’s broken healthcare system and be more caring patient advocates. She’s doing it through a childhood passion for writing and teaching, using the internet, social media and book publishing. As she approaches 70, she has a passion-fueled energy that’s hard to keep up with.

Three suggestions to help the move to a successful new retirement

1. Retire to something, not from something.
2. Use the 3-5 years ahead of your retirement date to chart a retirement course with your spouse/partner outside of the financial planning process. Get on the same page early. Work with a life or retirement coach to help chart this course.
3. Consider “practicing” retirement now by experimenting with things that may interest you beyond tennis/golf/fishing/yoga. Start isolating the things that excite and motivate you and that will help you achieve a fulfilling, happy retirement.

Suggested reading:

1. “The New Retirementality”, Mitch Anthony
2. “Boundless Potential”, Mark S. Walton
3. “The Big Shift”, Marc Freedman
4. “Finding Your Own North Star”, Martha Beck

Smooth sailing!!

When we talk about attributes or “soft” skills that play an important role in determining success, grit is somewhat of an unknown. Recently I was introduced to Angela Lee Duckworth’s TED talk about her research on “grit” as a predictor of success in work and life. The dictionary defines grit as “courage and resolve; strength of character”. When you think about successful leaders – having a values-based character, a strong passion for and commitment towards a vision, and the resilience to achieve it, is what stands out. Your professional journey is a marathon and not a race. To be in it for the long haul is success (not just achieving the milestones along the way), and it takes more than just talent or intelligence. Passion can drive you to graduate school or to innovate and start a company, but it is perseverance that will help you succeed and thrive. Can grit alone get you there? Probably not, but lack of grit surely will not!

It involves staying steadfast on your path, overcoming failures and viewing challenges as opportunities to grow, regardless of the effort involved. It involves risk, sacrifice, sincerity and self-control. It takes deliberate practice and intentional strategy. As Lincoln said “If I had 8 hours to chop down a tree, I would spend 6 of those hours sharpening my axe. “

Grit is a fascinating word for me personally. I have always appreciated passion and perseverance but to find a word that can articulate both of those significant qualities together is delivering a power packed punch! So, as you take on that next challenge in your personal or professional life, ask yourself if you have the grit to see it through. If you don’t, work on changing your mindset first. And if you do, success should follow…

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The company that puts you out of business will not look like you!

The job of an entrepreneur/CEO is to look around the corner to see what is coming in the future. It is hard to know what a competitor looks like when they may not look like me (see: Amazon vs. Sears, Uber vs. Yellow Cab).

When I peek into the future, how do I know what I am looking for? What will my competitor or my business model look like tomorrow? The risk of missing a change in the business model is great. My role is to work on new processes that can help my clients get more value and make Medic Management Group more competitive. Many CEOs are concerned that disruptive companies may enter their business segment and change the business model. Amazon may not enter my business space - health care management - but I have to worry about companies like Apple and Google.

In my world, I cannot be lulled into thinking that patients will continue to seek health care in brick-and-mortar buildings. The technology explosion in health care does not just relate to genomics, new medications and surgical treatments. Every day new technology is being developed to enable patients to be seen from remote location s through monitoring devices that communicate with the providers. The telemedicine advertisements that we see on TV are just the beginning.

Many entrepreneurs and CEOs are too busy working on the day-to-day issues of their companies to explore new opportunities. We are so entrenched in day-to-day that we do not think like the generation of entrepreneurs that is looking for the new way. In the past, we attended annual trade shows, or we would study our competition to see what they were doing. Today, by the time you see what the competition is doing or hear the ideas that are discussed at trade shows, it may be too late.

How do we keep from being 'Amazoned?'

1. Get new ideas from businesses not in your industry. When you meet friends or talk with colleagues, do not just ask ' how's business?' Ask what new ideas and technologies they are seeing in their field and consider how they can be adapted to your business.
2. Perform a critical analysis of the current business by your team or an outside entity. How can we do it better?
3. Learn about bots, artificial intelligence and new technology, and find out how they relate to your products and offerings.

As the CEO, owner, entrepreneur, you are the chief visionary. You cannot delegate something as important as understanding the future of your company. A 22nd century vision is critical. Those of us that "skate to where the puck is going, not where it is has been" have an advantage over our competitors, current and future.

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Last week when the guest speaker in my Organizational Behavior class mentioned “career lattice”, I saw many quizzical expressions on my student’s faces. I realized, where other industries have adopted this method of talent development and retention, the healthcare industry largely lags. Part of the reason is the level of specialization, training, and even licensure requirements in certain roles. Certain skills need to be honed over time and you get better at your “trade” the longer time you spend in it. This can and has, however, led to burnout in many healthcare professionals leading to a talent drain. Healthcare is now one of the largest employers in the country, so it is time we paid attention to breaking stereotypes. The hierarchical career ladder has always been around and may have worked well in the past. But as more and more professionals look towards versatile and rewarding careers, while still maintaining a semblance of balance and flexibility, the concept of a career lattice makes much more sense that it ever has. The other limiting factor is our definition of career growth. We mostly tie it to a title or compensation, making it very prescriptive and limiting our options. But how about expanding your professional toolkit or repertoire, getting outside your comfort zone to challenge your abilities, utilizing your skills and experience in a different area – is that not a growth opportunity? Sometimes to take a step ahead, you may need to take a few steps back or sideways!

Though it may not be applicable in some specialized niches, it is important that healthcare organizations explore and adopt the concept where high potential employees are given growth opportunities to explore other roles and develop new competencies. We know that changing an individual’s attitude or behavior based on an organization’s culture is a much harder journey than teaching new skills and competencies. They why lose a professional who has become an integral part of the organization due to a lack of opportunities? In some industries, it is the norm for professionals to remain in their roles only for a couple years before they move into another role. This enhances employee engagement, retention and loyalty, while ensuring a steady pipeline of motivated individuals within the organization to fill critical vacancies. It also significantly reduces the costs associated with recruitment. What are some best practices that healthcare can adopt? Most healthcare organizations are accustomed to matrix structures, so opportunities are plentiful.

When I look at my own career path, it has certainly been a lattice. I planned to get to the “top” and the quickest way was the hierarchical ladder. It was a competitive rat race. I wanted to remain in hospital operations as that was the world I knew, loved and thrived in. I exceled and did achieve my career goals becoming a hospital CEO. But that also got me to a crossroads in my personal life. I loved my work, but I also loved my growing family and had to make some difficult career choices to give both my best. What I have learned through my experience is to keep your options open and never be afraid to take risks. The adage “greater the risk, greater the reward” maybe cliched but is so true! What I feared to have been career suicide (stepping down from my first CEO role) launched my career into a very different and equally rewarding path! So, whether your organization supports a career lattice or not, don’t be wary to explore it in your own career journey and seek out opportunities that help round your experiences and not typecast you or limit your options. Be creative and enjoy the journey. It is not a race so why not take the scenic route?

The holidays are the perfect time to reconnect with old friends and colleagues that you may not have spoken to in a long time. The season is full of celebrations and parties where you are in the presence of a lot of untapped potential. Potential to make a connection. Spark or rekindle a new or old friendship. Networking is all about finding connection points.

Finding that common ground that endears you to the other person and during the holidays, those connections come even easier with the added ingredients of warm fuzzies (eggnog anyone?) and a healthy dose of good cheer. So, when you are headed to the next holiday party, don’t groan and moan and count the hours until you can be home in front of the fire, look at it as an opportunity to widen your net and build up your network.

How to work a room:

1. Don’t stand by the front door. When people first arrive to a meeting or party they are nervous and looking for a place to put their things or visit a bathroom. Standing by the door is a sure way to get overlooked.
2. Spend only five minutes with each person you meet. This is long enough to listen to what makes them unique and for you to establish a connection within exchanged pleasantries. Get their business card and offer yours if asked in return.
3. Make notes on their business cards. Anything that will help you remember that person when you look them up later is invaluable. There is no way you can keep everyone you meet straight and that one detail about that person could be what gets you that future meeting. It adds the personal touch.
4. Follow-up. Think of how many times you given out your business card. Now think about how many times someone used that business card to reach out to you after the fact? Part of working a room successfully lies in the follow-up. Connect with the person on LinkedIn, shoot them a quick note telling them how nice it was to meet them and add the fun fact about them you jotted down on their business card.

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Are you looking to be promoted?

If getting a promotion is important to you, then it is time to sit down and ask yourself what you can be doing to actively advance your career. Here are some suggestions.

Regain Career Momentum

Define what success looks like to you. Once you have established the main target, break it down into smaller achievable steps and goals. Implement a workable system that will increase your technical and emotional skillsets needed to move from one step to the next.

Manage Up

Managing up means that you go above and beyond the tasks outlined in your job description. You continuously go the extra mile. Your job is to make your immediate manager’s life easier. Learning to effectively "manage up" can put you in a great position to align with your immediate supervisor, integrate effectively with the organizational culture, receive great recommendations, and ultimately help you on board effectively.

Help your stakeholders recognize your ability to build and lead a high-performing team that goes above and beyond the call of duty. Leading well on a small scale shows initiative and ability. Report team successes to your direct supervisor, giving credit to both the team and team members. As their leader, their success is your success. Consistent progress in leading a high-performing team will show that you are able to graduate to more responsibility.

Build Your Network

Networking/connecting is essential to your success both while gainfully employed and in transition. Networking with a purpose is a vital component of anybody's career success but is often terribly neglected.

Ask Questions / Survey Your Surroundings

•Have I asked my immediate superior what it takes to get to the next position?

•How has this organization historically handled promotions?

•Do they generally promote from within or seek externally?

•What is the general time-frame for people to get promoted within the organization?

•Is the person you report to going anywhere?

•Does the person you report to have a history of mentoring his/her direct reports?

By defining your goals, developing a strategy, and become intentional about executing your plan, you can increase your chances of advancement immeasurably.

Here's to your success!

Jim

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A courageous person takes an honest look at who they are. A powerful person acknowledges their weaknesses and strengths then understands how to use them both successfully.

Leadership involves building and maintaining a high-performing team. Anything that detracts from your ability to build a team also detracts from your performance as a leader. Behavior impacts performance.

Personality assessments are designed to measure traits/behaviors that are part of an individual’s make up. Organizations attempt to utilize these to assess both fit and performance in certain positions but the real value is that an individual can get real insight into their strengths, potential areas of opportunity, and motivators.

It is good to be able to understand, articulate and utilize your strengths. Think of these as the gas pedal in a car. When utilized properly, they will move your leadership forward. However, it is also important to understand when you’re putting your foot on the brake and negatively impacting your leadership journey. An effective assessment can help you understand what is propelling your journey and what is holding you back.

What Inhibits Your Success?

To help you understand your strengths and motivators as well as identify your risk factors, Wiederhold & Associates offers The Hogan Leadership Forecast Series. Through the series, you will receive a report designed to help you develop as a leader.

It will provide insights about your behavior and traits that showcase strengths as well as behaviors and traits that could potentially undermine or inhibit your performance. And if you’re committed to being the best leader you can be, we will help you determine the best way to enhance your awareness and make impactful change.

If you’re in transition, a seasoned executive looking to take your performance to the next level or a leader who is ready to get off the hamster wheel, the HOGAN LEADERSHIP FORECAST SERIES may be your next step to finding true success.

Learn more about Wiederhold & Associates

HOGAN LEADERSHIP FORECAST SERIES

Here's to your success,

Jim

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Introductory Comments:

The healthcare industry is at a crossroads. Consumerism, regulatory requirements, payer requirements, employer demands and other factors are driving forces for change in service delivery. Now is the time to get it right. We need to reduce cost, control utilization, streamline delivery of care, deliver care in a manner that exceeds patient expectations at all times, manage the health status of the communities we serve and demonstrate continuous improvement in achieving best in class clinical outcomes.

The industry, as a whole, needs to focus on the “Triple Aim” (low cost, service oriented and high quality). In doing so, we cannot neglect that we can only navigate the course to achieving value based results with a high performing team of leadership representatives, management representatives, physicians, other clinical providers and staff, thus achieving the “Quadruple Aim.”

We must engage and empower our clinical and non-clinical workforce to maintain professional satisfaction and reduce the risk of burn-out from expecting more without addressing resource requirements. It is not easy, but it can be framed in a simplified philosophy of Performance Excellence. Performance Excellence (Operations, Service and Clinical) is the gold standard by which healthcare teams will be measured.

Is your physician enterprise designed to allow every member of your organization to autograph their work with excellence?

Workforce (physicians, advanced practice providers, clinical and non-clinical staff) engagement at all levels of your organization is essential to move forward in today’s ever-evolving healthcare market. A Performance Excellence Philosophy provides the systematic methodology to engage your workforce in achieving results.

The Baldrige Excellence Framework (Healthcare): As Systems Approach to Improving Your Organization’s Performance empowers your organization to reach its goals, improve results, and become more competitive. The framework consists of the criteria, the core values and concepts, and scoring guidelines to use as reference, to self-assess, or as a basis for external assessment. Whether or not your organization is “award and recognition oriented,” today’s ever-evolving healthcare environment creates to perfect opportunity to take a step back and assess your ability to achieve value based results.

Through active inquiry regarding your organization’s culture, you learn and develop your ability to accomplish what is important to your organization. A community/customer/patient centered philosophy, along with the critical aspects of: Leadership/Governance; Vision/Strategy; Measurement, Analysis, and Knowledge Management (through data analytics); and Operational Work Processes and Process Management, allows you to evaluate how prepared you are to achieve VALUE BASED RESULTS.

Through internal ASSESSMENT you may find that your organization needs external resources to develop the necessary structure and infrastructure to achieve your VISION. Experienced leadership with a demonstrated track record of achieving results within physician enterprise organizations may be difficult to find. You may need Interim Leadership and Management Advisory Services with the Resilience to do the “initial heavy lifting” of positioning your enterprise for high performance.

Today we explore ways to assess your systematic approach for delivering value in your communities.

Assess Your Physician Enterprise through a Systematic Approach

You need a systematic approach to assessing your physician enterprise ability to achieve results. You need a framework to deliver value. The challenge is to critically assess to learn how you are accomplishing your vision and strategic priorities. Today we pose several key questions to begin to assess your organization’s readiness to achieve value based results.

Has your organization set a strategic priority for achieving value based results in your physician enterprise?

How has your organization set a strategic priority for achieving value based results? “Value Based Care is Here to Stay”:

Vision and Strategy-Questions to consider:

Is it important to your organization?
Have you established a shared Vision of physician integration to achieve value based results?
Is your organization prepared to create greater value in the communities you serve?
Does your organization have the leadership with the demonstrated competency of RESLIENCE to navigate the path to value?
Do you need Interim Leadership or experienced external advisors to assess and develop your physician enterprise ability to deliver value based results

Please see Assessing Your Vision and Strategies, to begin your assessment: You may also request a copy from: This email address is being protected from spambots. You need JavaScript enabled to view it.

It all begins with LEADERSHIP:

Leadership must promote a systems perspective. A systems perspective means managing all the components of your organization as a whole to achieve ongoing success. A healthcare system has many inter-related, but not always highly integrated, components. Each component must be led and managed to function as a high performing organization within the context of the entire system. Most importantly, your physician enterprise (whether an employed network or Clinically Integrated Network) must demonstrate a successful track record of achieving results.

Assess your leadership and management structure to achieve results:

“Achieve Results-Leadership and Management”

Question to Consider-Leadership:

Do senior leaders lead the organization, consistent with your systematic approach?

Please see Assessing Your Leadership/Management, to begin your assessment: You may also request a copy from: This email address is being protected from spambots. You need JavaScript enabled to view it.

Governance:

How does your governance structure oversee your physician enterprise and address your organizational ability to achieve value based results?

Assess your governance structure to achieve results: "Governance”

Governance - Questions to Consider:

How does your organization ensure responsible governance of the physician enterprise?

How does your governing achieve accountability for:

• senior leaders’ actions
• strategic plans
• fiscal accountability
• transparency in operations
• selection of governance board members and disclosure policies for them, as appropriate
• independence and effectiveness of internal and external audits
• protection of stakeholder and stockholder interests, as appropriate
• succession planning for organizational leadership

Please see Assessing Your Governance, to begin your assessment: You may also request a copy from: This email address is being protected from spambots. You need JavaScript enabled to view it.

Knowledge Management/Transfer through Data Analytics:

How do you measure, analyze, and then improve organizational performance?

Assess your Performance Measures to achieve results: "Knowledge Management/Transfer through Data Analytics”

Questions to Consider - Performance Measures:

How do you track data and information on daily operations and overall organizational performance?

How do you select, collect, align, and integrate data and information to use in tracking daily operations and overall organizational performance; and track progress on achieving strategic objectives and action plans?

Please see Assessing Your Knowledge Management/Transfer through Data Analytics, to begin your assessment: You may also request a copy from: This email address is being protected from spambots. You need JavaScript enabled to view it.

Operations Management/Process Management:

How do you design, manage and improve your key health care services and work processes?

Assess your Work Processes/Process Management Methodology to achieve results: “Process Management-Achieve Value Based Results”

Questions to Consider-Work Processes/Process Management:

How do you design, manage, and improve your key health care services and work processes?

How do you determine key health care service and work process requirements?

Please see Operations Management/Process Management, to begin your assessment: You may also request a copy from: This email address is being protected from spambots. You need JavaScript enabled to view it.

Results:

A Performance Excellence Philosophy provides the systematic methodology to achieve results. Your organization will achieve value based results with unrelenting commitment from key stakeholders at every level.

You need a simplified approach to creating a culture of Performance Excellence to achieve results:

Question to Consider-Results

What are your health care and process effectiveness results?

What are your health care results and your results for your patient and other customer service processes?

Is your entire workforce engaged in achieving value based results?

Please see Assessing Your Results, to begin your assessment:

Key Take Aways and Next Steps:

• Assess and adopt a Vision of Value Based Care in your Physician Enterprise
• Implement a Culture of Performance Excellence
• Assess your Leadership/Management
• Assess your Governance
• Assess your Knowledge Management/Transfer (Data Analytics)
• Assess your Operations/Process Management
• Assess your Results
• You may need external resources to assist in assessment and development

Studies show that an average of 50% of newly hired executives not appropriately onboarded, either quit or were fired within their first three years.

A successful onboarding program accelerates the executive’s breakeven point on the investment the organization has made in talent acquisition and retention, as well as, aligns behavioral changes with organizational outcomes and goals. Results are just as important as the process.

Wiederhold & Associates Executive Onboarding Program

Wiederhold & Associates is perfectly positioned to be your partner in ensuring that your investment in new executives continues to reap long-term rewards, rather than ending up with the above-mentioned results. The Wiederhold & Associates team with 26 years of transition expertise in healthcare, focuses on tangible results in addition to ensuring a smooth transition.

Key Program Strategies Include:

• Defining roles and responsibilities
• Clarifying strategic results and creating new ones
• Managing expectations
• Building relationships and coalitions
• Managing intellectual and emotional reactions
• Maintaining balance
• Aligning and strengthening the leadership team
• Completing in-process assessments

Specific Areas of Focus Are:

• Executive’s personality and behaviors
• Alignment of goals/outcomes
• Building stakeholder lists
• Focusing on early wins
• Navigating organizational politics
• Learning organization’s culture
• Maintaining visibility
• Time management
• Balancing relationships/results
• Enhancing executive’s knowledge of the organization’s market
• Understanding organizational history
• Assessing skills and behaviors
• Building confidence
• Developing executive’s team dynamics
• Enhancing communication
• Creating a business journal
• Establishing a brand
• Empowering the executive’s voice within the organization
• Managing change
• Maintaining balance

To learn more about Wiederhold & Associates Onboarding Program, download a tri-fold brochure here.

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“If you can’t describe what you are doing as a process, you don’t know what you are doing.” Such a profound quote by W. Edwards Deming, largely recognized as the Father of the Quality Movement. Dr. Deming's famous 14 Points, originally presented in Out of the Crisis, serve as management guidelines. The points cultivate a fertile soil in which a more efficient workplace, higher profits, and increased productivity may grow. These management principles have a direct correlation to navigating the path to achieving results in the uncertain healthcare industry of today.

Deming’s 14 Points for Leadership/Management

While traditionally applied to product manufacturing, Deming theory has direct application across multiple industries, especially when rising consumer and regulatory requirements demand greater value. View healthcare service delivery as a product in high demand from consumers (patients, families and others). Expectations of lower cost and superb quality, delivered in a highly patient-centric and service-oriented environment, create an imperative healthcare systems must meet to remain relevant.

Healthcare leaders are served well when focusing on Deming’s 14 Points:
1. Create constancy of purpose toward improvement of product and service, with the aim to become competitive, to stay in business and to provide jobs.
2. Adopt the new philosophy. We are in a new economic age. Western management must awaken to the challenge, must learn their responsibilities, and take on leadership for change.
3. Cease dependence on inspection to achieve quality. Eliminate the need for massive inspection by building quality into the product in the first place.
4. End the practice of awarding business on the basis of a price tag. Instead, minimize total cost. Move towards a single supplier for any one item, on a long-term relationship of loyalty and trust.
5. Improve constantly and forever the system of production and service, to improve quality and productivity, and thus constantly decrease costs.
6. Institute training on the job.
7. Institute leadership (see Point 12 and Ch. 8 of Out of the Crisis). The aim of supervision should be to help people and machines and gadgets do a better job. Supervision of management is in need of overhaul, as well as supervision of production workers
8. Drive out fear, so that everyone may work effectively for the company. (See Ch. 3 of Out of the Crisis).
9. Break down barriers between departments. People in research, design, sales, and production must work as a team in order to foresee problems of production and usage that may be encountered with the product or service.
10. Eliminate slogans, exhortations, and targets for the work force asking for zero defects and new levels of productivity. Such exhortations only create adversarial relationships, as the bulk of the causes of low quality and low productivity belong to the system and thus lie beyond the power of the work force.
1. Eliminate work standards (quotas) on the factory floor. Substitute with leadership.
2. Eliminate management by objective. Eliminate management by numbers and numerical goals. Instead substitute with leadership.
11. Remove barriers that rob the hourly worker of his right to pride of workmanship. The responsibility of supervisors must be changed from sheer numbers to quality.
12. Remove barriers that rob people in management and in engineering of their right to pride of workmanship. This means, inter alia, abolishment of the annual or merit rating and of management by objectives (See Ch. 3 of Out of the Crisis).
13. Institute a vigorous program of education and self-improvement.
14. Put everybody in the company to work to accomplish the transformation. The transformation is everybody's job.

The focus of this article is to bring home the reality that EVERYTHING IS A PROCESS. “If you cannot describe what you are doing as process, you do not know what you are doing.”

Physician alignment, integration and engagement in integrated delivery systems are essential elements in navigating the complexity of healthcare service delivery. Healthcare organizations need a simplified approach to realize organizational vision of comprehensive and successful alignment and integration strategies. Creating a common Vision is essential. Healthcare organizations that focus on a vision of “maximizing success in the ever-evolving healthcare industry through physician alignment and integration” will ultimately build capability to meet and exceed consumer expectations in navigating the path to value-based care. Today’s ever-evolving healthcare industry requires a comprehensive Vision of Integration. Execution of the Vision is best achieved through a Leadership Philosophy of Performance Excellence.

The first key element in fostering a culture of performance excellence is to define the “WHAT” that constitutes excellence, frequently referred to as “the Triple Aim” of healthcare:

• Operating/Financial Excellence (low cost, highly efficient and cost effective service delivery),
• Service Excellence (service delivery exceeding patient and family expectations), and
• Clinical Excellence (best clinical outcomes for every patient and patient population).

The next essential element of a performance excellence culture is to define the “HOW” the organization will be led through:

• Stakeholder Engagement
• Knowledge Management/Knowledge Transfer
• Process Management

Organizations will not only achieve the “triple aim”, but will enhance performance through achieving the “quadruple aim” of healthcare. In addition to achieving traditional value-based results, a culture of performance excellence will yield higher levels of provider satisfaction and engagement while redefining service delivery. As highlighted in previous articles:

• Value Based Care is here to stay and healthcare organizations must overcome multiple organizational gaps that may contribute to not fully realizing a vision of success in a high performing integrated delivery system. Here
• Key Stakeholder Engagement is essential to execution of a common Vision:
• Physician Stakeholders (as well as others) should be engaged in organizational Governance, especially among healthcare providers, is essential to success in a value based environment. Here.
• Physician Stakeholders should also be engaged in Leadership and Management to achieve sustainable results. Here.
• Knowledge Management/Knowledge Transfer
• A common understanding of performance is best achieved through measuring, monitoring, reporting and analysis of key outcomes: Operational, Service and Clinical Metrics (Data Analytics) Here.
• Opportunities for performance improvement are quickly identifiable when using data analytics in evaluating current outcomes.Here.

This article expands on development of a Philosophy of Performance Excellence to achieve a vision of success through Performance Management. Measuring, monitoring, reporting, analyzing and improving performance begins with defining key metrics to create a common understanding. Internal and external benchmark measures are available through a variety of sources to build an improved understanding of: Operational/Financial, Service, and Clinical Performance. Now you need a methodology to achieve your desired outcomes.

Physicians and other care providers work within a defined process everyday of their lives when addressing and resolving patient needs for care. What is done when presented with multiple patients with complex healthcare needs? SOAP is a traditional approach to addressing patient needs:

The SOAP note (an acronym for subjective, objective, assessment, and plan) is a method of documentation employed by health care providers to write out notes in a patient's chart, along with other common formats, such as the admission note. Documenting patient encounters in the medical record is an integral part of practice workflow starting with patient appointment scheduling, to writing out notes, to medical billing. The SOAP note originated from the Problem Oriented Medical Record (POMR), developed by Lawrence Weed, MD.[1] It was initially developed for physicians, who at the time, were the only health care providers allowed to write in a medical record. Today, it is widely adopted as a communication tool between inter-disciplinary healthcare providers as a way to document a patient’s progress. SOAP notes are now commonly found in electronic medical records (EMR) and are used by providers of various backgrounds. Prehospital care providers such as EMTs may use the same format to communicate patient information to emergency department clinicians. Physicians, physician assistants, nurse practitioners, pharmacists, podiatrists, chiropractors, acupuncturists, occupational therapists, physical therapists, school psychologists, speech-language pathologists, certified athletic trainers (ATC), sports therapists, occupational therapists, among other providers use this format for the patient's initial visit and to monitor progress during follow-up care.

It is a well-defined thought process. Complete a SUBJECTIVE EVALUATION, an OBJECTIVE EVALUATION, an ASSESSMENT and a PLAN. Engage patients and family members when seeking to understand what is happening with a patient (Subjective). Gather facts/data regarding what is happening with a patient through diagnostic procedures (Objective). Review the information gathered and knowledge gained from the evaluations (Assessment) and take action to address what has been presented (Plan). Why not apply a similar process that is highly effective to leadership and management. That is a process management/performance management approach.

Performance Management

The days of simply making claims of high-quality, service-oriented and low cost care delivery are gone. Patients, families, communities, payers, regulatory agencies and other key stakeholders demand proof of performance. Measures of performance should focus on Operations/Financial, Service and Clinical Excellence. Internal and external benchmarking of performance is imperative. Once you understand current performance through data analytics, you need tools to achieve continuous improvement.

There are many theories of performance/process management. Theories and practices have evolved over time. Many are inter-related and draw on common practices. Process Management philosophies include, but are not limited to:

• Total Quality Management (TQM):
• Focus on the Consumer
• Continuous Improvement
• Quality Improvement
• Accurate Evaluation

• Continuous Quality Improvement (CQI):
• Analyse
• Refine
• Improve

• Plan Do Study Act (PDSA): Model for Improvement: What are we trying to accomplish? How will we know that a change in an improvement? What change can we make that will result in improvement?
• Plan: Objective, Questions and Predictions, Plan to carry out the cycle (who, what, where, when)
• Do: Carry out the plan. Document problems and unexpected observations. Begin data analysis.
• Study: Complete the data analytics. Compare data to predictions. Summarize what you have learned.
• Act: What changes are to be made? Begin the next cycle.

• Lean Management:
• Leadership Commitment to Project (s)
• Project Charter (Standardized for ease of understanding).
• Project Tracking (verify milestones)
• Assign Project Manager
• Engage Key Stakeholders
• Communicate Frequently
• Achieve Results

• Lean:
• Waste Reduction
• Continuous Improvement
• Respect for People

• Six Sigma-DMAIC:
• Define: Define project purpose and scope. Identify high level processes for improvement. Determine customer needs and benefits.
• Measure: Baseline data on current processes. Pinpoint problem locations and occurrences. Identify potential areas for improvement.
• Analyse: Identify root causes and validate root causes against captured data. Determine improvements that need to be made.
• Improve: Implement the improvements that have been determined to address the root causes.
• Control: Perform before and after analysis. Monitor processes/systems. Document results. Determine next steps/recommendations.

• Lean/Six Sigma:
• Lean: focuses on waste reduction by streamlining process
• Six Sigma: focuses on preventing defects through problem solving
• Lean/Six Sigma: Lean strengthens Six Sigma-Problem solving plus improving process delivers greater value-based results

The common thread in all methodologies is an unrelenting focus on seeking improved outcomes in everything we do:

• Cycles of improvement
• Engaging in a customer focus
• Understanding key stakeholder perspective
• Measuring current performance through data analytics
• Engaging those closest to the work:
• to define current processes (value stream mapping, flowcharting)
• to define desired outcomes of current processes
• to define undesirable outcomes (failures) of current process
• identify and define best practices
• identify and define outcomes
• identify and define preferred processes to achieve best practice performance and outcomes
• transfer best practices, best practice outcomes and preferred processes to:
• gain consistency across all players
• reduce variation in outcomes and results across all players
• meet and exceed customer expectations at all times
• reduce cost of service delivery
• increase throughput in service delivery
• provide consistent, high-quality outcomes

Performance Management Simplified

High performing leaders in healthcare organizations of today are challenged with the uncertainty of healthcare delivery in the future. Creating a performance excellence environment is the best to navigate the ever-evolving imperatives of service delivery. Value based results will be achieved through a leadership philosophy of performance excellence:

Engage your People

Evaluate your data; identify best practice

Know your process and design your process

Hardwire/Standardize best practice, process design to ACHIEVE

Key Take Aways:

• You have highly engaged employees, physicians, patients, family members, community representatives and payers.
• You have defined a common and shared vision for your organization through gaining knowledge of your key stakeholders’ perspectives
• You have defined what outcomes you and your organization are trying to achieve in terms of Operations, Finance, Service and Clinical indicators
• You have measured your current performance
• Now you want to improve performance:
• Everything is a process
• Gain an understanding of your current processes
• Identify your best practices
• Design process to achieve best practice performance
• Re-evaluate your performance to see if you are consistently achieving improved performance
• Modify your processes when necessary to consistently achieve higher levels of performance
• Hard-wire your processes to ALWAYS achieve best practice performance
• Never stop monitoring to verify your preferred state performance/outcomes.
• Pick a methodology for process management (they all work)
• Train for it
• Build consistency of approach

Next Steps:

• Define your performance excellence culture
• Relentless leadership focus on performance excellence
• Adopt your preferred methodology
• Formalize and standardize your methodology
• Listen to your key stakeholders
• Engage all parties in understanding improvement initiatives
• Gain understanding of performance through data analytics
• Design processes to achieve desired results
• Achieve success in all you do
• Demonstrate that you are creating value based outcomes

The Problem – Across the nation, health systems are reporting a sustained decline in Emergency Department utilization, resulting in decreased admission rates and reduced patient days. Regardless of the cause (Healthcare Reform, economic challenges, rising unemployment, etc.), the impact is clear – an average 3-5% drop in census and a significant loss of revenue.

The Emergency Department Imperative – On average, 12-15% of Emergency Department visits result in patients being admitted, which accounts for approximately 40-50% of a facility’s total admissions, and a contribution margin between $1k - $15k per admit. The direct connection between Emergency Department utilization, subsequent admissions and the resulting revenue indicates that the success of any facility in this changing healthcare landscape depends on increasing the number of times that new patients pass through the Emergency Department doors. Health systems operating Trauma Centers will have contribution margins exceeding the national average.

The Million Dollar Question – Understanding the concept of countering a declining census by increasing Emergency Department utilization is easy, but successfully operationalizing that strategy may not be. Simply put, how does one hospital or health system get more patients into their Emergency Departments than another? Although there are many potential answers to that question, experience shows that the most effective solution is for a facility or health system to develop a highly functional Regional Referral Program.

The Regional Referral Solution – Health systems should be able to successfully capitalize on its current Trauma status and market itself as regional destination, which will significantly increase patient admissions. A key to success will be aligning referring facilities, physicians, and transport providers through an efficient Transfer Center operation. Your organization will be able to benefit from those opportunities. Additionally, current successes show that facilities and health systems that have implemented Regional Referral Programs have grown their influence significantly garnering patient care and admission opportunities from facilities far outside of traditional referral patterns. This has proven beneficial because the payor mix of patients being referred from out-of-area tend to be equal to or better than the receiving facility’s current Emergency Department mix, resulting in a 15 to 1 return on investment.

Regional Referral Program Priorities – Numerous successful hospitals and health systems have developed very effective Regional Referral Programs by prioritizing the following:

Identification and Development of Key Service Lines – Determining which specialties (Trauma, Cardiology, Neurology, Pediatrics, etc.) the facility wishes to specifically solicit patients for. The goal is to develop a solid reputation as the “go to” receiving facility for the targeted service lines.

Aligning Physician Partners – The success of any Regional Referral Program depends on the participation and support of the facility’s physician partners, whether by promoting the program with regular visits to the region’s referring facilities, or by being consistently available and accepting patients. To achieve this, successful Regional Referral Programs have implemented effective Hospitalist Programs to receive the patients and specialist compensation programs that reward participation.

Transfer Center Utilization and Marketing – Effective Regional Referral Programs require three primary components; necessary specialties, physician participation, and a simple, consistent way for facilities to refer their patients. Structured Transfer Centers tie the entire referral program together with “one call does it all” ease, coordinating patient transfers from the initial request through completion of the transport. Mature Transfer Centers will also provide extensive operational reporting and key patient flow analytics for hospital administration. Focused marketing strategies can also convert the Transfer Center from a passive patient flow processing service into an aggressive volume builder for the facility or health system. Proven techniques can be employed to grow desired business through sound relationships with the referring parties.

Note: There are generally two methods of implementing a Transfer Center service; a facility can develop the service in-house or they can seek out a professional third-party Transfer Center service provider. An internal Transfer Center allows the facility or health system to maintain strict control of the staffing, customer interactions and processes, but a professional external Transfer Center will generally provide outstanding service delivery at a fraction of the cost.

Regional Referral programs are showing exceptional returns in the form of increased Contribution Margins per referral. The chart below – based on actual Regional Referral Programs – highlights the benefits:

Transfer Center Costs – Studies of current successful internal Transfer Center services show that the average cost per transfer request is approximately $230 for new centers and $190 for established centers (assuming a daily request volume of ~12). For facilities or health systems that prefer to forego the expense and coordination of operating their own Transfer Centers in favor of utilizing the expertise of a professional external service, the cost is obviously significantly lower – with no associated reduction in the contribution margin per transferred patient.

Conclusion – For hospitals or health systems seeking to counter the downward trend in Emergency Department utilization and subsequent census declines, it is essential that they develop a Regional Referral Program. By establishing themselves as “centers of excellence” in key service lines, partnering with their physician specialists, and easily facilitating patient flow through efficient Transfer Centers, facilities can continue to thrive even in today’s constantly shifting healthcare environment.

Solution - We can provide a comprehensive assessment of the opportunity for your organization to expand your market as a Regional Referral Center with a state of the art Transfer Center.

✔ Current situation
✔ Market potential for referrals
✔ Business plan for the recommended approach with a Return on Investment analysis
✔ Sensitive issues
✔ Hospital capacity readiness
✔ Medical Staff readiness
✔ Hospitalist Program effectiveness
✔ Case management strategies
✔ Nursing coordination
✔ Administrative and Medical Leadership buy-in

Please let us know if you would like to explore the assessment of the potential for your health system. We look forward to possibly assisting you with this important project.

Thank you,

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