By John Couvillon, President and CEO, Pinnacle Health Group
Today’s successful physicians possess a skill that their predecessors did not require: the ability to factor economic considerations into their clinical decisions. Finding doctors with this expertise is challenging because it is not part of their traditional training. Managed care is still in a transitional mode across the nation and the overwhelming majority of physicians entered practice during an era when insurance coverage made cost less significant.
As a result, savvy doctors are making behavioral changes to perform optimally in the group practices, hospitals, physician practice management companies (PPMCs), clinics, and health maintenance organizations (HMOs) that recruit physicians today. These organizations seek physicians who will operate as their partners in managed care. While there is no single answer, multiple methods exist to ensure success before and after an offer is extended.
Recruiting the Right Physician
As the first point of contact, physicians should obtain information about the client’s current and potential environment. In-depth discussions with candidates help determine whether the physician’s predisposition, experience and practice methods are a good match for the client’s managed care situation.
Once the physician is introduced to the client, the screening process varies depending on the amount of managed care penetration in the market. Hiring sources in areas with heavy managed care penetration tend to be the toughest. As an example, one PPMC in Baltimore, an area with about 65% managed care penetration, will not consider physicians who have a negative attitude about managed care. Capitated contracts account for more than 35% of the organization’s business, and attention to economic issues is crucial to success.
Others, usually in less developed markets, don’t place as much emphasis on managed care savvy during this stage of the process. The primary objective is often to attract qualified physicians. Don’t get the impression that managed care finesse is completely disregarded, though. Because of future trends, most regard managed care experience as helpful.
In one rural setting with a 110-physician, multi-specialty group managed by physician practice management company PhyCor, capitation is less than 3% of the current payor mix, but discounted fee-for-service has increased from 15-30% during recent years. The clinic is preparing for the future. Every physician brought on site for interviews sees and takes home information that specifies the current payor mix and managed care penetration — not only in the immediate area — but also 60 miles south in Atlanta, where healthcare dynamics are much different.
Other screening techniques depend on the position a recruiting source seeks to fill. Primary care physicians have a greater need to understand the overall economics of the managed care situation and the impact of their actions. For example, in a 65-physician, independent, hospital-affiliated, multi-specialty group, located 1/2 hour from Philadelphia, more than 50% of the practice’s primary care business comes from two large HMOs. Inappropriate referrals and costly tests subtract from the per-member/per-month income. Clinical decisions have a direct impact on the financial health of the practice.
On the other hand, when the same organization recruits a specialist, the primary considerations are clinical competence and the ability to interact well with patients. For specialists, managed care adeptness is not the principle criterion, but it helps.
While assessing physicians’ approaches to managed care is a subjective process, candidates rarely hide deep-rooted conflicts. Those recruiting should ask questions that inquire about feelings and experience, while paying particular attention to responses about adjustments the doctor is willing to make to operate successfully in a managed care environment. Answers focusing on maintaining clinical integrity are positive; those few who insist they will never make changes might not be the best candidates.
The Art of Influencing Behavioral Changes After the Deal is Signed
What happens after the physician comes on board may be even more important than identifying a doctor with the right attitude. Education and communication are the most essential components of a plan to influence physicians to operate as managed care partners. Our clients have developed numerous ways to make this happen. Again, the intensity varies by market, but even in rural areas, the organizations that are best positioned for success take initiative to educate their medical practitioners.
The previously mentioned PhyCor clinic offers a sophisticated program to educate physicians to become optimal practitioners in a managed care world. The PhyCor Institute offers a series of four training seminars for physicians. While the programs are optional, participants appreciate seeing thousands of physicians from 56 clinics across the nation who are part of their organization. They develop a sense of power and strength, and discuss strategy and how they can make a positive impact on providing medical care in a changing environment. In addition, PhyCor is developing an online forum through the Internet to enhance communication. The goal is to have a computer on the desk of every physician in the network.
While most organizations do not have the number of physicians and or finances to create similar programs, the more aggressive entities share a common strategy: individual monthly meetings with physicians to provide feedback and discuss performance. Among the topics discussed:
- Report cards from managed care organizations
- Coding practices
- Expenses
- DRGs
- Time Management
- Cost of care
- Utilization of specialty and hospital services
- Patient satisfaction studies
- Charting and documentation
- Number of patient encounters and number of new patients
- Charges generated and average charge per visit
These discussions sessions are a powerful motivational tool for physicians. Individual meetings accomplish another important objective: developing a personal relationship and building trust. At one clinic, a member of the senior management team personally conducts these sessions during the first three months, hand-walking them through each line of a comprehensive financial statement until a level of comfort is attained. Other executives make a point to schedule individual meetings with physicians not only to educate the doctors, but also to help establish their own credibility.
Some organizations take personal involvement one step further by inviting physicians to participate on boards and committees. Those who do gain an in-depth understanding of the demands created by managed care organizations. They often become emissaries, sharing information with their colleagues. Physicians, our clients tell us, are more responsive to information delivered by their peers.
While institutes, individual meetings, and physician involvement seem to have the biggest impact in developing partnerships, simple communication goes a long way as well. Nearly all of our clients conduct orientation sessions for new physicians that usually address managed care issues. Some also offer workshops and special meetings that address specific topics, but those who offer continuing medical education credits are most successful in their efforts.
Newsletters and memos are more traditional methods used to share information. They provide value because every recipient receives the same information and documents can be referenced weeks and months after distribution.
As your organization strives to develop physicians as managed care partners, remember that influencing behavior is not an overnight process. The ability to factor economic considerations into clinical decisions is a skill today’s physician needs. The best way to accomplish your objective is to provide education, data, and feedback to help physicians understand how you both benefit from a mutual partnership.