Engaging Physicians: Insights and Actions for Results

1. Engaging Physicians: Insights and Actions for Results Steven M. Berkowitz, MD SMB Health Consulting, Austin, TX 512-415-6095 steve@smbhealthconsulting.com

2. 2012 Clients- Two Lessons Learned

3. Engaging Physicians: Insights and Actions for Results • Clinical Integration • Embracing data transparency • Implementing best practices • Excel at Pay for Performance • Financial Integration • Enterprise-wide cost reduction • Hospital Physician Partnership • An aligned, long term collaborative relationship

4. What’s New with Health Care Reform?Same Old Wine in a Brand New Bottle ?

5. What’s New with Health Care Reform?

6. You can always count on Americans to do the right thing… …after they’ve exhausted all the other possibilities !!” Winston Churchill

7. People do not change until the pain of staying the same… … exceeds the pain of changing. Anonymous

8. The Health Care Team Medicine is a Team effort…. …..Why do we insist on playing Solo!

9. The Health Care Team Medicine is a Team effort…. …..Why do we insist on playing Silo!

10. So, What’s This Going to Look Like?Form Follows Function Hospitals Physicians Inputs Results Efficiencies

11. So, What’s This Going to Look Like?Form Follows Function Inputs Results Hospitals Physicians Decreased payment: VALUEvs volume Some risk Increased demand: Greater volume Aging, chronic Transparency of VALUE: Clinical Outcomes Patient Satisfaction Cost Effectiveness Efficiencies: Clinical/ Operational Financial Infrastructure/ Governance

12. Winning the Game What is the best model for your organization? Any hand’s a winner…. Any hand’s a loser !!

13. What Does the Model Look Like?Form Follows Function ALL MARKETS ARE UNIQUE !! • What are the needs of the community that you serve? • Quality, accessible, cost-effective care • What are the needs of the physicians? • Quality medical care • Practice/ economic stability • What are the needs of the hospitals? • Quality, accessible, cost-effective care • Partnership relationship with the medical staff

14. Fundamental Requirements to be a WinnerIntegrating the Components of Health Care Delivery Clinical Integration Financial Integration Hospital Physician Partnership

15. Fundamental Requirements to be a WinnerIntegrating the Components of Health Care Delivery X- ABC Hospital X Clinical Integration Financial Integration X X Hospital Physician Partnership

16. Fundamental Requirements to be a WinnerIntegrating the Components of Health Care Delivery Clinical Integration Financial Integration Hospital Physician Partnership

17. Clinical Integration The Continuum Clinical Integration Population Management Common Quality Goals Common IT Platform Best Practice Implementation Clinical Integration

18. Engaging Physicians: Insights and Actions for Results • Clinical Integration • Embracing data transparency • Implementing best practices • Excel at Pay for Performance • Financial Integration • Hospital-wide cost reduction • Hospital Physician Partnership • An aligned, long term collaborative relationship Clinical Integration

19. Three Imperatives for Effective Clinical Integration Clinical Integration 1. Embracing Data Transparency • Implementing Evidence-based Practices • Excel at Pay for Performance

20. Value-Based Purchasing The increasingly informed consumer will make health care decisions on the basis of VALUE VALUE = Outcomes + Satisfaction Cost The CONSUMER ultimately determines which of the above elements constitute VALUE

21. The Role of TransparencyFundamental Types of Data Transparency Price Transparency Quality Transparency

22. The Role of TransparencyFundamental Types of Data Transparency Price Transparency Quality Transparency

23. Read all about it !! April 2005 Data Transparency

24. This is Your Life !! Data Transparency in Action Data Transparency

25. Data Transparency That which is measured, tends to improve. That which is measured publicly, tends to improvefaster. “What we concluded was that even when hospitals know their performance is not good, that's not sufficient motivation for them to do something. Making it public made a big difference in motivating them to improve.” Judith Hibbard, Health Affairs 2003 Data Transparency

26. If the other guy’s getting better, then you’d better be getting better faster than that other guy’s getting better… • …Or you’re getting worse. • Tom Peters

27. Exposure to and Use of Quality InformationPercent Who Saw and Acted Upon the Information Choice of Hospitals Kaiser Family Foundation, October 2008

28. Data Transparency and Accountability Transparency is the best thing that’s happened to quality since antibiotics.. by decreasing variance and improving results. As transparency matures, it will rewrite the book on: Who is your competitor? Data Transparency

29. Strategic PlanningWho is Your Competitor… and the Role of Transparency? Stage IV ?? The whole world ?? Increasing Transparency Stage III The entire nation ? Stage II All hospitals in region Stage I “The other guy”

30. Playing the Game What is the best model for your organization? Any hand’s a winner…. Any hand’s a loser !! Define and Excel in your Core Business !!

31. Two Fundamental Types of Data Transparency Price Transparency Quality Transparency

32. Engaging Physicians: Insights and Actions for Results Do your hospital and physicians… … embrace data transparency ?

33. Three Imperatives for Effective Clinical Integration Clinical Integration 1. Embracing Data Transparency 2. Implementing Evidence-based Practices • Excel at Pay for Performance

34. Implementing Evidence-Based Medicine What Can we Learn from the Airline Industry ?

35. What Can we Learn from the Airline Industry?Teamwork: GuidelinesandChecklists

36. Our Greatest Challenge in Clinical Medicine Eliminate the “DEADLY” Delay !!

37. The Deadly Delay…From Clinical Trials to Clinical Practice…

38. Where Do We Find the Best Practices ?Examine Your Own Specialty Literature Implement the Guidelines Recommended by your OWN Specialty Society

39. What Can we Learn from the Airline Industry ? Elimination of Ambiguity “the eliminationofambiguityis consistently cited as a key factor in protocol success and safety” Degani and Weiner 1993 Most medical guidelines are based upon ambiguity as a guiding principle of protocol development

40. Example:Oxytocin Treatment GuidelinesACOG 2006 Compendium “Any of the low or high dose regimens outlined in table 2 are appropriate” (0.5 – 6 mU/min every 15-40 min) “Each hospital’s OB/Gyn department should develop guidelines for preparation and administration of oxytocin” “The uterine contractions and fetal heart rate should be monitored closely” Evidence-Based Medicine

41. Example:Postdates GuidelinesACOG 2006 Compendium “ Women with post-term gestations who have unfavorable cervices can either undergo labor induction or be managed expectantly” “Delivery should be effected if there is evidence of fetal compromise….” Evidence-Based Medicine

42. How to Land a 747 in a Strong Cross Wind**(Had It Been Written by ACOG) • Use any settings of the plane’s instruments you feel like • Every airline and pilot can do it differently • Be really careful as you get close to the ground Steve Clark, MD

43. Do Guidelines Help or Hurt? “Yeah, but Pilots do not have to worry about Malpractice Suits” Obstetrician, Texas

44. Guidelines for Guidelines There will be MORE guidelines in clinical medicine Guidelines were NEVERintended to apply to all patients and do NOT take the place of individual physician judgment Expect physicians to occasionally deviate from guidelines in the daily practice of prudent medical care When so… … DOCUMENTIn the medical recordthat: The patient was seen and evaluated The options were thoughtfully considered The best clinical judgment was used Discussed with the patient

45. Adverse Outcomes Adverse Outcomes protocols Do Guidelines Help or Hurt? We keep missing the point….. Simply put… Evidence-based Guidelines reduce adverse outcomes! Evidence-based Guidelines improve patient care ! Evidence-Based Medicine

46. Engaging Physicians: Insights and Actions for Results Do your hospital and physicians… …implement best practices ?

47. Three Imperatives for Effective Clinical Integration Clinical Integration 1. Embracing Data Transparency 2. Implementing Evidence-based Practices • Excel at Pay for Performance

48. Pay for Performance Pay for Performance Hospitals Physicians

49. Pay for Performance What Pay for Performance is NOT: • A increase in revenue • A break-even with revenue What Pay for Performance IS: • A way to partially recoup some of the REDUCTIONS we will see in revenue

50. Pay for Performance What Pay for Performance is NOT: • A increase in revenue • A break-even with revenue What Pay for Performance IS: • A way to partially recoup some of the REDUCTIONS we will see in revenue 5 – 10 % of Total Medicare… Or more !!