Population Health Era Medical Staff Development Planning ... · Mailing List Data State License Databases Vitals, Health-grades, Yelp AMA Masterfile. ... Hospital’s Aligned Physicians

Population Health EraMedical Staff Development Planning

March 19, 2014

Overall Purpose

What is Medical Staff Development Planning (“MSDP”)?

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Why is MSDP Both Necessary & Advised?

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Why is MSDP Both Necessary & Advised?

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Health ReformHealth Reform

Evolution of Medical Staff Development Planning

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1980-90’s Late 1990’s 2004 2010 2014

IRS & “Community Need”

Rudimentary Medical Staff Development Plans

Compliance-Focused Using Dated Ratios

Oversupply Concerns (GMENAC)

Advent of ManagedCare

Stark Law Geography

Plans Still Compliance Oriented

Increasing Competition & Industry Complexity Requiring Better Solutions and Data

Affordable Care Act

Ongoing Competition, Complexity

More Sub-Specialization;Extenders;Patient Access; Changing Physician Workforce

Population Health; Clinical Integration;New Delivery Models;Value-Based;Industry Consolidation

Robust, Strategic Medical Staff Development Plans Required

What Are a Plan’s Key Components?

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• One-on-One Interviews• Physician Survey• Patient Access Study

Local Market Reality

• Physician Supply Database• Community & Hospital Supply/Demand• Served Lives Analysis

Quantitative Results

• Synthesize All Inputs• 3-Year Recruitment Strategy• Population Health Scenarios

Recruitment Strategy

Final Medical Staff Development Plan

Steering C

omm

ittee Guidance

Who Should Be Involved in the Planning?

Steering Committee

• President / CEO

• Chief Medical Officer

• Medical Staff Leaders

• Informal Physician Leaders

• Strategy / Development

• Physician Recruitment

• Board Member

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How Should You Gain Medical Staff Perspective?

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Why is Senior Management Input Important?

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How Does Patient Access Impact the Plan?

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How Does Patient Access Impact the Plan?

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Quantitative Inputs

What Should the Demand Data Include?Why Are Publicly Available Physician-to-Population Ratios Less Valuable?

GMENAC and other publicly available ratios:• Developed decades ago

• Do not adjust for age or gender make-up

• Do not account for changing utilization

• Do not account for changing practice patterns

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Robust, all-payer actuarial use rate data

Specific to populationage and gender

Broad list of adult & pediatric sub-specialties

Utilization adjustments for well-managed population

Is There an Easy Way to Assemble Physician Supply?

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Is There an Easy Way to Assemble Physician Supply?

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Physician Practice Websites

Hospital Provider Rosters

Mailing List Data

State License

Databases

Vitals, Health-grades,

Yelp

AMA Masterfile

Is Primary Research Necessary?

• Multiple Office Locations

• Multiple Specialties

• Productivity Adjustments

• Source Counts

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Dat

abas

e Ac

cura

cy

Number of Phone Calls

Strategic Analysis

What is the Purpose of a Strategic Analysis

• Identify market opportunities for services

• Customize the analysis for the institution: what are our needs?

• Integrate local market reality with the quantitative modeling

• Develop a recruitment strategy positioned for success

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Hospital Strategic Need Calculation

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Total Market Demand

Step 1:Define Strategic Service AreaUnderstand Related Age & Gender Demographics

Hospital’s Portion of Demand

Primary Service Area

Secondary Service Area

Tertiary Service Area

Calculate Total Demand in the Market

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Total FTE Demand

40

40

40

120 FTEs


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Total Market Demand



Step 2:Determine Institutional Served LivesCurrent & Projected

Calculate the Hospital’s Portion of the Market

• Population-based “Portion of the Market”

• Served Lives = number of residents served by the hospital

• Estimate using inpatient, outpatient, & physician market share

• Apply a set of growth targets to model future market capture

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Primary Service Area

Secondary Service Area

Tertiary Service Area

Calculate the Hospital’s Portion of the Market

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Total FTE Demand

40

40

40

120 FTEs

30

10

4

Hospital Portion: 30 + 10 + 4 = 44 FTEs

The Portion of the Market Varies by Specialty and Geography

Primary Care Example• The hospital’s portion of the

market is heavily weighted towards the population near the hospital campus

Sub-Specialist Example• Tertiary providers draw from

a wider geography and serve a larger portion of distant population centers

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PSA

SSA

TSA

PSA

SSA

TSA


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Total Market Demand




Total Market Supply

Step 3:Assemble Service Area Physician Supply Data

Hospital’s Aligned Physicians


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Total Market Demand




Total Market Supply



Step 4:Identify Aligned ProvidersQuantify Institutional Commitment

Calculate Physician Commitment Levels

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1.0 1.0 1.0

100%Commitment

70%Commitment

0%Commitment

1.0

3.0 FTE Physicians in

the Market

1.7 FTE Physicians at the Hospital0.7


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Total Market Demand




Total Market Supply



Step 4:Identify Aligned ProvidersQuantify Institutional Commitment

Step 5:Calculate Surplus or Deficit for the Market and Institution

Project the Strategic Surplus/(Deficit)

Specialty Supply Demand Surplus/ (Deficit)

Family Medicine 88.1 104.7 (16.6)

Internal Medicine 31.1 62.5 (31.4)

Obstetrics & Gynecology 27.2 24.1 3.1

Pediatrics 23.0 36.6 (13.6)

Urgent Care 4.7 6.8 (2.1)

Total Primary Care 174.1 234.7 (60.6)

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Projected Surplus/(Deficit)Includes Impact of:

Total Service Area Hospital PortionProjected Retirements +Demographics & Aging

Projected Retirements +Demographics & Aging+

Targeted Strategic Growth

Supply Demand Surplus/ (Deficit)

22.1 34.3 (12.2)

14.0 20.5 (6.5)

11.0 11.9 (0.9)

10.3 11.3 (1.0)

1.9 2.3 (0.4)

59.3 80.3 (21.0)

Segment Projected Physician Needs by Driver

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Current Gaps

Population Growth & Aging

Succession Planning

New Served Lives

Maintain Current Market Share

Capture Incremental Market Share

• Changing needs of aging patients

• Demand from new residents

• Address potential retirements

• Serve a larger portion of the population by specialty & geography

• Fill gaps in existing services

Strategic Priority

Other Services

No Priority

Define the Hospital’s Service Line PrioritiesService Lines/Specialties

Allergy & ImmunologyBariatric SurgeryBreast SurgeryCardiac SurgeryCardiology - EPCardiology - InterventionalCardiology - MedicalColon & Rectal SurgeryDermatologyEndocrinologyFamily MedicineGastroenterologyGeneral SurgeryGynecology OncologyHematology/OncologyInfectious DiseaseInternal MedicineMaternal Fetal MedicineNephrologyNeurologyNeurosurgeryNeurosurgery - SpineObstetrics & Gynecology

SOncology SurgeryOphthalmologyOrthopedic SurgeryOrthopedic Surgery - HandOrthopedic Surgery - SpineOtolaryngologyPain ManagementPediatricsPhysical Med./RehabPlastic SurgeryPodiatryPsychiatryPulmonaryRepro. EndocrinologyRheumatologySleep MedicineSports MedicineThoracic SurgeryTransplant SurgeryUrgent CareUrologyVascular Surgery

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Develop Customized Recruitment Targets

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Hospital Strategy

SuccessionPlanning

Quantitative Results

Quantify Recruitment Targets by Driver of Need

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Fill Current Gaps 11

Demographic Changes 2

Succession Planning 11

Market Share Targets 8

Total New Physicians 32

Summary Recruitment

Targets:

Create the Recruitment Strategy

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Recruitment Approach• Increase alignment• Employ existing area physicians• New recruitment• Physician vs. extenders

Recruitment Vehicle• Employed network• Independent practices• Start-up practice

Budget and Cost• Recruitment expense• Independent practice support• Employed group economics

Financial Impact• Overall financial impact on the

institution given the recruitment strategy


Planned Three-Year Recruitment Activity

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Total Three-Year Target:

32 Physicians

Employment:18 Physicians

Financially Assisted

Independent Recruitment:5 Physicians

Other Independent Recruitment:3 Physicians Non-Hospital

Recruitment:4 Physicians

Other Approaches:2 Physicians

Impact of Population Health

Population Health Scenarios

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Medicaid Expansion

122,492

95,503

92,305

79,005

72,358

70,383

59,912

Orthopedic Surgery

Cardiology

Neurology

Primary Care

Pulmonary

Plastic Surgery

Gastroenterology

Identify Gaps to Service Existing Lives

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Number of Served Lives

Serving Populations with an Integrated Group

How Many PCPs Needed to Support One Specialist?

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Specialty PCPsMedical Sub-SpecialtiesCardiology - Medical 16Gastroenterology 13Hematology/Oncology 20Infectious Disease 57Pulmonary 21

Surgical Sub-SpecialtiesColon & Rectal Surgery 104General Surgery 15Neurosurgery 167Orthopedic Surgery 9Urology 20

What does “Well-Managed” Look Like?• Active use of treatment guidelines

• Physician education on ways to provide care more efficiently

• Financial incentives that reward providers for efficient utilization

• On-site utilization management of inpatient services

• The use of a primary care manager

• Integration of physician extenders

• Programs that teach populations when to seek medical assistance

• Disease management programs targeting at-risk populations

• Use of information systems that support utilization monitoring

• Active use of case managers for acute and chronically ill patients

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What is the Potential Impact on Physician Demand?

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SpecialtyUtilization % Change

from Traditional toWell-Managed

Primary Care (13%) decreaseObstetrics and Pediatrics 17% increaseCardiology (18%) decreaseInfectious Disease (11%) decreaseRheumatology (26%) decreasePsychiatry (4%) decreaseCardiac Surgery (8%) decreaseOphthalmology (18%) decreaseSpine Surgery (22%) decrease

Tools & Analyses

Medical Staff Development Planning Checklist

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One-on-One Interview Findings

Physician Survey Results

Patient Access Study

Physician Supply Database

Strategic Surplus/Deficit Analyses

Served Lives Analysis

Recruitment Targets


Population Health Scenarios

Compliance Analysis

Executive Summary Version

Scenario Planning Tools

Contact Information

Jon GeisePrincipal3d Health, [email protected]

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Documents

Population Health Era Medical Staff Development Planning ... · Mailing List Data State License Databases Vitals, Health-grades, Yelp AMA Masterfile. ... Hospital’s Aligned Physicians