Transparency The Road to Change and Sustained Accountability Sharp

1 © 2008 Studer Groupwww.studergroup.com

Transparency: The Road to Change and Sustained Accountability

Stephen Beeson, MD Sharp HealthCare: Sharp Rees-Stealy Medical

Elena CresapChief Operating Officer

Sharp HealthCare: Sharp Mission Park Medical Group

Julie KennedyStuder Group

What’s Right in Health CareSM | Evidence to Outcomes

Presentation Objectives

• Learn how to coach physician leaders in skills needed to foster accountability

• Learn how to use data to create urgency and change for individual physicians

• Hear how leadership developed ownership for leading results through examination of data and creation of data reporting tool



The Missing Piece

• What is the missing piece in your ability to get results?


Transparency

• We had the data• We had the tools• We had the tactics

• We did not have URGENCY to change…



Leadership Engagement

• Our leader was engaged and helped to build or create the urgency……


Transparency Gets Resultswith CEO Donna Mills, Sharp Rees-Stealy Medical Centers, San Diego CA

In the last five years, Sharp Rees-Stealy Medical Group, a large multi-specialty group practice, has driven patient satisfaction from the 25th to 72nd percentile through a transition to a performance culture of full transparency with physicians. As a result, the medical practice was the number one ranked medical group in California at the end of 2007 in quality and service by the Blue Cross Quality Report Card. Sharp Rees-Stealy is also a 2006 Studer Group Fire Starter award winner.



Measurement Transparency

• The optimal application of physician measurement must include:– Valid data– Comparative data– Transparent data

• The application of measurement drives and aligns physicians to achieve measured goals


Conditions for Measurement Effectiveness

• Goals must be based on evidence

• Physicians must be given support to improve performance

• Individual physician goals must align with system goals



To Improve Physician Support

• Physicians have voice in goal selection

• Communication of goals to physicians is done by respected physician leadership in partnership with leadership team

• Measure what you want to achieve


Reporting Performance

• Reporting of performance to physicians should be:– Timely– Accessible– Simple– Visible



Transforming a Culture

• Leadership transparency and commitment to basics

• Culture of Transparency• What do patients want?

– Positively memorably service and quality experience

– Caring and informative staff and practitioners

We had a great leadership team…




Hit The Wall


The First Steps- Get Physicians on Board

• I met with the Medical Director

• “Lets be transparent about everyone’s patient satisfaction data!”



It Was a Process and a Journey

Steps toward our goal:• We needed data to prioritize. We reviewed data

and saw parallels to high patient satisfaction, high productivity and engagement.

– MD seeing own data (this did not create change)

– All MDs at a site seeing each others data– All MDs in medical group seeing each others

data– Data is posted on intranet


Physician Data Report

• Data across clinics and by individual MDs

• Report to be practical and useful

• Physician Leader buy-in was necessary at this level!



First Physician Data Report


Nudging Medical Group Leadership Along

• Medical Director worked with physician leaders to develop consensus on data

• Established target for “percent fill” or access • Established an RVU target (AMGA Median),

adjusted for FTE• Established patient satisfaction mean threshold

for compensation component at 85%• Parallel implementation of new compensation

created synergy and new metrics



Physician Data Report


Why Were We Successful?

• Collaborative partnership with physician leader

• Included data that was important to the individual MD in practice

• Sharing of data and interpretation of data and how it related to loyalty growth, finance and physician and staff satisfaction



Each Physician Leader Must Decide

• What to incentivize• What metrics to monitor• Each group may be different• Keep in mind factors which influence

payer mix• It continues to be an evolving report


FinanceQuality

Clinical Outcomes

Achieve system goals

P4P

Complaint management

Service

Patient Satisfaction

Increase RVUs

Increase Panel Size

Decrease Transfers

out

Market Share / Loyalty

Membership

Retention

Positive Word of Mouth

Employee & Physician

SatisfactionIncrease

Retention Improve

RecruitmentImprove

work/life balance

Revenue Targets

RVUs

Decrease transfers out

Increase reimbursement

Connect Results Across Pillars

People Growth Community

Excellent Community

CitizenOutreach

Programs

Community Service

Hours by Staff



Diabetes ManagementReduce the percentage of patients with HbA1c measurement under poor control by 5%. Goal: 9.60%10%

Lipid ControlAchieve top decile performance in SMP medical group’s diabetes management with an LDL (Low Density Lipoprotein) cholesterol under 100. Goal 62.1% Top decile 47.71%5%

20% QUALITY

Colorectal ScreeningImprove the percent of patient’s age 50-80 who have appropriate screening for colorectal cancer by 5%. Goal: 49.65%5%

Patient Satisfaction – Medical GroupAchieve overall medical practice visit patient satisfaction score at or above the 75th percentile.10%

25% SERVICE

Patient Satisfaction – Urgent CareAchieve overall medical practice visit patient satisfaction score at or above the 75th percentile.5%

Physician SatisfactionAchieve the score of 4.0 in overall physician satisfaction with SMP staff and division services. 10%


Use of Physician Data Report

• As a rounding tool for site directors• For internal benchmarking to create a

burning platform• To show outliers in practices• For reward and recognition• For coaching and counseling• During peer review• For staffing



Individual MD Coaching Using Data

• MDs with bottom quartile patient satisfaction

• Transfer out rate as a burning platform for improved access

• Some MDs asked for coaching after seeing the data!


Julie’s Rules for Coaching!

• Low patient satisfaction• High peer interview• High quality results in metrics

• DESIRE TO BE COACHED ~ physicians had to demonstrate insight that their actions are responsible for their results!



Collaborative Coaching with MDs and MAs Using Data

• We can coach transparently when data is transparent!

• MA connects to physician to support success

• Physician and MA dialogue on how to provide the very best experience for the patient

• MA manages up physician; physician uses key words to reinforce service elements impacting patient satisfaction


Cedar Clinic Reporting Cedar Pt Sat Scores

31

39

13

82

13

2

53

79

9

75

88

96 98

50

11

94

44

4

43

82

99

34

19

94

21

61

1218

91

3

83

38

91 9299

23

5

17

37

64

86

26

13

52

94

9 8

34 3633

148

0

36

21

4

74

82

90

67

94

8479

0

99

38

53

96

11 9

72

79

91 9396

0

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40

60

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100

120

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Feb Mar Apr

SMP Overall Goal



We Continue our Transparency Journey!

• Physician Data Report is shared with leadership

• Site leadership works side by side with site Associate Medical Director

• All patient satisfaction results are shared for all sites by department, physician module and down to the individual Physician/MA, and desk level

• All ancillary departments share site by site results down to the desk level


Sharp Mission Park Medical Group Overall Provider Satisfaction*

7%

23%

67%

4%

20%

76%

0%10%20%30%40%50%60%70%80%90%

100%

% Fair % Good % Very GoodResponse Category

Per

cent 4Q 2003

1Q 2008

* Composite score for 10 provider care questions – Press Ganey Survey

9% increase in the “top box”

scores



In the End

• Physician performance on measured goals should impact income

• Measurement and accountability are a NECESSITY for organizational performance

Thank You! Stephen Beeson, MD

Sharp HealthCare: Sharp Rees-Stealy Medical

Elena CresapChief Operating Officer

Sharp HealthCare: Sharp Mission Park Medical Group

Julie KennedyStuder Group

Documents

Transparency The Road to Change and Sustained Accountability Sharp