Julie S's Profile
Thank you Neil. The culture of the leadership groups felt they were aligned. However, the impact to the thousands of employees was not appreciated until post-affiliation. Lessons learned….discuss as much at every level prior to changes (discuss as much is legally allowed during the exploratory phases for example), set up “listening circles”, or “town halls” for discussion and questions, and evaluate/measure physician and employees satisfaction, engagement, prior to affiliation, with specific attention to how an affiliation or merger would change their alignment, etc. All of that has happened to a great deal post-affiliation.
Make the dashboard relevant to the physician’s day to day practice, and easy to read and interpret, otherwise not likely to be used. Also…accurate data is important/required. For example, at our institution, on our dashboard we recieve individually our production vs budgeted RVUs, etc. It turned out that 2 FMLA’s of employees within the billing department happened within the same month, and billing and dropping of E&M charges lagged by 4-6 weeks as a result. The physician’s saw their dashboard substantially change, but not concordant with their actual work done. This caused “panic” to say the least, to have physician’s pay be so closely tied to RVU production month to month, and 30% drops were seen with many providers. After many days to several weeks, eventually the root cause was seen. So…if you use/develop a dashboard so linked to pay and production, if their is a system’s issue…be prepared to inform quickly those that need to rectify that information, as provider and physician satisfaction otherwise will loose trust in the dashboard’s accuracy.
We have seen a shift in our region of the country to the employers themselves driving where some procedures are performed, based on cost of care and quality of care, with contracts negotiated based on these metrics for specific procedures, including hip and knee replacement. For example..Boeing with contracts in the Mid-West to have non-emergent CABG performed out of state, etc. We are seeing this shift with total hip and total knee, forcing patients to travel 100-200 miles to recieve their treatment from their home based on decreased out of pocket expense if the preferred clinic/system is used for the procedures. So my question is…do you have estimates on your cost of care for specific orthopedic procedures, and quality measures that are associated, that you could present to the local employers and companies in this apparently very competitive market place?
I think you will see a substantial improvement in efficiency and patient satisfaction by “bringing the resources to the patient”, such as dedicated days of the week for Breast Cancer Clinic, or GI malignancy Clinic, or Liver tumor Clinic, etc. The patients and families would have the benefit of being seen the same day by the surgeon, medical Oncologist, and Radiation Oncologist on the same day, and meet with their other team members at the same time, such as a Nurse Navigator specific to that disease. Also consider having a mini-tumor board on those days where the more difficult cases are discussed by the multi-disciplinary team. I am a Medical Oncologist, caring for adult patients with cancer. We are not an academic center, but with schedule all of these appointments on the same day for the patients and families, and have found improved satisfaction, improved understanding of the plan moving forward, and buy-in from the team. When I refer a patient to an academic center for a specific oncology diagnosis, for example “Sarcoma”, that patient is seen by the sarcoma surgeon, med onc, rad onc, etc., on the same day, in the same clinic location. So these disease specific clinics are housed within Medical Oncology, with the surgeons, etc., coming for that day or half day with the understanding that their focus will be on patients who have a common cancer. The medical assistants, schedulers, receptionists, nurse navigators, etc., have found improved job satisfaction and improved efficiency. Bringing the MDs on board to this idea will by default bring the staff on board.