May 15, 2014

CEO-Physician Advisor Evolution: Barriers and Opportunities

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While no one can know exactly what the future will look like in these rapidly changing times, hospitals need a strategy for success, especially regarding how to manage the continuum of care.

I believe that one critical success factor will be the next iteration of physician leadership in the hospital and healthcare C-suite, specifically as it pertains to the development of a more prominent role for physician leaders in utilization and the care continuum to act as a bridge between administration and the medical staff.

The relationship between medical staff and hospital administration has always been essential, but it has not always been positive. Over the last few years, many external forces – not the least of which including reimbursement and competition– have driven physicians and hospital administration into conflict. But now the external landscape is changing because of mandates such as the Patient Protection and Affordable Care Act (PPACA) and value-driven reimbursement, which incentivizes physicians and hospital administration to work together.

The Recovery Auditors represent one example of how physicians’ behavior directly affects hospital finances. Appropriate physician documentation can make the difference between a hospital getting paid for a claim and a denial of payment. Furthermore, efficiency of patient processing and resource utilization are directly affected by the physician and how well the physician and hospital staff work together. A reduction of one day in the average length of stay for a hospital can add up to a million dollars very quickly.

Hospitals and physicians simply cannot be successful without each other. However, it will take understanding and hard work on both sides to make real and positive changes resulting in productive collaboration and partnerships. Most hospitals have chief medical officers or vice presidents of medical affairs, but these positions are responsible for a broad range of duties, and we all know that utilization management is not a popular topic among physicians.

The next iteration of physician leader should serve as the middleman connecting C-suite, finance, and clinical operations to ensure complaint documentation and utilization. This will require physician leaders who understand finance and documentation and can serve as both a resource and a driver of accountability for medical staff. The C-suite will have to empower these physician leaders in ways not previously seen, including by forming a direct reporting relationship to C-suite operations instead of to the CFO, VP of quality, or utilization.

So, enter the new-world physician leader, a hybrid with the clinical skill set to gain the respect of medical staff and the organizational skill set to manage systems for accountability. The developing role of the physician advisor (PA) is a perfect fit for this role. But hospitals will have to invest in the education and training necessary to fulfill the requirements of the job, and physicians will have to embrace a new way of thinking under a physician leader.

Exhibiting the hybrid knowledge set means the following:

  • Expertise in resource management and quality;
  • Understanding of how organizations function (e.g. strategy and operational effectiveness);
  • Getting things done through others (delegate to hospital staff);
  • Fundamental knowledge of finance;
  • Organizational charts; and
  • How to lead groups.

But how do we get there? Let’s start with factors we must work though to find common ground as leaders to influence medical staff. What are the innate differences between leaders in the hospital C-suite and leaders in the medical staff? Research shows that the two groups have differing education, career paths, organizational perspectives, and personalities.The comparison below gives good insight into these differences:

Physician

CEO

  • Doer
  • Solution-oriented
  • 1:1 interaction
  • Always “on”
  • Decision-maker
  • Autonomous
  • Patient advocate
  • Professional identification
  • Immediate gratification
  • Planner/designer
  • Process-oriented
  • 1:many interaction
  • Some downtime (changing)
  • Delegator
  • Collaborative
  • Organization advocate
  • Organizational identification
  • Delayed gratification

Add to this list the notion that we speak different languages. For example, below is another side-by-side comparison of a physician and CEO:

Physicians

CEOs

  • Document plans of care and notes in patient chart
  • Talk about UTI, PTCA, CBC
  • Center on patients

 

  • Document organizational plans and minutes of meetings to advance plans
  • Talk about EBITDA, FTEs, cost per APD
  • Center on the organization

Add to these intrinsic differences the stress of change on physicians. With the Patient Protection and Affordable Care Act (PPACA) driving physician employment and power shifting to institutions, physicians are being threatened at an emotional level. Physicians report being worried about the future of patient care and the notion of becoming shift workers.There is also a generational gap that marks a larger shift than was seen in previous generations. Baby boomers value the relationship with the patient and independent decision-making. Younger physicians value a balanced life and predictable work schedule. But they do have one thing in common: all physicians fear administrators when it comes to making medical decisions.

Hospital CEOs are faced with just as many challenges. Reimbursements are uncertain, and there is pressure to keep up with technology. Hospitals are expected to manage the entire continuum, requiring a shift from departmental management to matrix management. Managing a multi-generational hospital workforce is just as challenging as addressing the generational gap among physicians. And I would hazard a guess that just like physicians, administrators do not want to be responsible for medical decisions.

All of these differences and challenges might seem impossible to overcome. But we simply have no choice, and we will require a new paradigm with a new approach. Through respect, understanding, and acknowledgement of differences between physicians and hospital administrators, a collaborative approach can be developed and perhaps a new environment of collaboration instead of conflict will become the new norm.

The biggest winner will be the patient in terms of receiving seamless care.

About the Author

Elizabeth Lamkin, MHA, is a partner in PACE Healthcare Consulting. Elizabeth has more than 20 years of C-suite level hospital executive management experience. Most recently, she was the CEO/Market President for Tenet Healthcare’s Hilton Head Regional Healthcare. Elizabeth holds an undergraduate degree in Business Administration, Cum Laude and a Master’s in Healthcare Administration from the University of South Carolina.

Contact the Author

elizabeth.lamkin@pacehm.com

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Elizabeth Lamkin, MHA

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