V2V Management Solutions

Value-based Management for Health Care Providers

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Don’t look back, you’re not going that way

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Part II:  How to envision a successful future

The advice I gave my colleagues around that board room table, “Don’t look back,” reflected that we were on a journey. And, while on that journey, what does it take to find the path in front of you? The tool I use is a three-step process. The first step is to just “breathe.” That implies giving yourself a chance to breathe in and to oxygenate your brain. I know it sounds more than a bit esoterical, but I’ve found breathing in helps you stay present and allows you to think more clearly.

When you don’t breathe–in fear, flight, or when you’re challenged–you tend to think from the survival quadrant of your brain. When you take a deep breath, you’re now thinking with your frontal lobe, and moves your thinking from the back of your brain, that survival quadrant, to the front of your brain. This one act of breathing allows you to think and be more mindful of where you are; it allows you to become cognizant and not wallow in reactive mode. After taking a deep breath, you realize you can go forward, now. You can find the path in front of you. Now, what?

From this point, you can now assess your situation and make a determination. You’ve recognized you won’t go back. Now you can ask yourself a very important question: “What do I need to pick up and carry forward and what do I need to leave behind?”

“Let go be free.”

Don’t look back, you’re not going that way:

  • Part III:  Creating a trusted circle that brings others along with you – Coming Soon!

Let’s Talk Value – a three part series for Medical Clinic Administrators

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Part I – Removing the cliché from Value in your clinic practice operation

If you walk into a medical practice right now and use the word “value” in a sentence, it’s almost saying a dirty word.  Physicians think you’re talking about quality metrics, equating to value-based reimbursements.  The process the regulatory body has used to engineer the shift from a volume-based reimbursed methodology to a value-based methodology has essentially tainted the word “value” in their estimation.  It’s a false premise of value.  If you ask a physician if many of the methods used to capture quality metrics actually reflect quality within their practice, they would tell you, “no, it usually means more clicks in the EHR.”

Unfortunately, it makes having a conversation about the real value found within the medical practice a very difficult discussion.  You must first reframe the definition and its resulting connotation.  Everything that is associated with shifting to a value-based model has so heavily burdened the medical practice, that it’s left a bad taste in everyone’s mouth.

So, to be clear, I’m not talking about THAT type of value. The premise of value is not exclusively associated with new reimbursement methodology.  At every medical practice that I advise, my challenge is to educate the physician and administrative leadership about what value management really is.

Value management is dedicated to motivating people, developing skills, and promoting synergy and innovation, with the aim of maximizing the overall performance of an organization.  Value is derived when satisfaction outweighs the cost.  It’s about the relationship between meeting a need and meeting expectations while balancing the impact of the cost required to do so.

Value management is a combination of planning tools and methods to strike that optimum balance of project benefits in relation to project costs and risks.  I came to this philosophy as I was completing my Master’s thesis; our team investigated “value” at large corporations.  These organizations have entire value managementdepartments devoted to ensuring, overall, the company teams collaborate, no division is a silo and value remains a focus across the organization.

As I reflected on this construct, my aha moment was that rarely has anyone ever talked about how to define value across the medical practice environment with this specific value management focus.  For example; there are specific aspects of solutions and applications that divide the front and back office.  Some EHRs provide a solution or add-on module for a single problem or issue but are not designed to integrate and enhance the entire practice causing redundant workflows, increased errors, and additional staff work and frustration.

So, I asked myself:  What is the value management opportunity in health care, and specifically, within the medical practice?

If we start thinking about it, taking the cliché out of value is really about aligning work with mission and vision.  Ask yourselves, who first needs to feel they have received value for their interaction with your practice?  If patients don’t receive what they perceive as a valuable care, they won’t come back.  If physicians don’t receive the tools they need or adequate income for their efforts, they won’t stay.  If the staff doesn’t get adequate training or an encouraging work environment that helps them do their jobs, they will find other ones.  If the practice doesn’t have the appropriate resources, it becomes inefficient and unsustainable.

I’ve been fortunate to help many practices reframe their definition of value, to look at value differently and realign the various aspects of their business.  When the medical practice works to ensure that anything done adds value rather than detract from it, the end result will be superior quality and outcomes, a premier work environment, and highly engaged and trained staff; fostering increased profitability.

Read Part II next.

Don’t look back, you’re not going that way

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Part I:  Recognizing when the lessons of the past hold you back from a successful future 

Frequently, I support organizations as an interim executive to either start something or to repair something.  I’ve learned along the way that a lot of folks are unwilling to take that first step because of their perceptions or opinions learned from what they experienced in the past.

It’s part of human nature to remember the pain from the past.  In fact, that skillful memory has been vital to our evolution as humans… We learn, early, ”don’t touch the hot stove…” and, once we learn that lesson, the question becomes “why go near that stove again when there is a whole world around you to explore?”  Those are valid questions.

In particular, I was working with an organization needing to restructure its governance.  Often, I sat with my colleagues around a table in the boardroom and was bombarded with comments like “we used to,” “they always,” “it never,” and my personal favorite, “we can’t.”  The amount of energy required to manage the past was draining the individuals called to move their organization forward.    I sat there thinking that while it’s important to be mindful of the past, it’s as important to ensure it doesn’t tie us to an anchor on a short rope at high tide.

As a leader, helping your team to embrace opportunity challenges you to let go of historical assumptions and behaviors.  In this transformation of health care, what preserved you in the past might actually drown you in the future.  Historically, we were very paternalistic in our models of care; the doctor knows best.  Don’t question the nurse.  However, patients are more informed, for better or for worse, in today’s world.  Providers are evaluated on the patient’s perception of satisfaction and engagement.  So, therefore, what worked in the past may very well prevent you from being successful in the future.

So, while sitting at that board room table I wondered to myself, “why am I giving time and energy to a conversation that isn’t going to help us move forward?”  And, I observed to our team, “Don’t look back, you’re not going that way.”  We do need to mourn the loss and, yet, it’s important to recognize when to let go, to take a deep breath, and reach forward.

 

Don’t look back, you’re not going that way:

  • Part II: How to envision a successful future – Coming Soon!
  • Part III:  Creating a trusted circle that brings others along with you

The Clinic Administrator Sandwich: Part 2

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Thriving amid the transformation in healthcare

Part 2:  Inspiring the Burned Out Healthcare Provider: 

Clinic administrators are sandwiched in the middle between the challenges of today’s patients and burned out healthcare providers.  Physicians used to want their children to be doctors and follow in their footsteps, becoming pillars of the community, like Marcus Welby, MD.  Now, many doctors encourage their kids elsewhere, feeling providers just aren’t treated with the same respect today.  Amid this transformation, you have to find a way to figure out what excites your providers about healthcare.  Here are a couple of good ideas:

  • Publicize clinical excellence: For example, we’re already doing a lot of work to prove our quality outcomes for MACRA or other quality payment programs, why not publish those results?  Whether an article, podcast, your social media pages, or in patient e-news?  You might be surprised at the response among your clinical cadre and patients, alike.
  • Reward excellence in patient satisfaction: Another way to inspire your clinicians is to reward them for higher patient satisfaction and engagement scores.  The key is to figure out what motivates them.  At one practice that I consulted with, providers earned Amex reward points.  It was a great motivator for both clinical excellence and to encourage a healthy work-life balance.

Ultimately, you want to become the go-to practice in your community, so that local patients and employers become your best advocates to ensure your providers are included in-network for insurance carriers.  Leadership and communication skills of the clinic administrator can help overcome the perils of a burned out provider during this transformation in health care.

What is a trans-for-ma-tion-ist?
One who brings about a thorough or dramatic change.

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by Deb Wiggs, FACMPE, V2V Founder

Some leaders are alert to an industry shift and then there are some who take an active role in helping your medical practice adapt to what is considered sweeping transformation.

So, together with the founders of V2V, we called the question. What does it mean to be a transformationist, exactly? Being a transformationist, we think, characterizes one who ushers his or her practice through the sweeping and fundamental change within the health care industry. Transformationists are part of the solution, not part of the problem, helping your practice survive and thrive amid the new business of health care. What are the skills necessary to be in the transformationist role at your practice? At V2V, we break it down into a few key characteristics necessary to become ADEPT™ at the new business of health care.

  1. Future-focused: A transformationist is forward-thinking and excited about change. While there are some enduring characteristics of your practice, that don’t change and never need to change, the business of your practice will not thrive without evolving. You, as a transformational leader, recognizes when change is disruptive and your team needs to forge on. As many physician leaders and administrators are recognizing, the lack of change threatens the viability of the medical practice.

  2. Dynamic learner: Being available and open to others’ input is another essential transformational quality. You must be open to learning new skills, and seek ways to innovate your daily work by incorporating new technology into your processes. For example, I still run across practices where physicians refuse to adopt email and the Internet for more effective communication and data exchange. This is one of those areas I would tell you to apply the “Stop it” button. Stop being so recalcitrant! On the flip side, some practices have embraced technology, even deploying smart phone “Apps” for disease management for conditions like diabetes and congestive heart failure. Given the speed our culture is deploying new processes and technologies, transformationists must be in a constant state of learning.

  3. Available: The first aspect of being available is the ability to think past your programming. A transformationist is comfortable with pushing the envelope on structure, creating such things as practices without waiting rooms, allowing patients to make their own appointments, and, even being part of a solution that may require your clinic to collaborate with what are otherwise competitors. Sometimes I’ve heard it called “Collabition.” Another aspect of being available is being present. Are you in the here and now? Have you put away your cell phone, and moved out from behind the computer keyboard and monitor? I call it having your MBWA (management by walking around.) and evolving your management style to be a promoter, which lets others solve the problem, not you. Are you seen, not as a MOM (medical office manager) but as a resource to help others’ be successful? That is a transformationist.

  4. Affable: It means being, flat-out, nice. Over the past decade or so, we have lost the premise of being nice to one another, including the regular use of “please” and “thank you.” If you are affable, people are more likely to listen to you. Humor helps, but it isn’t a requirement Every time you leave someone’s presence, if you take nothing more from this blog, please remember to thank people for their time. I worked with a physician as his MA and office manager who, every night, thanked his front office staff for their time. And guess who had the best schedule and dedication among his ten other practice physicians? Yep, you got. He does. That’s the power of being affable. A transformationist is adept at inspiring the effective and efficient medical practice team.

  5. Adaptable: I always say “blessed are the flexible, for they will never be bent out of shape.” And, a transformationist is one who is aware of the need to evolve and adapt in order to accomplish a greater goal, not merely to change because “everyone else is doing it.” To be adaptable, you have to know where you are going and how you’re going to get there so you know when you can be flexible. I’m looking at this from two sides; an adaptive leader understands transformation is both thorough and dramatic. Thoroughness reflects the ability to get the job done, and that requires you to create a plan. Flying by the seat of your pants just rips your pants; don’t do that. As the old adage goes, failing to plan is planning to fail. The second aspect of transformation is that it is dramatic. By having a plan, the ADEPT™ and adaptive leader has the ability to perform a “gut check” with the understanding there are times to modify the plan, or not, in order to go forward.

To thrive as a transformationist is more than just filling a seat on the bus, even if it IS the driver’s seat. It takes an intestinal fortitude that comes from being deeply committed to influencing how care is delivered in your sphere of influence. These five characteristics fully fuse together when combined with tenacity and passion for helping the organization continue to move forward. By tenacity, I mean standing up when no one else will and by passion, I mean seeing it combined with bravery, which allows you that privilege. There is nothing more gratifying than to see your direct efforts help promote an organization’s success. That is what it means to be a transformationist.

ADEPT:
The Five Functions of Value

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By Michelle Wier, MBA, CMPE, V2V Founder

A year ago, the four of us, myself, Deb Wiggs, Nancy Babbitt, and Irv Barnett, joined forces to found V2V Management Solutions.

Why did we do that?

Well, we felt that our ideas on what drives value in medical practice management is pretty unique, and specific.  Our initial discussions sparked something akin to that phrase, “the sum of the whole is greater than the individual parts.” What does that mean, in real terms, to the medical practice? It’s a philosophy that leads to the goal of value management across the medical practice.

True, “value” is an over-used term and focuses largely on financial-based or clinical-based imperatives in our industry. However, the basic premise of this age-old term, “value management” represents so much more.  It means improving and sustaining a balance between the wants and needs of all stakeholders and the resources required to satisfy those needs. So we asked ourselves,” what would value management look like within the medical practice arena?” What evolved was our ADEPTSM philosophy for driving sustainability in the new business of health care.

So, what is ADEPTSM? The five functions of value across a medical practice.

Application.

Deploying new technologies and processes into practice defines the new normal in health care.  However, it’s not just about optimizing your EHR for patient and clinical performance.

Distinction.

What sets your brand apart?  Do you know?  The future will be driven by each encounter, and will be more patient-centered than ever before.  It’s important to know how you are perceived in the market and whether it reflects who you really are.

Effectiveness.

Effectiveness is achieved by ensuring the highest in clinical quality and service to your key stakeholders: Your patients, your employees, and the community.  And, it’s imperative to be dedicated to continuous improvement in all aspects of your organization.

Profitability.

Successful financial and clinical operations are not mutually exclusive.  In fact, in the new business of health care, improving both service effectiveness and operating margins is imperative to sustainability.

Talent.

A tremendous amount of effort is focused on talent acquisition through recruitment.  What about onboarding, organizational development, or interim management?  If as much effort was focused on retention as recruitment, the medical practice would reap many rewards.

Over our years in medical practice management, the founders of V2V learned that when any one of these five elements is missing, the success of the practice is at risk of becoming unsustainable.  However, when a practice transforms financial and clinical operations by becoming ADEPTSM across these five value functions, it creates a sustainable model for success in this new business of health care.  The medical practice of the future will be driven by each encounter and be more patient-centered than ever before.  It takes focused work to transform your practice, but it is not an unsolvable puzzle.  The benefits to your patients, to the livelihood of your clinical and operations staff members, and to your own success, is worth it.  And, that’s really why we’re here.

Applying MACRA:
Discovering a Rosetta Stone for Quality Payment Programs at your Practice

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By Nancy Babbitt, V2V Founder

Let’s face it, MACRA is just the latest in regulation “Hell.”

How do you focus on the business of care delivery and be ready for the next round of quality payment programs.  In short, how do you think beyond MACRA? Successfully answering this question will help you break the code and remain profitable throughout this transformation in healthcare.

Here are two ways to go beyond MACRA:

  1. Become ADEPT™ at MACRA communication:
    If you are a practice that is participating with MACRA and reporting quality measures, this is an essential skill.  If you haven’t been successful yet, I’ve often found among my clients that you just might not be documenting or reporting in their approved format.  The opportunity before you is to gain an ADEPT™ advantage, becoming skilled at the secrets of anything, as we call it.  One way is to optimize the technology in your practice, and that means more than just your EHR.  It has the effect of improving workflow and ensuring your quality data and outcomes at your fingertips.  This way, no matter how you need to format your quality measure reports, you are prepared.

  2. Know your payer mix: 
    MACRA is only for Medicare, so you have to determine whether it’s worth your time and effort in the first place.  If Medicare is only 5% of your practice, your time might be better spent figuring out how to optimize opportunities for quality payment programs with other insurance carriers.  However, if you’ve already started down the MACRA road you can still use the data collection to discover value opportunities across the care delivery continuum.  It’s important to say all is not lost when you evaluate your quality programs with other payers and discover MACRA might not be for you.

Either way, the fundamental point of going beyond MACRA is to establish your framework that catalogues and reports your quality outcomes and measures the ROI (return on the investment) of your time.  That way, you get to the table to negotiate payer contracts, your quality data and care delivery costs accurately reflect the true cost of care.  Once you master that formula, it’s like discovering a Rosetta Stone for success in your practice.  The business of health care is undergoing a transformation; your opportunity is to go beyond today’s hot topic and establish a cost-effective framework for quality, engagement, and, ultimately profitability.

The Clinic Administrator Sandwich: Part 1

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Thriving amid the transformation in healthcare

Part 1, Engaging the Changing Patient:

Clinic administrators are sandwiched in the middle between the challenges of today’s patients and burned out healthcare providers.  However, the future is not so grim; there are many ways to engage your patients that foster both better outcomes and a better bottom line.  The clinic administrator can help the office be better prepared.  Here are just a couple of suggestions:

  1. Engage your patients regarding their health: Understand that patients today are more complex, because many have not had consistent access to routine healthcare.  They will need more information on managing co-morbidities and it’s important to show that you can help them learn how-to be an active partner in their recovery and then manage their good health.
  2. Engage your patients on the new-normal of financial liabilities: Train staff on the front end to coach patients about the total cost of healthcare. Today’s high deductibles are really high, several thousand dollars, and in more and more cases should be collected up front, instead of following past practices where patients are billed after collecting from insurance companies. This brings with it a new sort of sticker shock to the patient and also a new sort of risk on the part of the practice.  Many practices are just now realizing that their largest payer can sometimes be the patients, themselves.   I call it screening patients before scheduling.  Before care is given, these items are a MUST from each patient:
    1. Proof of insurance coverage
    2. Collect deductible, up front, and
    3. Have a credit card, on file, for each patient.
    4. Offer consumer financing options, in case a large deductible or co-pay out-of-pocket is not feasible for patients.

Patient communication is more critical than ever during this transformation in healthcare.  Make sure that everything is in writing and that patient policies as well as reliable education sources are clearly communicated on your website, and other specific places. There is a lot of opportunity for successful patient engagement and the clinic administrator can lead the way.

 

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Trusted Resources:

Survey Vitals    
“Knowing it is time to reshape your current reality is the first step to transformation. When we contacted V2V, our goal was to innovate our clinic network from all aspects; integration, structure, financial controls and leadership. Michelle and her team at V2V helped us develop a well-defined plan. In transformational management one hears Quality times Acceptance equals Results (Q*A = R). Along with the quality of recommendations, V2V worked diligently to garner both input and acceptance from providers and staff. This is what I believe will ensure long-term, sustainable success for our clinics in a very uncertain time..”

Steven D. Febus – Chief Financial Officer, Pullman Regional Hospital

“Knowing it is time to reshape your current reality is the first step to transformation. When we contacted V2V, our goal was to innovate our clinic network from all aspects; integration, structure, financial controls and leadership. Michelle and her team at V2V helped us develop a well-defined plan. In transformational management one hears Quality times Acceptance equals Results (Q*A = R). Along with the quality of recommendations, V2V worked diligently to garner both input and acceptance from providers and staff. This is what I believe will ensure long-term, sustainable success for our clinics in a very uncertain time..”

Steven D. Febus – Chief Financial Officer, Pullman Regional Hospital

“Michelle Wier, CMPE, worked with our EMS program for a year, providing interim financial management at a crucial time for our hospital district based agency. Her exemplary work included budget and tool development, redesign of our financial statements, and a compensation analysis for all EMS positions. She helped provide crucial accountability for our internal accounting systems, contract negotiation support and a streamlining of our in house processes and reporting structures. I highly recommend her work product and greatly appreciate her astuteness and work ethic.”

J. Michael Edwards, DDS, MD, FACS – Commissioner, San Juan County Public Hospital District #1 San Juan Island EMS and MedEvac

“Knowing it is time to reshape your current reality is the first step to transformation. When we contacted V2V, our goal was to innovate our clinic network from all aspects; integration, structure, financial controls and leadership. Michelle and her team at V2V helped us develop a well-defined plan. In transformational management one hears Quality times Acceptance equals Results (Q*A = R). Along with the quality of recommendations, V2V worked diligently to garner both input and acceptance from providers and staff. This is what I believe will ensure long-term, sustainable success for our clinics in a very uncertain time..”

Steven D. Febus – Chief Financial Officer, Pullman Regional Hospital

“With excitement and enthusiasm I announce the transition of Wier Management Solutions to V2V Management Solutions. I’m honored to partner with some of the industry’s best “Transformationists,” who will assist our clients in realizing and enhancing the value within their organizations.”

Michelle Wier – President, Wier Management Solutions, Inc.

“Knowing it is time to reshape your current reality is the first step to transformation. When we contacted V2V, our goal was to innovate our clinic network from all aspects; integration, structure, financial controls and leadership. Michelle and her team at V2V helped us develop a well-defined plan. In transformational management one hears Quality times Acceptance equals Results (Q*A = R). Along with the quality of recommendations, V2V worked diligently to garner both input and acceptance from providers and staff. This is what I believe will ensure long-term, sustainable success for our clinics in a very uncertain time..”

Steven D. Febus – Chief Financial Officer, Pullman Regional Hospital

“Knowing it is time to reshape your current reality is the first step to transformation. When we contacted V2V, our goal was to innovate our clinic network from all aspects; integration, structure, financial controls and leadership. Michelle and her team at V2V helped us develop a well-defined plan. In transformational management one hears Quality times Acceptance equals Results (Q*A = R). Along with the quality of recommendations, V2V worked diligently to garner both input and acceptance from providers and staff. This is what I believe will ensure long-term, sustainable success for our clinics in a very uncertain time..”

Steven D. Febus – Chief Financial Officer, Pullman Regional Hospital

“Knowing it is time to reshape your current reality is the first step to transformation. When we contacted V2V, our goal was to innovate our clinic network from all aspects; integration, structure, financial controls and leadership. Michelle and her team at V2V helped us develop a well-defined plan. In transformational management one hears Quality times Acceptance equals Results (Q*A = R). Along with the quality of recommendations, V2V worked diligently to garner both input and acceptance from providers and staff. This is what I believe will ensure long-term, sustainable success for our clinics in a very uncertain time..”

Steven D. Febus – Chief Financial Officer, Pullman Regional Hospital