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Value-based Management for Health Care Providers

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The Physician Lifestyle You Deserve

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In A Perfect World Blog Series – Part Two

By Andrew Craigie,

Are you a physician ready to change the game in your medical practice?

You are committed to excellence for your patients, and realize that your business has become all-consuming. It’s time to put into place a new way of thinking, and receive the lifestyle you deserve inside your practice, and within your own life. We would like to review with you a timeless author’s perspective on thinking, and new areas to examine that can open up endless opportunities. Your perfect practice can exist, it’s simply time we look at things through a new lens.

Medical Practice and Family Life

For the physician practicing in today’s healthcare marketplace there are really four pathways to consider: independent practice, group practice (partnership), contracted, or employed. The path the physician chooses is usually influenced by several personal realities such as risk/reward, location preference and, most certainly, lifestyle.  To “tick the most boxes”, many physicians welcome the idea of being in private practice.  The allure of being an Entrepreneurial Physician is genuine; then they learn just how challenging it is to manage the business side of their practice effectively and profitably.  I would like to suggest an even greater consideration, is the toll this can take on personal relationships if they do not have a plan for balance.

The first reality for any physician launching their own practice to realize is that all business is “family” business.  If you are an independent business owner every decision you make about your business, every priority, is influenced by the business and therefore has an impact on your family and personal relationships.  Being the captain of your own ship can be a great joy, but it is very important to remember that your family is also coming along for the ride.

In his book The E-Myth Physician, Michael Gerber shares a story of Keith and his wife Susan.  Keith is inspired to go into the field of medicine.  He and Susan make the sacrifice to put Keith through medical school and residency.  Keith goes to work for a medium size medical practice in Sacramento, California, they start a family and life is good.  Eventually Keith becomes increasingly frustrated with how the medical practice is being managed.  He and Susan talk again and agree to take the risk of striking out on their own, in private practice.  “Thus began the practice of Dr. Roberts.  He quit his job, took out a second mortgage on their home, and leased a small office.”  The practice grew and gradually consumed more and more of Keith’s time, managing employees, negotiating with insurance companies, seeing patients, and paying the bills.  He became consumed by the business and gradually became more distant from Susan.  You can finish the story… It doesn’t take much thought to see how this might end.

Start with a big dream, the dream starts to unravel.  STOP!  As Gerber says, “Business is only business, it’s not your life.”  I can attest, the physician who makes the bold decision to launch their own practice, can be successful, thrive in their medical practice and have a life outside of the business.  To accomplish this, they must plan for life with at least the same level of commitment that they plan for the success of their practice.

Gerber suggests three distinct steps to succeed in life and business…

  1. Innovation: Continue to find better ways of doing what you do.
  2. Quantification: Once that is achieved, quantify the impact of these improvements on your business.
  3. Orchestration: Once these improvements are verified, orchestrate this better way of running your business so that it becomes your standard, to be repeated time and time again.

The principle is simple (but not easy) – Take control of your business; take control of your life.  Take Gerber’s advice start to conceptualize work in three areas: Entrepreneur, Manager & Technician.  Then organize your work and life into day-tight compartments, standardize your work, and commit to a disciplined approach.  I like to think of this as “Clarity of purpose & discipline to process”.  There are tremendous opportunities and innovations in the marketplace of ideas that can help create real margin in your business.  Leverage these opportunities to create more margin in your life also.

We would like to introduce you to a team that can help you succeed in business and life, iPX Physicians https://www.linkedin.com/company/ipx-physicians/ .  iPX is bringing a fresh perspective to the physician office, harnessing advancements in technology and innovative practice design so our physician partners can work on their business and experience the joy of practicing medicine again.

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

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.

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“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