The new chief clinical officer of Virtua Health shares her best practices for creating residency programs.
Jennifer Khelil, DO, MBA, led the creation of residency programs at Virtua Health before becoming the health system's chief clinical officer.
Khelil was promoted to executive vice president and chief clinical officer of Virtua early this month. She had served as CMO of the health system since 2019 and was previously vice president of medical affairs starting in 2013.
Virtua has added several residency programs to the institution over the past five years, including residencies in family medicine, internal medicine, obstetrics and gynecology, surgery, and psychiatry. The health system has a fellowship program in cardiology and will be adding an anesthesiology residency program.
The southern New Jersey health system has quadrupled the size of its residency programs over the past five years.
Jennifer Khelil, DO, MBA, led the creation of residency programs at Virtua Health before becoming the health system's chief clinical officer.
Khelil was promoted to executive vice president and chief clinical officer of Virtua early this month. She had served as CMO of the health system since 2019 and was previously vice president of medical affairs starting in 2013.
Virtua has added several residency programs to the institution over the past five years, including residencies in family medicine, internal medicine, obstetrics and gynecology, surgery, and psychiatry. The health system has a fellowship program in cardiology and will be adding an anesthesiology residency program.
"Part of running a successful academic institution is having faculty engagement and having faculty who are excited about teaching," Khelil says.
When Virtua started the process of launching residency programs, there was some push-back from physicians, according to Khelil.
"We had some faculty who were concerned about what it meant for them and how it would affect the day-to-day care of patients," Khelil says. "We had to provide some education, and we had to give them the resources they needed."
In particular, physicians wanted training on how to educate residents, so the health system introduced faculty development tools and education.
"We taught our physicians how to teach and how to give good feedback," Khelil says. "Part of a resident's program is that they receive monthly evaluations. So, we trained our physicians on how to evaluate a resident."
Virtua achieved faculty engagement once physicians began interacting with residents, Khelil explains.
"We got wonderful feedback," Khelil says. "The faculty got excited. Having young people in the institution with inquisitive attitudes brings a level of excitement."
The health system has developed a robust faculty, which is not only interested in teaching but also clinical research, according to Khelil.
"We have brought many research opportunities into the organization, including clinical trials and device trials," Khelil says. "We have partnered with industry partners to bring cutting-edge advances to our organization."
An essential element of successful residency programs is recruiting the right residents, Khelil explains.
"When we recruit our residency class, we look for residents who will fit into our culture," Khelil says. "We want residents who are just as excited and just as interested in engaging in clinical learning and research as our faculty."
Virtua is particularly interested in recruiting resident candidates from New Jersey.
"If you grew up in New Jersey and you train in New Jersey, you tend to stay in New Jersey after your training," Khelil says. "Every state is facing a shortage of healthcare workers, so if we can select individuals from this geographic region and train them, and they stay in the state, that benefits everyone in New Jersey."
Jennifer Khelil, DO, MBA, is chief clinical officer of Virtua Health. Photo courtesy of Virtua Health.
Leading strategic growth
In addition to building residency programs, Khelil was involved in leading strategic growth initiatives before becoming chief clinical officer.
"When you talk about strategic growth, you are really talking about partnering with your community and meeting your community where it needs to be met," Khelil says.
One of the first strategic growth initiatives Khelil helped to lead was an effort to increase patient access to services.
"That included putting practices in remote areas of our counties that did not have access to primary care," Khelil says. "That included pulling specialists into those practices, so that patients did not have to drive 45 minutes to see a specialist."
Another strategic growth initiative was stepping up efforts to address social determinants of health, according to Khelil.
"We have an area that is a food desert—those patients do not have access to healthy food," Khelil says. "We have put programs in place to address that need."
Those programs include a mobile farmers market and a mobile grocery store, since part of the patient population does not have a supermarket in their general vicinity.
"Those patients are going to small corner stores that do not have fresh produce or fresh meats," Khelil says. "The mobile farmers market goes out to areas in the community that do not have access to fresh produce or meat."
"We have a grocery store on wheels," Khelil says. "We took a New Jersey transit bus and retrofitted it as a grocery store. We can drive into any parking lot or drive down to any street and allow people to shop for healthier foods, including fruit and vegetables."
Nutritionists are paired with the mobile farmers market and the mobile grocery store, so they can advise people on how to prepare healthy meals.
Supporting physician services
Khelil has been involved in efforts to support physician services at Virtua.
"At Virtua, physician services come down to our medical staff," Khelil says. "We must provide resources to the medical staff so they can come in every day and do their jobs."
A primary area where the health system has been providing resources to physicians has been to address clinician burnout, according to Khelil.
"The past few years in healthcare have been rough on our providers," Khelil says. "They have had stresses that we had never seen before—the coronavirus pandemic stressed the workforce for not only nurses but also physicians."
The first step was to ask physicians about the challenges they were facing.
"The doctors told us that they loved taking care of patients and loved being at the bedside, but there was other noise that was weighing on them," Khelil says. "Doctors were burdened with the electronic medical record, the patient message in-box, and other touch points that impacted their day and pulled them away from the bedside."
To help physicians cope with the electronic medical record and documentation burdens, Virtua adopted an ambient listening AI tool.
"Instead of having to leave the bedside and sit down for 20 minutes to compose a note, the clinician can leave the bedside and already have the structure of a note in place," Khelil says. "They can edit the note. They can add to the note or delete information from the note. It speeds up the process, so our clinicians are spending more face-to-face time with our patients."
Physicians at the health system receive as many as 100 patient in-box messages per day that need to be answered, according to Khelil.
"We addressed the patient message in-box," Khelil says. "We put processes in place, and we put people in place who could offload some of the patient messages."
Good communication between a hospital's administrative team and the clinical staff is pivotal, this CMO says.
Holly Hill-Reinert, MD, is not only the inaugural CMO of her hospital but also is serving as a CMO for the first time.
Hill-Reinert assumed the role of CMO at WVU Medicine Jackson General Hospital in November. Prior to taking on her new role, she was chief of staff at Jackson General Hospital Morad-Hughes Health Center, which focuses on primary care. Hill-Reinert's clinical background includes working as an internist, pediatrician, and hospitalist.
Hill-Reinert has a strong set of goals as an inaugural CMO.
"Obviously, quality care and safety are of utmost concern," Hill-Reinert says. "We must have physician involvement as the cornerstone of those efforts."
"One of my priorities is to advocate for the staff at our institution," Hill-Reinert says. "I would like to assist in improving communication and camaraderie as well as bolster excellence."
In particular, Hill-Reinert wants to improve communication between the hospital's administration and clinical staff.
"I do not agree with the us-versus-them dynamic of administration and clinical staff," Hill-Reinert says. "The hospital will function better if we collaborate and share information."
To improve communication, Hill-Reinert, who participates in the senior administrative team's meetings every other week, is playing the role of liaison between the administrators and clinical staff as well as convenor.
"I bring information back to the medical staff," Hill-Reinert says. "I am trying to get physicians and other providers energized and more involved in the committees that we have."
Boosting care quality
Efforts to promote care quality are two-fold, according to Hill-Reinert.
"First, you must enhance the patient experience and patients' perception of the quality of care that they are receiving," Hill-Reinert says. "At the end of the day, when patients fill out surveys, they make the call on the level of their experience."
"Second, you must provide patient-centered care and evidence-based medicine as well as measure your quality metrics," Hill-Reinert says. "Part of this effort is continually educating your staff and training them to drive quality improvement."
The hospital's nursing staff and a regional group at WVU Medicine play a key role in monitoring quality metrics.
"We follow many metrics such as length of stay, days on antibiotics, central line infections, and catheter infections," Hill-Reinert says.
A CMO is an essential player in efforts to promote care quality, Hill-Reinert explains.
"I need to engage the physicians and get them involved in the peer review committee as well as the processes that we are working on and trying to improve," Hill-Reinert says. "Just being cognizant of what we are doing is important."
Bolstering patient safety
Engaging the frontline staff is essential to promote patient safety, according to Hill-Reinert.
"The most important aspect of patient safety is accountability and ownership across the frontline staff, including nursing, phlebotomy, imaging, and the providers," Hill-Reinert says.
The hospital is working on new ways to hold staff accountable for patient safety events.
"We have stood up a peer review committee," Hill-Reinert says. "We also have a new system called Origami for filing patient safety events or complaints. These reports come back to me if they involve any of our providers."
Origami is a web-based program that any staff member can go into and type in a patient's information. Then, the system will present a form to detail a patient safety event. Reports of medical errors are forwarded to Hill-Reinert, a root-cause analysis is conducted, and the hospital's peer review committee decides whether there was a deviation from care quality. The response to a medical error depends on the severity of a patient safety event.
A CMO plays a central role in promoting patient safety, Hill-Reinert says.
"I can lead staff training and encourage them to practice safely," Hill-Reinert says. "I can make sure that we are thorough and try to hold people accountable."
Keys to hospitalist success
Hill-Reinert has several years of experience working as a hospitalist, and successful hospitalists have several characteristics, according to Hill-Reinert.
"You must have the right physicians," Hill-Reinert says. "They must be responsible, good communicators with patients and the care team, and good with time management. They should not only be timely with their care but also mindful of documentation and other providers."
Hospitalists should have incentives such as safety bonuses, which energizes them to provide better care, Hill-Reinert says. It is crucial for hospitalists to stay up to date on the latest care standards and emerging treatments.
"When we start medical school, one of the first things we are told is that staying up to date is like drinking from a fire hose, and that never stops," Hill-Reinert says. "You must learn how to manage staying current."
With about half of physicians experiencing burnout, boosting physician well-being is an essential goal for health systems and hospitals.
In the latest edition of HealthLeaders' The Winning Edge webinar series, a three-member panel discussed best practices for improving physician wellness.
The discussion included three key takeaways: ways to encourage physicians to seek help, how to help doctors to remain healthy, and the importance of acknowledging physicians when they do good work as well as providing ways to give physicians a voice in their organization.
The panelists also discussed other issues, including the value of leadership in bolstering physician wellness. For example, the panelists said leadership development programs need to give top leaders education on providing an environment of psychological safety for physicians and other staff members.
Tune in to view a video of the webinar to gain all the insights of the panelists on effective strategies to boost physician wellness, which help position healthcare organizations for success.
In HealthLeaders' latest The Winning Edge webinar, a three-member panel discussed the best practices for promoting physician wellness.
With about half of physicians experiencing burnout, promoting physician wellness is a top concern for healthcare organizations across the country.
Physician burnout spiked during the coronavirus pandemic. In a 2021 survey, 62.8% of physicians reported experiencing burnout symptoms. In 2023, 48.2% of doctors reported experiencing at least one symptom of burnout, according to American Medical Association data.
With about half of physicians experiencing burnout, promoting physician wellness is a top concern for healthcare organizations across the country.
Physician burnout spiked during the coronavirus pandemic. In a 2021 survey, 62.8% of physicians reported experiencing burnout symptoms. In 2023, 48.2% of doctors reported experiencing at least one symptom of burnout, according to American Medical Association data.
An essential element of ensuring that physicians feel secure in seeking help is reducing stigma, according to the panelists.
One way to reduce stigma is to eliminate questions about mental health on physician licensing and credentialling forms, which is one of the goals of the Dr. Lorna Breen Heroes' Foundation. Getting rid of these questions takes a big step toward reducing stigma, since according to the panelists, they do more harm than good.
Reducing stigma also requires a cultural shift in the physician profession, according to the panelists. Part of physician training usually entails messaging that doctors are supposed to be strong emotionally and mentally. This messaging results in an "internal voice" that says physicians should not have to reach out for help when they are struggling, the panelists said.
The top leadership of healthcare organizations need to provide an external voice that says it is OK for physicians to not be OK and to seek help, the panelists said. It is also helpful for senior leaders to share their own vulnerabilities such as struggles with mental health and addiction.
Another way to address stigma is to provide physicians with confidentiality when they use mental health resources, according to the panelists. Doctors are often hesitant to use their healthcare organization's employee assistance program over confidentiality concerns, and it is helpful to grow partnerships with external organizations that can provide mental health services.
2. Helping physicians to remain healthy
Healthcare organizations should build structures such as well-being committees to help physicians remain healthy, the panelists said. Health systems must also consider creating a chief wellness officer position as part of the organization's senior leadership.
Establishing well-being structures and creating a chief wellness officer position provides a voice that says physician wellness is an important goal for a healthcare organization, according to the panelists.
A healthcare organization should also implement a physician wellness program with a strong structure, Campbell said. At Allegheny Health Network, the health system's wellness program follows the principles of the Stanford Model of Professional Fulfillment. The Stanford model has three core elements: a culture of wellness, efficiency of practice, and personal resilience.
To promote their own health, physicians should practice self-care, according to the panelists. Doctors often put themselves last after their patients and families, but they should be focused on building blocks of health such as nutrition and sleep. Physicians should also try to take time off as afforded by their organization.
3. Showing physicians appreciation and providing them with a voice
Doctors who feel valued are less likely to be burned out, according to the panelists.
Healthcare organizations should have formal and informal ways to recognize their doctors when they do good work, the panelists said.
For example, formal recognition can be given through an awards dinner. Informal recognition includes positive conversations on a day-to-day basis with team leaders. These conversations are a way to recognize a physician staff's unsung heroes.
Doctors should feel engaged in the direction of their organization, according to the panelists. Senior leaders and team leaders should have listening sessions with their physicians, so they feel they are being heard and get feedback on their comments.
Part of leadership development programs at healthcare organizations should include giving top leaders education on providing an environment of psychological safety for physicians, the panelists said. This education should encourage senior leaders to admit their own fallibility, to show they are willing to listen, and to be flexible.
This webinar was sponsored by the American Medical Association.
The stakes are high, with physician burnout linked to lapses in patient safety and care quality. Our next Winning Edge webinar explores how to address this crucial problem.
Physician burnout is one of the tragedies of U.S. healthcare, and it has a significant impact on patient care.
Society expects physicians to heal and comfort people when they are suffering. But about half of all doctors are themselves suffering from burnout, which includes emotional, mental, and moral injury.
Physician burnout spiked during the coronavirus pandemic. In a 2021 survey of physicians conducted by the American Medical Association, Mayo Clinic, Stanford University School of Medicine, and the University of Colorado School of Medicine, 62.8% of physicians reported experiencing burnout symptoms.
In 2023, 48.2% of doctors reported experiencing at least one symptom of burnout, according to AMA data. This was the first time the rate of physician burnout was below 50% since 2020.
There are three main symptoms of physician burnout, according to the American Academy of Family Physicians. Exhaustion is characterized by low physical and emotional energy levels. Depersonalization includes sarcasm and cynicism about patients and jobs. Lack of efficacy features doubt about the meaning and quality of providing care.
There is no silver bullet to address physician burnout and no singular approach to boosting physician well-being.
In interviews with HealthLeaders, healthcare leaders have said that efforts to promote physician well-being fall into two primary categories: system and individual approaches.
System approaches focus on barriers to well-being at the organizational level. Efforts to address these barriers include reducing administrative burdens on doctors, providing flexibility in scheduling, and optimizing electronic medical records.
Individual approaches include employee benefits, resources for physicians to seek help for emotional or mental distress, and methods for increasing personal resilience.
Focusing on solutions
For clinical care leaders, promoting physician well-being and addressing physician burnout is essential to the success of their organizations. That is why HealthLeaders is bringing together a panel of industry experts to share best practices and innovative approaches.
The next webinar in our Winning Edge series, which will be held on Tuesday, January 21, from 1 to 2 PM ET, will tackle physician well-being and burnout head-on. Discussion topics include eliminating barriers to doctors reaching out for help, designing interventions to keep physicians healthy, providing forums for doctors that offer psychological safety, and addressing workplace violence.
Our panel includes:
Thomas Campbell, chief wellness officer, Allegheny Health Network;
Christopher Cheney, event moderator and HealthLeaders CMO editor;
Jim Gilligan, VP of health system and group partnerships, American Medical Association;
Amy Jibilian, chief wellness officer, Lehigh Valley Health Network; and
Shawn Jones, medical director of provider wellness, Baptist Health Medical Group.
This is not just another webinar—it is an opportunity to learn from the best in the business and take away strategies you can implement at your organization.
Join us as we explore physician burnout and physician well-being in depth. Help your doctors avoid the tragedy of physician burnout.
Top clinical officers at NYU Langone Health and Scripps Health share what their organizations learned from the coronavirus pandemic.
It has been five years since the first case of COVID-19 was diagnosed in the United States, and a pair of top clinical officers says there are a dozen lessons learned from the pandemic.
On Jan. 20, 2020, the first case of COVID-19 in the United States was diagnosed in Snohomish County, just north of Seattle, Washington. The ensuing pandemic exacted a heavy price on the country, with more than 111 million cases and 1,219,487 deaths reported through April 2024, according to worldometer.
At NYU Langone Health, one of the lessons learned from the pandemic was the value of preparation, according to Fritz François, MD, executive vice president, vice dean, and chief of hospital operations at the health system.
NYU Langone Health has been holding tabletop exercises for disaster scenarios once or twice a year since Superstorm Sandy in 2012.
"On Jan. 8, 2020, we held a tabletop exercise for an outbreak of a respiratory virus," François says. "The question was, what would we do? The entire organization came together to think about what we would do for an outbreak. Just a few weeks later, there was an incredible outbreak worldwide and a pandemic would be declared. We had lead time to prepare."
Several aspects of that tabletop exercise were applied during the pandemic, François says.
The health system talked about having a core group of individuals who were trained to take care of respiratory virus patients. They dedicated the ICUs as areas to care for the sickest patients, and intensivists who could take care of these patients. They talked about making sure they had the right equipment and supplies, and talked about having the right protocols to support the patients.
Lessons learned at NYU Langone Health
NYU Langone Health learned six primary lessons from the pandemic, according to François.
First, health system leaders need to think about where patients are going to go during a respiratory virus outbreak. They need to think about where respiratory virus patients are going to be placed in emergency rooms and hospital inpatient units.
Health system leaders also need to think about load-balancing patients at multiple hospitals.
"You need to consider hospitals that are being overwhelmed versus hospitals that are not overwhelmed," François says. "You have to coordinate where patients are sent."
Second, health system leaders need to think about personnel. They must determine whether they have the right personnel, not only in terms of specialists who can care for individuals with respiratory illnesses but also nurses and technicians.
"You need to think about the group of individuals who need to come together to provide care for patients," François says.
Third, health system leaders need to acquire adequate supplies of personal protective equipment (PPE) for staff members.
"We had thought about it in advance, and we ensured that all of our staff had the appropriate PPE," François says.
Fourth, health system leaders need to provide the necessary products and equipment in their supply chain. In the case of the pandemic, this included respirators and monitors.
Fifth, health system leaders must implement the proper processes and protocols. For example, there should be processes for moving patients from one area to another. Treatment protocols were a challenge during the pandemic because COVID-19 was a novel virus.
"You need to have evidence-based protocols to ensure that care is being provided effectively," François says. "Our protocols were reviewed by subject matter experts. When new data came out, we updated the protocols."
Sixth, health system leaders should focus on performance. At NYU Langone Health, this meant developing a plan to respond to the pandemic and measuring how the health system performed.
"We developed a dashboard that allowed us to understand how many patients were coming through the emergency departments, how many patients were being admitted, how many patients were in the ICU, how many patients were on ventilators, and how many patients did not survive," François says.
Standardizing care is essential to achieve a high level of performance, according to François.
"By standardizing care, we wanted to make sure that anyone who came to our health system—whether it was Manhattan, Brooklyn, or Long Island—received the same quality of care," François says. "From a health equity perspective, this was critical."
Lessons learned at Scripps Health
Scripps Health also learned six primary lessons from the pandemic, according to Ghazala Sharieff, MD, MBA, corporate senior vice president as well as chief medical and operations officer for acute care at the health system.
First, Scripps learned that the health system could ramp up telehealth services.
"Before COVID hit, we saw 188 patients through telehealth in a six-month period in 2019," Sharieff says. "In the peak of COVID, we were seeing 3,000 patients a day through telemedicine."
Second, Scripps learned the value of virtual meetings for staff members.
"We have become much more efficient in our meetings," Sharieff says. "There is value to in-person meetings, but for things that are routine such as operations meetings and updates, we are doing that effectively through virtual meetings."
Third, from a CMO perspective, Sharieff learned the value of having a regional CMO group meeting regularly during the pandemic.
"We realized early on during the pandemic that there was conflicting information from the Centers for Disease Control and Prevention, state authorities, and county officials," Sharieff says. "CMOs from across our region needed to get together, so we could have a consistent message going out to our staff."
The regional CMO group was able to join forces on advocacy during the pandemic. As a group, they were able to send a letter to the state saying that weekly staff testing was not feasible.
"There was a point in time when the state wanted us to test every staff member for COVID every week," Sharieff says. "It was not practical. We didn't have enough tests for the patients who were sick."
Fourth, Scripps understood that working as a health system rather than a collection of five individual hospitals is important during a crisis. Like NYU Langone Health, Scripps used load balancing to make sure that none of its hospitals were overwhelmed during the pandemic.
"We are much more proactive now," Sharieff says. "We learned how to pivot and move quickly."
Fifth, as a CMO, Sharieff discovered the value of working closely with the health system's supply chain.
"I recommend that CMOs across the country get more involved in their supply chains," Sharieff says.
Sixth, Sharieff learned that a CMO must be intimately involved in crisis management during a pandemic.
"A CMO should be present in the command center and not delegate that work," Sharieff says. "You need to roll up your sleeves and do the work."
SSM Health has established "foundational building blocks" to support value-based care.
The chief clinical officer of SSM Health is passionate about value-based care.
Stephanie Duggan, MD, became chief clinical officer of SSM in November 2023. Prior to joining SSM, she was president and CEO of Ascension Michigan for five years.
"I love value-based care because value-based care means we as a health system are doing our job for those in the communities we serve," Duggan says. "When we think about value-based care, it is about being there for the patients every time they need care. With value-based care, we get credit for being able to give care in a more efficient manner."
SSM has four "foundational building blocks" to support value-based care that are paired with care management programs.
Rising labor costs are among the challenges at medical groups, survey finds.
Medical groups are continuing to feel the strain of internal and external pressures, including rising labor costs as well as increasing demand and access issues, according to the AMGA.
"With a stifled reimbursement environment and continued financial pressures, medical groups are forced to double down on operations and expense management," the AMGA said in a prepared statement.
The AMGA survey includes three key findings.
First, operating expense increases outpaced revenue gains. Median investment per physician eroded for system-affiliated medical groups from $249,000 to $256,000, excluding overhead allocations.
Second, to address physician shortages and access issues, utilization of advanced practice providers (APPs) such as nurse practitioners and physician assistants has increased sharply. APP utilization has grown from 36.8% of total providers (2020 AMGA survey) to 45.9% (2024 AMGA survey).
Third, the AMGA2024 Medical Group Compensation and Productivity Survey found provider compensation was up 5.3% from the prior year. The AMGA 2024 Medical Group Operation and Finance Survey found salary and benefits increased, while other operating expenses dropped.
"This finding indicates that the portion of the company's revenue being allocated towards compensation and benefits continues to grow (as a percentage of revenue)," the AMGA said, "while expense management in organizations is focused on management of non-salary spending."
Mark LePage, MD, MBA, FACHE, is senior vice president of medical groups and ambulatory strategy at Trinity Health. Photo courtesy of Trinity Health.
Increasing labor costs
Medical groups are experiencing higher labor costs "across the board," but physician compensation has become a major driver of increased salary expenses, says Mark LePage, MD, MBA, FACHE, senior vice president of medical groups and ambulatory strategy at Trinity Health.
"We have experienced increased labor costs on the physician side and the provider side," LePage says. "There is an inherent shortage of physicians and providers across the country."
At Trinity Health and many other health systems, special circumstances are putting upward pressure on compensation for some physician specialties, LePage explains.
"For example, we have increased the sites where we are providing anesthesia services, which has further increased demand on a limited supply of anesthesiologists," LePage says. "More and more imaging is being done throughout the healthcare enterprise, so we are experiencing shortages of radiologists in some markets."
There are several strategies to offset labor costs, according to LePage, including making sure all staff members are working at the top of their licenses.
"We want to make sure that staff are doing the things that only they can do," LePage says.
Technology is also part of the solution.
"We need to look at where we can off-load work to computers," LePage says. "We need to look at places where the electronic medical record can do more of the work for us than having people do the work."
Additionally, Trinity Health has deployed AI tools to boost the efficiency of clinicians, according to LePage. The health system has adopted DAX Copilot to decrease the documentation burden on clinicians. The ambient listening AI tool records the interaction between a clinician and a patient, then generates a clinical note for the EMR.
"It allows our physicians and other providers to spend more time with the patients," LePage says.
Expenses outpacing revenue
While expenses such as labor costs have been increasing at medical groups, revenue has been stagnant or even decreasing, according to LePage.
"We have had inflationary pressure that has impacted not only labor but also real estate and supplies," LePage says. "At the same time, when you look at the Centers for Medicare and Medicaid Services (CMS) conversion factor for professional reimbursement in healthcare, that has been decreasing year after year."
To make matters worse, commercial payers have been following CMS' lead in limiting physician reimbursement, LePage explains.
Advocacy must be part of the strategy to address the imbalance between expenses and revenue.
"First, the AMGA and others are doing a lot of advocacy work with the government about how we need to change the formula for the CMS conversion factors," LePage says. "Second, we need to work with commercial payers [to advocate] for reimbursement increases that more accurately reflect the inflationary pressures we are facing."
LePage recommends medical groups increase operational efficiencies and reduce operational expenses.
"We have to manage all of the components of our operating expenses much more closely," LePage says. "For example, there is an increasing threshold for physician productivity that we need to achieve to offset inflationary pressures."
Medical groups need to contain supply chain costs and manage real estate assets effectively to decrease operating expenses, according to LePage.
Revenue cycle is another area of focus.
"Looking at the revenue cycle, we need to make sure that we capture all of the dollars that we have actually provided in services," LePage says.
APP utilization
The increased utilization of APPs reflects significant trends in the healthcare workforce and the U.S. patient population, according to LePage.
"The healthcare needs of the population are increasing as the population ages," LePage says. "We need to incorporate APPs into the care delivery model because there are not enough physicians to provide care."
Leaders at Trinity Health believe the best model for APPs in care delivery is a team-based approach, where APPs and doctors work in cooperation as colleagues, LePage explains.
"We believe the best construct is a team construct in which you have physicians and APPs working together as part of a team," LePage says. "The skills of APPs and the skills of physicians as well as the experiences of both help to augment what we are trying to do in our care environments."