It takes more than money for hospitals and health systems to motivate and retain employed physicians, says a senior executive at Catholic Health Initiatives.
More doctors are leaving private practice for positions in hospitals and health systems—and they report the new model of doing business looks promising. The benefits of being of an employed physician are anticipated to include "improved communication, greater transparency, better physician job satisfaction and a more patient-centered focus," says a survey by the American College of Physician Executives.
"It's the reality, and healthcare needs to accept this reality," said Peter B. Angood, MD, CEO of the ACPE. "Everything is moving in the direction where physicians want to be employees…I'm not a zealot of it, but it's a phenomenon that's happening, and we need to embrace it."
A 20-question survey sent to 10,000 members of the ACPE was completed by 617 respondents. Of those, 59 percent said that at least 50 percent of the physicians in their healthcare organization were directly employed—and 18 percent of the respondents said all physicians in their organization were directly employed.
Not Like the 1990s This isn't the first time the healthcare industry has trended away from private practice and toward hospital-employed physicians. In the early 1990's, physicians began flocking to healthcare organizations as a part of the Managed Care trend, which later fizzled out amidst a consumer backlash citing decreased quality of care and allegations of withholding necessary medical procedures to cut costs.
Angood says the current push toward employed physicians is different. "It seems both the physician workforce as well as healthcare systems are committed to not having the same issues pop up as did in the early 1990's," he said, adding that many of this generation's physicians are happy to take advantage of focusing on treating patients and to take advantage of the improved work-life balance that working for a hospital or other organization offers.
"It's getting harder and harder to manage your own practice. Smaller groups don't have the capital, and banks don't want to lend money for these things," T. Clifford Deveny, MD, Senior Vice President, Physician Services and Clinical Integration at Catholic Health Initiatives, said.
In addition to freeing themselves of duties related to finances, marketing, and other administrative physicians frequently find benefits packages in large organizations superior to anything they could obtain in private practice, with traditional benefits such as paid time off, competitive health insurance and retirement savings programs, and in some instances, "boutique" benefits such pet health insurance or concierge services.
Tradeoffs
"Traditionally, a physician is trained to be an independent thinker and do what they think is best, but integrated systems are there for the benefit of the patient, not the practitioner," Deveny said. "I've always been cautious to say whether employing physicians will improve their jobs."
Deveny also expressed concerns about physicians feeling like they were simply a cog in a machine, rather than a doctor actually treating patients. "When the IT guy or finance person doesn't meet your needs, you get frustrated," he commented.
A very real issue is ensuring that physicians feel a sense of purpose and that they are valued by the organization that employs them. While only 20 percent of those who responded to the ACPE's study disagreed that the physicians employed by their organization were satisfied by the current employment model, some remain skeptical.
"This is still too new. The growth has been too dramatic in the last two to three years. People are still trying to figure out who is their partner and what they're all about," said Deveny, pointing out that after mergers and acquisitions, many physicians now work for strangers who did not hire them and are still trying to figure out their place within their systems.
More Than Money While some might jump to the conclusion that paying physicians better is a way to keep them satisfied at work, the survey results were sharply divided. Only 32 percent of those who responded to the survey said their organizations used financial incentives to motivate physicians to be actively engaged in the financial success of the organization.
"It's not just all money," Angood said. "Physicians want to be engaged in the decision making process and have access to the data and info the health system has. They are very data-driven, want to create change based on data and participate in discussions around how to create the change."
Deveny contends that money isn't always the motivator that will keep physicians satisfied and engaged in their jobs. "You have to offer more than money. They want a meaningful role in the direction of the organization," he said.
"It may sound corny, but an organization that gives them a sense of purpose, like a faith-based organization or a high-performing organization, makes them feel like they're part a greater good. At the end of the day, humans want to be loved."
HR is traditionally not considered a source of strategic organizational power, but HR teams within hospitals and healthcare systems are uniquely equipped to lead healthcare organizations through this unprecedented time of transition.
Whatever your role in healthcare, you're keenly aware that the industry is experiencing great amounts of change right now. Legislative reforms and new regulations are pushing the business of healthcare forward at an unprecedented pace. In many cases, the industry is moving into uncharted waters, and employees are along for the ride, whether they want to be onboard or not. In such a situation, it is absolutely necessary to have strong leadership.
But who should be leading?
Human resources is uniquely poised for this role, being well-versed in employment law, and attuned both to the organization's staffing needs and the needs of its staff as well. While HR is traditionally not the place organizations turn to for strategic ideas, HR teams within hospitals and healthcare systems are uniquely equipped to lead and to influence other leaders through the difficult transitions the industry is currently facing.
Not Just Paper Pushers Long gone are the days when HR staff simply administered the hiring process, worked to get payroll turned in on time, arbitrated employee disputes, and made sure the cafeteria was a pleasant place to eat lunch. Since the early 00's, however, HR's job throughout many different industries has been moving toward a more consultative role.
"I think the HR role has really changed over the last couple years," Tedd Trabert, Chief Human Resource Officer at Health Choice Network in Doral, FL. "We've become a partner to the organization. We're like a rudder, guiding the organization and navigating the waters of policy. And who better to guide the ship than HR professionals?"
Lynette Walker, Vice President of Human Resources at Baptist Health in Lexington, KY., agrees. "This is an exciting time for human resources." Today's HR staff gets to blaze the path and set precedents for future generations of HR staff—how much control over an organization's culture and workplace will an HR department have twenty years from now? This is especially true in healthcare organizations, where increased regulation and changing demographics are making someone with a working knowledge of employment law and [the] ability to work with a wide variety of people a valuable commodity.
HR as a Partner "In years past, we were the enforcer—going to HR used to be like being sent to the principal's office," remembers Trabert. But that's changing. If an organization is being effectively run, human resources shouldn't be seen as the disciplinarian within the group, he says.
"We shouldn't be seen as an enforcer of the rules. Employees should see us as more of an aid than an enforcer."
Walker echoes this. "I hope we're viewed as a partner, considered collaborative with the rest of the business, helping them with new programs and business ventures. We want to be your partner to help guide you on things that you need to consider," she said.
Some of the duties HR can take on include making sure all employees understand and can adhere to new laws, setting up trainings to bring everyone up to speed with new technologies, and coordinating internal transitions.
HR can also provide a reality check, explaining to the leadership team what is possible from both personnel and legal perspectives. Of course, while doing this, they also have a responsibility to the organization to ensure that the mission statement remains intact, and that the culture continues to be sound, healthy, and positive.
While these are important functions in any industry, it is doubly true in the healthcare industry. The reforms and mandates being implemented now will forever change the employee culture within healthcare organizations. "[There is] a lot of change happening all at once. It's a stressor to most cultures," Walker told me.
The Human Face of Reform The new importance of electronic health records systems, the move from fee-for-service to value-based care, and the large volumes of new patients to treat are going to have a direct effect on all providers, to some extent. Someone needs to take charge in setting the right tone in the face of these changes.
Walker agrees that HR should take a proactive role not only in making strategic decisions and working to stick to new policies, but also in being the human face of reform and explaining the new ways of doing things in a way that all employees can understand.
"One of our jobs as HR professionals is getting staff members to understand why the changes are being made, and that it's not because we're trying to make them miserable. There's a method to the madness," she said. "This is another role HR can play a big part in. How do you maintain the culture that you have with all the changes going on?"
The human resources department is the first line of defense in helping to change a culture, Trabert says.
"We can totally influence how easily they will assimilate to a new policy. If you have a culture of telling employees both the positives and the negatives of changes as they come up, they will be more able to accept it. They look to HR as the policy makers and for guidance."
CMS Administrator Marilyn Tavenner has announced that the ICD-10 deadline will not be delayed, but she is offering relief to providers, payers, and health information technology vendors struggling to meet Meaningful Use Stage 2 requirements.
Two announcements from Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner at the HIMSS 2014 conference in Orlando Thursday will have wide-ranging implications for healthcare providers, insurers, and vendors.
The deadline for implementing the ICD-10 diagnostic coding set, which had already been delayed one year to October 1, 2014, will not be delayed again, Tavenner said.
And while the Stage 2 Meaningful Use deadline will also not be delayed, Tavenner said that providers and vendors struggling to meet the incentive program's requirements will see some flexibility.
During the keynote presentation Thursday morning at HIMSS 14 in Orlando, Tavenner announced a partial reprieve for physicians and medical systems finding it difficult to adjust to Meaningful Use guidelines—but urged professionals to come up to speed quickly.
"We have decided to permit flexibility on how hardship exemptions will be granted," Tavenner said. "I must stress we expect all providers to meet requirements in 2015. I urge you to meet the requirements this year." Scattered applause broke from members of the crowd as Tavenner made the announcement.
"We certainly have experienced… difficulties, and I can personally relate to the challenges of new systems, relationships with vendors, and charting a course through previously unnavigated waters," Tavenner said, referring to the well-documented difficulties with the healthcare.gov website.
When confronted by a question regarding patient safety during the Q & A session after the keynote, National Coordinator for Health Information Technology, Karen DeSalvo, said, "We are exploring our options to help you… we want to make sure you are not penalized for doing the right thing."
These comments come at a time when many within the healthcare industry are expressing concerns regarding the ability to adopt the Meaningful Use standards as specified in the HITECH act. On the Friday before HIMSS, more than 40 healthcare industry groups penned a letter to Health and Human Services Secretary Kathleen Sebelius seeking more time for Meaningful Use attestation, and citing concerns over patient safety and lack of vendor support.
On Thursday, in an exclusive interview with HealthLeaders Media, Intermountain Healthcare CIO Marc Probst disclosed that his organization is unready to seek MU Stage 2 attestation and will forgo incentive payments and trigger penalties.
'It's Time to Move On' While concerns from within the industry are being taken seriously, there will be no turning back. While CMS will be offering exemptions on a case-by-case basis, "Now is not the time for us to stop moving forward," Tavenner said. She was especially unyielding regarding the new ICD-10 coding system.
"Let's face it guys; it's time to move on," Tavenner said. "There will be no change in the deadline for ICD-10. CMS began installing and testing systems for ICD-10 in 2011. All fee for service systems at CMS are ready."
Earlier this month, in response to concerns raised by providers and a group of U.S. senators, CMS agreed to perform end-to-end ICD-10 testing with a small sample group of providers selected to represent "a broad cross-section of provider types, claims types, and submitter types."
The College of Healthcare Information Management Executives (CHIME) responded to Tavenner's comments at HIMSS in a statement released shortly after the keynote speech.
"[CHIME] welcomes CMS Administrator Marilyn Tavenner'sannouncement this morning, acknowledging the need to provide relief for our nation's providers. Such relief is vitally important for the future success of Meaningful Use, as ICD-10 deadlines and continued shifts in payment policies demand an ever-increasing amount of IT and workforce resources," the statement read.
In the event that expansion of the Hardship Expectations provides the "kind of relief the industry desperately needs," CHIME will pledge to assist CMS "in every way possible," the statement continued. "It will be CHIME's highest policy priority to ensure that providers receive the kind of relief they need in order to deliver quality care."
In a letter citing concerns for patient safety and a lack of vendor support, more than 40 physicians groups and medical associations are urging HHS Secretary Kathleen Sebelius to allow more time for Meaningful Use attestation.
A coalition of more than 40 physicians groups and medical associations is calling for additional time to meet the goals of the Meaningful Use program. In a letter to U.S. Health and Human Services Secretary Kathleen Sebelius Friday, the group asked for "additional time and new flexibility" to implement electronic health record systems.
The letter was released as the 2014 HIMSS conference was about to begin in Orlando, FL.
"We recognize the vital role your department has taken in advancing the adoption of health information technology in the United States and appreciate your willingness to be flexible in extending the start of Stage 3 to 2017," the letter said. "We fear the success of the program is in jeopardy, however, if steps are not taken now to address our shared concerns."
More than 5,000 hospitals and 550,000 eligible professionals must adopt the 2014 standards to meet the threshold of meaningful use criteria in the next seven months. The authors of the letter, which include the American Hospital Association, the American Academy of Family Physicians, the American Medical Association, and the National Rural Health Association, consider the federal timeline unreasonable, and say that vendors cannot keep pace with provider needs.
"With only a fraction of 2011 Edition products currently certified to 2014 Edition standards, it is clear the pace and scope of change have outstripped the ability of vendors to support providers. This inhibits the ability of providers to manage the transition of the 2014 Edition… in a safe and orderly manner," the letter said.
It strongly recommended that HHS extend the deadline to meet Stages 1 and 2 through 2015 and "add flexibility in Meaningful Use requirements to permit as many providers as possible to achieve success in the program."
Leaders of the organizations that signed the letter echoed these sentiments.
"The AMA is increasingly alarmed that the meaningful use program continues to move full steam ahead without regard to the challenges faced by physicians, hospitals and vendors during the past few years," said AMA President Ardis Dee Hoven, M.D. in a statement.
"Continued difficulties experienced in the current program are a clear sign that federal requirements must be revised. Greater flexibility for physicians is needed to meet the meaningful use requirements and avoid unfair penalties, and less proscriptive certification criteria will help vendors better focus on the clinical needs of their physician customers."
Chantal Worzala, PhD and director of policy at the American Hospital Association, expressed concern about safety in a statement issued by the AHA. "Hospitals are working earnestly towards the goal of care transformation that is supported by safe and effective information systems. The AHA and other organizations signing [the letter] understand that HHS has the same goal. However, we are seeing that as many as 40 percent of hospitals could be at risk of missing the 2014 certified EHR adoption and meaningful use requirements if they remain the same. We urge HHS to provide the flexibility needed to help these hospitals pass the finish line safely."
"Physicians need more training and education to learn how to best deploy and use the EHR systems they are purchasing," Hoven said. "We have to recognize that if you require EHRs to be all things to all people —regulators, payers, auditors, lawyers—then it diminishes its ability to perform the most critical function—helping physicians support their patients."
