medical staff development plan mapra educational conference october 9, 2015 allison mccarthy...
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Medical Staff Development PlanMAPRA Educational Conference
October 9, 2015
Allison McCarthyPrincipal
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Med
ical
Sta
ff D
evel
opm
ent
Plan
Demand/Supply
Community Health
Retirements
Provider Perspective
Competitive Dynamics
Strategic Initiatives
• Each entity and combined• Defined markets
– Entity• Primary, secondary, tertiary• Regulatory
– System
• Organizational shifts– Acquisitions– Departures
• Health reform transitions– Risk contracts– Population health
• Clinical programs
COMMUNITY NEED ANALYSISDemand versus Supply
4
Hospital Defined Markets
B oston
B rock ton
Q uincy
T aunton
W ey m outh
P ly m outh
B ra intree
R ando lphN orw ood
S toughton
M ilton
B ridgew ater
M arshfie ld
D edham
E aston
C anton
M iddleborough
H ingham
N orton
S cituate
R ock land
S haron
P em brok e
A bington
D uxbury
W estw ood
W hitm an
H anov er
E ast B ridgew ater
K ingston
R ay nham
C arv er
H ull
H o lbrook
Lak ev ille
N orw e ll
H anson
H a lifax
C ohasset
W est B ridgew ater
D ighton B erk ley
A v on
P rov incetow n
P ly m pton
Cap e Cod Bay
Cap e Cod
A tlant ic O cean
P ly mouth Bay
M assachuset t s Bay
0 3.3 6.7 10
Miles
Map layersState (High)County Subdivision
County Subdivision selection setsPrimary Service AreaSecondary Service AreaExtended Service AreaSelection:4
B oston
B rock ton
Q uincy
B rook line
T aunton
W ey m outh
P ly m outh
B ra intree
R ando lphN orw ood
S toughton
M ilton
B ridgew ater
M arshfie ld
D edham
M ansfie ld
E aston
C anton
M iddleborough
H ingham
N orton
S cituate
R ock land
S haron
P em brok e
A bington
D uxbury
W estw ood
W hitm an
H anov er
E ast B ridgew ater
K ingston
R ay nham
C arv er
H ull
H o lbrook
Lak ev ille
N orw e ll
H anson
H a lifax
C ohasset
W est B ridgew ater
D ighton B erk ley
A v on
P rov incetow n
P ly m pton
0 3.3 6.7 10
Miles
Map layersState (High)County Subdivision
County Subdivision selection setsGASH
Regulatory Defined Market
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Database of Providers
• Physicians and ACPs• Market inclusive
Service Area Definitions
• Regulatory market (GASH)• Primary service area (PSA) • Secondary service area (SSA)
FTE Refinement• Age• FTE vs. Bodies• Clinical practice
Determining Supply
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• Population size in each market region – Current and 5 year projected census estimates
• Physician-to-population ratios determine full-time equivalent (FTE) needs by specialty – blended approach
• Population estimates ineffective for hospital-based specialties• Some specialties lack unique ratios
– Vascular surgery included with general surgery– Radiation oncology– Occupational medicine– Podiatry– Oral Surgery
Demand Estimates
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• Physician-to-population ratios to determine community need– By specialty – Population by service area
• Ratio providers – GMENAC (Graduate Medical Education National Advisory Committee)
• Committee of healthcare experts convened by Congress to assess U.S. healthcare manpower needs in 1980 – still considered a valid standard today
– Managed Care• Jonathon Weiner et al. in 1994 and updated in 2004 developed estimates based on
a number of closed-panel HMOs (included more than 350 clinic sites, 33 hospitals and more than 8 million consumers)
– Solucient – regionally based• 2003 estimates based on National Ambulatory Health Care Administration,
Medical Group Management Association and private/public claims data
Demand Parameters
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GASH Population = 250,000
SpecialtyPhysician-to-
Population Ratio Demand Supply VarianceCardiology 3.9 9.8 12.0 2.3Dermatology 3.2 8.0 7.0 -1.0Orthopedic Surgery 7.2 18.0 13.5 -4.5
Nationally recognized sources
Population/100,000 x Ratio
Medical staff roster, physician directories, licensure boards, etc. Supply - Demand
How the Math Works…..
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AverageSpecialty AHP PHYSICIAN TOTAL DEMAND VARIANCE AHP PHYSICIAN TOTAL DEMAND VARIANCE Age
Family Medicine 3.60 13.00 16.60 10.04 6.56 3.60 11.00 14.60 10.18 4.42 48General Internal Medicine 0.60 1.05 1.65 8.30 (6.65) 0.60 1.05 1.65 8.42 (6.77) 57
Pediatrics 1.80 4.00 5.80 4.48 1.32 1.80 4.00 5.80 4.55 1.25 48
Obstetrics & Gynecology 1.20 3.00 4.20 3.39 0.81 1.20 2.00 3.20 3.44 (0.24) 44
Allergy & Immunology 0.05 0.05 0.37 (0.32) 0.05 0.05 0.37 (0.32) 34Cardiology 2.60 2.60 1.24 1.36 2.60 2.60 1.26 1.34 48Dermatology 0.15 0.15 0.89 (0.74) 0.15 0.15 0.90 (0.75) 49Endocrinology 0.05 0.05 0.29 (0.24) 0.05 0.05 0.29 (0.24) 32Gastroenterology 0.79 (0.79) 0.80 (0.80)Hematology/Oncology 0.42 0.42 0.87 (0.45) 0.42 0.42 0.88 (0.46) 49Infectious Disease 0.05 0.05 0.32 (0.27) 0.05 0.05 0.32 (0.27) 44Nephrology 0.05 0.05 0.36 (0.31) 0.05 0.05 0.37 (0.32) 35Neurology 0.66 (0.66) 0.67 (0.67)PM&R 0.40 0.40 0.50 (0.10) 0.40 0.40 0.51 (0.11) 58Psychiatry 1.20 1.20 3.23 (2.03) 1.20 1.20 3.28 (2.08) 54Pulmonary Medicine 0.15 0.15 0.49 (0.34) 0.15 0.15 0.50 (0.35) 42Rheumatology 0.10 0.10 0.34 (0.24) 0.10 0.10 0.35 (0.25) 40
General Surgery 3.13 3.13 2.78 0.34 3.13 3.13 2.82 0.30 49Neurosurgery 0.08 0.08 0.36 (0.29) 0.08 0.08 0.37 (0.29) 40Ophthalmology 2.00 2.00 1.51 0.49 1.00 1.00 1.54 (0.54) 51Orthopedic Surgery 0.60 3.20 3.80 1.95 1.85 0.60 2.20 2.80 1.98 0.82 50Otolaryngology 1.05 1.05 1.03 0.02 1.05 (1.05) 62Plastic Surgery 0.20 0.20 0.52 (0.32) 0.20 0.20 0.53 (0.33) 58Thoracic Surgery 0.31 (0.31) 0.31 (0.31)Urology 0.90 0.90 1.03 (0.13) 0.90 0.90 1.05 (0.15) 46
Anesthesiology 4.20 4.20 2.80 1.40 4.20 4.20 2.84 1.36Emergency Medicine 3.60 5.00 8.60 3.45 5.15 3.60 5.00 8.60 3.50 5.10 51Pathology 1.41 (1.41) 1.43 (1.43)Radiology 3.00 3.00 3.01 (0.01) 3.00 3.00 3.06 (0.06) 41
2015 2020
Note: Average age excludes physicians 65+ years.
Community Need - GASH
OTHER FACTORS
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Need for:• _________________• _________________• _________________• _________________
Medical Staff Development Plan Input
Community Health IssuesStatus Indicators (1)
Primary CareDental Care
CancerLung Cancer
Mammography ScreeningClinical Care Ranking (2)
Diabetes Incidence and ScreeningHigh Blood Pressure
Preterm BirthsMental Health
Alzheimers DiseasePoor Physical Health Days (3)
Poor Self-Reported Health StatusPoverty Level
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Panel Size
Degree of Risk
Medicare
ACO/Multiple payers
System Employees
Single Payer
Medicaid
Health Reform Engagement
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• Specialty care– Address chronic disease– Increase use of ACPs– Carefully managed transitions– Clear agreement on roles
• Other points of care– Sub-Acute/Long term care– Home/Palliative care– Behavioral health facilities
• Primary care – Diverse venues– Range of provider types– Larger panel sizes
• Diverse settings– Population based– Offices and facilities
• Manage care differently • Replace those who can’t
The Right Mix
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• NPs/PAs– Getting harder to recruit
• Pharmacists– 157k shortfall by 2020
• Others– Mental health providers– Care coordinators– Educators/health coaches
5.6
phys
icia
ns a
nd M
As
1.5 ACPs
1 Pharmacist
1.2 RNs
2.0 LPNs
Group Health, Seattle, WA
10, 000 patient panel
Change in “Who” is Needed
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• To ensure medical staff breadth and depth over time • Balance between new practitioners, mid-career
professionals and mature physicians • Ensuring equilibrium within each clinical specialty • Age 65 is a traditional point of retirement
consideration
Succession Planning
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• Medical staff specific• Industry average age =
49 years• High risk - specialties
50%+ is 60+ years • Pending risk – specialties
25-49% is 60+ years
Specialty N Avg Min Max N %Allergy & Immunology 1 34 34 34 0%Cardiology 9 48 36 56 0%Dermatology 3 54 44 65 1 33%Emergency Medicine 5 51 36 59 0%Endocrinology 1 32 32 32 0%Family Medicine 12 49 32 63 2 17%General Surgery 5 49 35 59 0%Hem/Onc 4 53 44 65 1 25%Infectious Disease 2 44 41 46 0%Internal Medicine 2 57 56 58 0%Nephrology 1 35 35 35 0%Neurosurgery 2 40 35 45 0%OB/GYN 3 44 32 63 1 33%Ophthalmology 2 51 39 63 1 50%Orthopedics 5 53 36 66 2 40%Otolaryngology 2 62 61 63 2 100%Pathology 1 65 65 65 1 100%Pediatrics 4 48 37 54 0%PM&R 1 58 58 58 0%Plastic Surgery 2 58 56 59 0%Psychiatry 3 54 49 58 0%Pulmonology 3 50 39 67 1 33%Radiology 3 41 31 55 0%Rheumatology 2 53 40 66 1 50%Urology 4 53 38 71 1 25%Grand Total 84 50 31 71 14 17%
60+
25-49%50%+
Physician Profile – Age Analysis
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Primary Care
Psychiatry/Mental Health
Timely care/access
Neurology
Appropriate referrals/coordinated care
Endocrinology
Dieticians/nutritionists
Pediatric subspecialties
Child psychiatry
Dermatology
Rheumatology
Prevention
Access for poor
Selected other specialties
0 5 10 15 20 25 30 35 40
Medical Staff Survey
# of Responses
Interview Findings
Physician Input
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Patient Choice
Capacity
Availability
Expertise
Networks
0 20 40 60 80 100 120Second opinions from outside specialists
Patient request to leave the area
Long appointment wait times in our area
Specialists in our area have full practices
We do not have the specialties in our area
Specific specialty gaps/limited options
Better clinical capability outside of the region
Superior technology elsewhere
Better hospitals elsewhere
Health plan restrictions among area specialists
Other reason
Out-of-area referral patterns
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Employed Group
Competitor #1
Competitor #2
Community Health Center
Unknown/Unaffiliated
Competitive ConsiderationsAdult PCPs by Affiliation (FTEs)
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• Increasing or decreasing• Will new physicians help• If so, which ones• Recruit, acquire or
affiliate
Cardiology
Oncology
Surgery
Ortho
Neurosurgery
Other Competitive Dynamics
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• Strategic growth plans• Market position• Medical staff perspectives• Potential physician transitions
• Population projections• Current physician supply• Projected physician demand• Community health needs
Community NeedOrganizational Need
Physician Recruitment PrioritiesPhysician Recruitment Priorities
Synthesize Findings
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• Financially supporting private practice recruitment requires two key components – Defined community need in the specialty area– Supported private practices are located within the GASH
• If not present, can still recruit but through models other than private practice income guarantees i.e. employment– To recruit in specialty areas which are strategically important but for
which there is not community need– To place physicians in markets other than GASH identified
communities
Recruitment Parameters
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CriteriaWeight
Ranking (1=Low; Med=3;High=5)Internal Medicine 0 0 5 1 5 1 5 1 3 0.6 3.6
Urology 5 1 3 0.6 5 1 1 0.2 3 0.6 3.4Family Medicine 0 0 5 1 5 1 5 1 1 0.2 3.2
Pediatrics 0 0 5 1 5 1 5 1 1 0.2 3.2Cardiology 5 1 0 0 5 1 1 0.2 3 0.6 2.8Psychiatry 0 0 0 0 5 1 5 1 3 0.6 2.6
Ob/Gyn 5 1 0 0 3 0.6 3 0.6 1 0.2 2.4Cardiovascular/Thoracic Surgery 5 1 0 0 5 1 1 0.2 1 0.2 2.4
Endocrinology 0 0 5 1 5 1 1 0.2 0 0 2.2Hematology/Oncology 5 1 0 0 5 1 0 0 0 0 2
Neurology 0 0 5 1 5 1 0 0 0 0 2Orthopedic Surgery 5 1 3 0.6 0 0 1 0.2 1 0.2 2
Pulmonary Medicine 0 0 3 0.6 5 1 0 0 0 0 1.6Dermatology 0 0 0 0 0 0 3 0.6 5 1 1.6
Gastroenterology 0 0 0 0 3 0.6 0 0 1 0.2 0.8Infectious Disease 0 0 0 0 3 0.6 1 0.2 0 0 0.8
Ophthalmology 0 0 0 0 0 0 1 0.2 3 0.6 0.8Physical Medicine & Rehab 0 0 0 0 3 0.6 1 0.2 0 0 0.8
Allergy/Immunology 0 0 0 0 0 0 2 0.2 5 0.5 0.7Otolaryngology 0 0 0 0 0 0 3 0.6 0 0 0.6Rheumatology 0 0 0 0 0 0 1 0.2 0 0 0.2
Nephrology 0 0 0 0 0 0 0 0 0 0 0Plastic Surgery 0 0 0 0 0 0 0 0 0 0 0
Final Priority Level
GASH Need (System)
20%
Succession Planning
Need20%
CHNA Need20%
Service Line Growth Target
20%
Physician Expressed Need
20%
Weighted Priorities
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Specialty Year 1 Year 2 Year 3Internal Medicine 5 5 4Ob/Gyn 3 3 2Pediatrics 1 1 1Total Primary Care 9 9 7
Allergy/Immunology 1Cardiology 1Endocrinology 1 1Gastroenterology 1 1General Surgery 2 2 2Hem/Onc 1 1 1Infectious Disease 1Orthopedic Surgery 1Psychiatry 1 1 1Rheumatology 1Thoracic Surgery 1Total Specialty Care 8 8 6
Total Annual Recruits 17 17 13
Annual Recruitment Recommendations
Your Expertise
Converting to Recruitment Plan
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1. Degree of priority – strategy, access, availability, etc..
2. Employment or income guaranteea. Budgeted dollarsb. Prior experience – management,
billing, staffing
3. Practice location identifieda. Space - existing vs. newb. Colleagues and staff – “fit”
needsc. Management capacity and
expertise
4. Support requirementsa. Marketingb. Hospital services – operating
room, beds, ancillaries
5. Development potential a. Pent-up demand b. Referral basec. Competitive edge
6. Recruitment factorsa. In-house capacityb. Experiencec. Budgetd. Time to recruit
Recruitment Planning Criteria
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Recruitment Roadmap Specialty Practice Location Reason Start Date Recruiter Approved Team
Members
Family Medicine
ABC Group Ostrow Replace July 2016 A. McCarthy Yes Dr. ADr. B
Pedi NP XYZ Group Minnie Add Now K. Barlow Yes Dr. MSally M.
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• MSDP more than community need• Capture all influencing factors• Team involvement• Regular updates• Benefits to recruitment
– Bring in your expertise– Understand the “why” behind the recruit– Proactive vs. reactive approach – Longer range perspective
Conclusion
