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Journal of ASPR - Winter 2013 - Planning in the midst of reform
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Medical staff development

Planning in the midst of reform

By Jennifer Moody, Managing Principal, AmeriMed Consulting, Fort Worth, TX

In the midst of significant health reform, physician recruiters are juggling many priorities as hospitals and clinics scramble to ready for the coming changes. Physician integration, electronic health records implementation, and physician satisfaction duties are just some of the responsibilities being added to the recruitment mix. Now more than ever, recruiters need a comprehensive medical staff development plan that provides a clear direction and withstands federal scrutiny. A good plan should take into account not only recruitment priorities but federal compliance guidelines, necessary elements for successful onboarding of new practitioners, hospital retention efforts, and phased succession planning.

Now more than ever, recruiters need a comprehensive medical staff development plan that provides a clear direction and withstands federal scrutiny.

The first key to having a successful plan is having a full inventory of existing practitioners in the market. It’s important to have an inventory that is unbiased toward hospital loyalty and considers the physician’s practice scope within the full service area. To compile a full inventory, several baseline data sources should be used and practice styles should be directly verified with physician practices. Other factors such as subspecialization, time spent in clinic locations versus procedure locations, acceptance of new Medicare and Medicaid patients, and appointment wait times should be documented as well, painting a much clearer picture of the medical landscape. Pure headcounts can often mask access issues within a market.

Once an inventory of practitioners is completed, it should be compared on a population-basis to what may be typically found in a similarly sized market. It is important to remember that ratio comparisons don’t often tell a complete story. These figures are based on averages — and while using several will generate a reference range for typical norms, there may be valid reasons to be below the norms and have a well-served medical community. Conversely, there are often legally permissible reasons for a community to have an apparent surplus of physicians and still need to recruit.

It is important to remember that ratio comparisons don’t often tell a complete story.

One issue often raised in the wake of health reform is whether the population ratios will adjust now to fit the growing demand for health services. Some ratio models have always assumed access and coverage for the full population, while others have been based on the overall US supply of physicians on a population distributed basis. Use of these types of ratios is appropriate for planning for the immediate future since federal legal guidelines for community need exist to encourage a fair and equitable distribution of physicians across communities. Likewise, while it’s tempting to add allied providers to the mix of practitioners when calculating need, their inventories should be maintained on a parallel basis and not added into physician numbers when using physician-to-population ratios. Allied providers and their utilization style within individual specialties and/or practices should always be considered on a qualitative basis, however, as they may help alleviate access concerns or increase the intake of new patients (and reducing wait times for appointments).

Documentation of need whenever the population need does not readily support it requires close observation of legal guidelines. Hard data showing lack of access with existing providers should be obtained, such as validation of wait times being outside of norms for the specialty, lack of access for specific payors that can be remedied by new physicians, or continuation of critical services to the community through physician coverage for emergency call. It’s important that data be collected as widely as possible — surveying all members of the medical staff, for example, or interviewing a cross-section of physicians to obtain opinions on access and referral issues. The information used should be replicable — i.e. if a random cross-section of physicians from your community were sampled, would the same issues be reported?

Documentation of need whenever the population need does not readily support it requires close observation of legal guidelines.

Finally, it’s important to consider the immediate future. For Julie Goetz, senior physician recruiter for Salina Regional Health Center, Salina, KS, the plan is helping guide strategic planning. “As health care changes and it becomes more important for hospitals and physicians to integrate, we use our medical staff development plan as a tool to formulate an integration strategy with both physicians and other critical access hospitals in our region. The plan allows us to start conversations with other stakeholders on the medical staff needs now and in the future, ensuring patients are getting the healthcare excellence and access they need and deserve.”

Planning up to 36 months out can be supported on a legal basis so a three-year look forward at both changes in the service area patient population (such as growth, aging, or other significant demographic shifts) as well as in the physician population can create additional needs that are legally justified. Particularly with physician succession planning, it’s important to remember that a physician’s total practice style should be considered. Often, it is appropriate to begin succession recruitment well before retirement if other practice style changes such as reduction/elimination of call, closure to new patients, or practice scope limitations start occurring in a physician’s final practice years.

The medical staff development plan should be a guiding tool for discussions about not only recruitment, but other service line and physician practice decisions. Annual updates to the plan are important to keep the inventory of physicians current. Plans should be redone completely at regularly scheduled intervals to ensure that the baseline for need assumptions is fully reconsidered no more than every three years. The data that a solid plan provides can help ease many of the concerns that healthcare organizations have in today’s changing environment.

Journal of ASPR - Winter 2013

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