What Right Looks Like
5 Tips for High Impact Physician Goals
with David Dunlap, President and CEO; Dr. William Carroll, Chair, Dept. of Orthopedic Surgery; and Dr. Priscilla Holtzclaw, Chair, Dept. of Family Medicine; Roper St-Francis Healthcare
When Roper St. Francis Healthcare—a system with more than 90 clinics in Charleston, SC—doubled the number of its employed physicians in 2009, cracking the code on physician alignment and accountability became top priority. (The organization currently performs in the top decile of physician and employee engagement, with many Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) composites above the 90th percentile.)
Four years ago, Roper St. Francis began using Studer Group's Leader Evaluation Manager® (LEM) software to identify and track objective, measurable goals for its leaders, including hospitalists. "Since all leaders were already being evaluated on the LEM, it was a natural next step for us to move all physicians and providers to Studer Group's new Provider Feedback System," explains David Dunlap, president and CEO at Roper St-Francis. "Metrics are designed uniquely for physicians." (The Provider Feedback System (PFS) is an adjusted version of the LEM that is physician-centric.)
5 Tips for Getting it Right
#1: Begin the transition sooner rather than later.
Don't wait until maximum reimbursement penalties under Medicare's Value-Based Purchasing Program hit in FY2014. Give physicians time to adjust by beginning performance feedback now.
At Roper St. Francis Physician Partners, the orthopedic group took the lead on their own. "We collectively decided it was our job to advance the orthopedic line for quality patient care," explains Dr. William Carroll, chair, Dept. of Orthopedic Surgery at Roper St. Francis Mount Pleasant Hospital and chair of the Physician Partners Communication Committee. "So all the orthopedic specialties came together and decided on performance metrics (e.g., overall quality of care for physicians, SCIP VTE)."
#2: Use individual feedback to drive broader goals.
Frequently, Studer Group finds gaps in the ways goals cascade between the organization and physician practice patterns. And often, these occur in two key drivers of organizational financial performance: cost efficiency and patient perception of care. "Our hospitalists reduced length of stay for observation patients (with LOS greater than 24 hours) by 60 percent over two years," adds Dunlap. "This was a direct result of ensuring their individual evaluation goals were aligned with those of the organization to track performance on this metric."
#3: Sometimes, less really is more.
Avoid the temptation to inundate your physicians with too many (or wildly complex) goals. Having data isn't the problem. In fact, we are often data rich and knowledge poor! Making the measures meaningful is the challenge. That's why Studer Group finds that six to 10 metrics are plenty. "Physicians—and all leaders—want goals that show clear priorities with actionable information so they know where to focus and how to have an impact," explains Dan Smith, MD, Studer Group's medical director.
#4: Engage physicians in metrics selection.
Physicians must be involved in which metrics have the most meaning. After all, providers drive so much of bottom line financial performance. Once an appropriate "menu" of metrics has been developed that reflect organizational priorities, gain buy-in and focus by asking for input (e.g., "Which of these metrics best represents the quality outcomes you deliver as an ED physician?")
#5: Establish both common and personalized measures.
The most effective approach is a combination of goal metrics that are common across the organization (e.g., CAHPS), and individualized according to medical specialty (e.g., rate of return to primary care providers). Weights also vary. For example, post-surgical infection rates might be weighted heavily for surgeons because of the financial impact to the organization. (Tip: Weight a goal at least 30 percent to reflect urgency.)
And most importantly: Move away from the "rear view mirror approach." Physicians don't want to hear about what they should've done differently at year-end when it's too late. They want regular feedback about what they can do now.
"By nature, physicians are competitive and data-driven," explains Roper Chair of Family Medicine Dr. Priscilla Holtzclaw. "They want to be a '5' on every performance metric. If you give them baseline data early, provide evidence for best practices, and coach them with tools and training, you will achieve exceptional outcomes for your community and organization."