This article appears in the November 2012 issue of HealthLeaders magazine.
At one time, compensation may have been a sleepy activity—administrative at its core, but hardly routine. The foundations for compensation are the written and unwritten agreements between employer and worker. At the executive level, both the demands and the compensation tend to be greater, and so it is essential to lay out clear expectations and a commensurate set of incentives.
As the healthcare industry shifts from a fee-for-service foundation to one of value-based purchasing, executive compensation programs are affected, as well. Most enterprises attempt to base a portion of compensation on performance, providing a mechanism for emphasizing one's role in helping the organization meet its objectives. Leaders contributing to the 2012 HealthLeaders Media Executive Compensation Survey indicate that, overall, 80% of their compensation is base salary, while 10% is an incentive payment. The rest is retirement and noncash compensation.
Of the four items mentioned most frequently as being the basis for incentives, two are conventional financial targets—operating margin and financial efficiency. The other two are care performance metrics—clinical quality and patient satisfaction. As one would expect, more executives with clinical responsibilities cite clinical performance as an incentive. But patient satisfaction and clinical quality are among the top four items mentioned by individuals with administrative, operations, and finance responsibilities, as well as those with clinical responsibilities.
"With a move toward more of a value-based system, there should be more of a focus on at-risk compensation, moving toward a system where all of us—doctors, hospitals, and providers—are going to be taking on more financial risk in addition to the clinical risk of caring for patients," says Jeffrey M. Fried, FACHE, president and CEO of Beebe Medical Center, a not-for-profit health system serving Sussex County, Del., from a 210-licensed-bed hospital in Lewes and six other locations.
For this year and next, a financial measure, operating margin, tops the list of objectives on which incentives are based. The second- and third-most mentioned items are patient satisfaction targets and clinical quality targets. Even though 72% of respondents from health systems use clinical quality measures as incentives, 72% of that industry setting also use operating margin. But the ascendance of clinical measures as incentives is not a big-enterprise phenomenon.
"Whether it is a big system or a small system or a standalone hospital, we are going to have to be good at tracking performance measures, and tracking how we are performing, and providing incentives for people to achieve the levels that we want to achieve," says Fried, an Intelligence Report advisor. "Everybody is going to have to be good at that, or they are not going to survive."
Nearly all respondents (95%) agree completely or agree somewhat that their organizations need more incentives based on clinical quality performance. Dianna Grant, MD, vice president of medical management and chief medical officer of the 169-licensed-bed Advocate Trinity Hospital, which serves southeastern Chicago, says that incentives based on clinical performance are as important as financial measures. "We have demonstrated that if you do the right thing, you are going to make the financial measures," she states. But Grant cautions that finance executives may have a different perspective because, one way or the other, the financial foundation for much of the industry will continue to be based on patient revenue and cost accounting.
Executive skills in flux
The shift to value-based purchasing also is reflected in respondents' appraisals of skills executives need for success in the future. Ability at cost containment and achieving performance top the list of skills that support a non-CEO executive's success both today and in the five-year time frame. Skills deemed to be more in demand in the future will be the ability to optimize results along a continuum of care and the skills in physician alignment.
Now and in the future, chief executives need physician alignment skills, which are considered by 62% of respondents to be among the top three skills needed for a CEO to be successful. The second-most frequently mentioned item—skills at performance metrics—was mentioned by only 39%, which underscores the importance of the top item.
"If you are working in healthcare, obviously the ability to get along with physicians is a pretty important quality," says Paul Hensler, CEO of Kern Medical Center, a 222-bed acute-care county-owned teaching hospital in Bakersfield, Calif. "There is a strategic aspect to alignment: the CEO strategically thinking about the things that result in strong physician alignment for the future. Some of the things that are important for alignment sometimes are not very popular. You are taking people whose training and background is largely independent and trying to get them to come together as a team and work for the common good. The hope is that by building a better institution, their individual welfare is improved."
Increasing in importance in the future for CEOs will be skills at mergers and acquisitions, the ability to structure contracts for risk sharing, and leading the organization to provide services along a continuum of care. Judy Brown, executive vice president and chief operating officer for East Jefferson General Hospital, a 420-licensed-bed community hospital serving Metairie, La., explains that a broader set of collaborators requires a broader set of skills.
"You need to understand care partners' businesses and service lines, how they impact the health of the patient, how the care is given to the patient, and where the best place to give the care is," Brown says. "This means aligning with physicians and other partners, third parties along the continuum. Relationships are going to be very important."
As one might expect, most organizations have specialized needs. Alan Fisher, FACHE, CEO of the 40-bed Advanced Specialty Hospital of Toledo, a long-term acute care facility in Ohio, expects that, because of competition, CEOs will need marketing skills.
"The public is becoming more savvy," he says, "and they are looking for quality outcomes. Because of the competition we have in the specialty hospital space, it will be imperative in the future for a hospital to have sound benchmarking and quality programs, to demonstrate to the market that this model of care may be best suited for hospital systems by assisting in reducing their 30-day readmissions"
Increases expected
Half of the executives in our survey (53%) expect total compensation to increase next year. For most (56%), the amount of increase will be relatively modest, 3% or less. One-third (34%) will see increases of 4% or 5%. One-third (37%) expect no change in compensation in the coming year. Although the expectation of reduced reimbursements is challenging the industry to deliver more for less, it is important to remain competitive with compensation. As the incentive proportion of compensation increases, overall compensation may become more volatile, with the result that fewer will see standard year-to-year increases and some may experience declines from one year to the next.
Factors to manage in short- and long-term
Overall, 89% or respondents agree completely or agree somewhat that annual incentive milestones may be too short, and that time periods longer than a year may provide a better match with performance in light of the industry's shift in emphasis to overall population health.
Especially considering the nation's long-term financial slump and what can be at times a highly charged political discourse, healthcare executive compensation earns a degree of public attention. More than one-third (39%) agree completely or agree somewhat that the public's desire for transparency hinders their ability to offer competitive compensation packages. And more than half (53%) agree completely or agree somewhat that their need to focus on cost containment hinders their ability to offer competitive compensation packages.
"There will be pressures from outside organizations and the community," says Kenneth S. Lewis, MD, JD, CEO of Union Hospital of Cecil County, a 122-bed not-for-profit acute care hospital in Elkton, Md. "It will continue to be an area that is closely watched in all industries, and even more so in healthcare, as there are increasing pressures to ratchet down costs."
Also, more than half (53%) say the stalled housing market presents executive recruiting problems.
A fundamental change in compensation
Lewis sums up how the shift to value-based purchasing is driving a fundamental change in the basis for executive compensation: "Revenue always was a surrogate for growth and productivity. Now, what we are really looking for are measures of efficiency, good patient outcomes, cost management, and operating margin."
Boards are modifying executive compensation programs accordingly, linking broad strategic directions to specific objectives. Although there is general acceptance of the concept of value-based purchasing, many organizations will be challenged by various organizational and operational tactics, executive compensation included.
This article appears in the November 2012 issue of HealthLeaders magazine.
This article appears in the October 2012 issue of HealthLeaders magazine.
For many healthcare leaders, it's a case of easier said than done.
"Hospitals are real good at identifying expenses and cutting them," says William Cors, MD, MMM, FACPE, chief medical quality officer at the 185-staffed-bed Pocono Medical Center of East Stroudsburg, Pa. "But if they are so good at it, why doesn't it ever solve the problem?"
There are three principal levers that business leaders can pull to reduce costs, and respondents to the 2012 HealthLeaders Media Cost Containment Survey use all of them. First, one can reduce the amount spent for items. Second, one can issue and enforce a spending target by edict. Third, one can operate more efficiently. Of the three, operating more efficiently may be the most challenging to implement, but may offer the best opportunity for sustainable gains.
It's a classic: Supply-chain efficiencies
Nearly one-third (30%) of leaders saw their greatest cost savings in the prior fiscal year from supply-chain efficiencies, and virtually the same percentage expect supply-chain efficiencies to be their biggest contributor to savings in the current year. The savings can be substantial: One-fifth (21%) of respondents reported supply-chain savings in excess of 10%.
Although negotiating with suppliers is hardly new, purchasers have been newly empowered by industry shifts toward value-based purchasing and the certainty of reduced reimbursement. These fundamental shifts prompt healthcare organizations to examine cost factors with new resolve. In addition, changes in reimbursement are prompting a trend toward consolidation, and the resulting larger organizations have more leverage when consolidating their purchases.
Nickolas A. Vitale, executive vice president and chief financial officer of Beaumont Health System—a three-hospital system based in Royal Oak, Mich., with revenue of $2.1 billion—has seen substantial supply-chain savings by implementing a single systemwide pharmacy formulary; previously the three Beaumont hospitals had ordered pharmaceuticals independently. Savings in 2010 were in excess of $1 million. "In 2011," Vitale says, "we were able to negotiate an additional $3.4 million per year by going to a common formulary and bidding it out as a system."
Labor costs and labor efficiency
In most hospitals, labor is the largest single expense, but labor is not an attractive target for cost cutting, at least via layoffs or reductions in force. Few groups on the clinical team correlate to patient volume as closely as nurses, so administrators are loath to trim nurse positions. Nearly one-fifth (18%) of respondents expect to eliminate administrative staff at the VP-level and up in the next fiscal year, and more than half (51%) expect to reduce the numbers of other nonclinical personnel, but only 11% will be reducing nursing FTEs.
Thomas Selden, FACHE, president and CEO of Southwest General Health Center in Middleburg Heights, Ohio—a 354-bed organization with 2011 total revenue of $285 million—looks at just about every cost-saving effort as a nurse-saving effort: "I do that calculation in my head: How many nursing jobs can I save if we save on some process?"
Labor reductions and efficient use of labor are related, of course. The proportion of respondents who expect that their top cost-containment savings for the current fiscal year will come from labor reductions—21%—is exactly the same as the number who expect top savings from labor efficiency. "Those two really go hand in hand," says Vitale. "You can't really capture reductions until you are using the labor you have more efficiently."
Administration: Friend or foe?
Budgets come from administration. Patient care comes from the clinical staff. Traditionally, the groups are not inclined to work closely, so in some organizations, closeness becomes someone's job. At Pocono Medical Center, that is part of Cors' responsibilities.
"We have the traditional finance-driven budget process and then we have a clinical-driven examination of how we are actually providing care," Cors says. "Part of my job is to bridge the chasm between the finance department, which isn't even in the hospital—it's four blocks away—and the clinicians, who come to work through the hospital's side door by the medical staff lounge." Mentioned by 19%, survey respondents say physician-hospital relationships represent the biggest barrier to achieving sustainable cost reductions, which is second only to government mandates (27%).
Fundamental healthcare industry changes such as new regulations, the shift to value-based purchasing, declining reimbursements, and merger and acquisition activity are challenging working relationships. Says Cors, "With these changes, people are scared, they are uncertain. We can see the nature of conflict going off the scale on physician-hospital relationships. Hospitals that successfully navigate physician-hospital relationships will do well, and the hospitals that do not will not." A principal tactic used by Cors and Pocono in pursuit of efficiency is care coordination. "We are taking a service line approach, bringing together disparate elements that might touch the same surgical patients during their stay. By coordinating better, we will be looking at some significant changes in our work process and therefore our costs."
Process variation and process efficiency
"On a year-after-year basis," says Selden, "I find the efficient use of labor to be the No. 1 contributor to cost containment. Expense reductions via purchasing and supply-chain efficiencies are opportunistic." Speaking about the dependence on the labor force to deliver the organization's core service, he says, "The number of people who come to work every day to deliver care, that's bedrock. But if you are not controlling it, you have lost control of the whole operation." Among the principal tools Selden and Southwest General are using to pursue efficiency are benchmarking, identification of variances, and process engineering.
Near-term, the industry shift to value-based purchasing is affecting reimbursement rates, which causes administrators to approach cost containment with new vigor. Long-term, healthcare organizations increasingly will add clinical labor efficiency to classic accounting tactics such as budget edicts and purchasing efficiencies. Making efficiency work will require new work methods, new work collaborators, and new systems for monitoring and reporting. It will require some precision to make sure that the required infrastructure investments do not gobble up all of the potential savings.
Reprint HLR1012-3
This article appears in the October 2012 issue of HealthLeaders magazine.
This article appears in the September 2012 issue of HealthLeaders magazine.
Physician alignment is, in part, about filling the beds and securing physician buy-in. According to Lloyd K. Ford, president and CEO of Riverview Regional Medical Center, a 281-bed acute care hospital in Gadsden, Ala., "It’s about maintaining current levels, plus growth. Ultimately, we are always looking for growth." Increasingly, healthcare organizations are adjusting the mix of physician organizational models to achieve that alignment.
The 2012 HealthLeaders Media Physician Alignment Survey shows that the medical staff model of working with independent physicians is in decline. While it is used by 67% of organizations today, looking forward three years, only 50% of respondents expect to include the medical staff model among their top three staffing models. "You are starting to see the end of the independent physician," says Ford, who served as lead advisor for this month’s Intelligence Report.
In the three-year time frame, nearly three-quarters (71%) of respondents expect their percentage of employed physicians to increase.
Aligning to capture revenue, control costs
The changing revenue picture causes both physicians and hospitals to do some financial soul-searching. Independent private-practice physicians worry about declining reimbursements, just as hospitals do, and seek employment to stabilize their income. Many newly minted physicians seek employment right after their residencies, opting out of establishing and running a medical practice of their own.
Hospitals need to understand and control cost and perform in a way that will maximize reimbursement rates. Hospital IT systems monitor both financial and clinical events. But such systems, to be effective, need virtually universal buy-in to EMRs, CPOE, and other information-capture and analysis programs. Two-thirds (64%) of respondents place physician buy-in to quality and safety initiatives among the top three motivations behind their alignment strategy for employed physicians.
Vanguard Health Chicago is working toward the buy-in objective with independent physicians in addition to employed physicians. Louis D. Papoff, an advisor for the Intelligence Report, is vice president and chief financial officer of ambulatory operations for Vanguard Health Chicago, part of Vanguard Health Systems of Nashville. He says, "From a corporate point of view, our executives recognize and strongly believe that physician integration is essential. And it can be done alongside employing physicians. We want to be a system that is able to achieve ACO savings and achieve significant quality results that in turn can be used as leverage for better quality-based payments. The only way to achieve that would be to make sure that the private practitioners are appropriately and fully integrated
into our program."
Collaboration, metrics
Among the trends that healthcare organizations are exploring to achieve the goal of stronger hospital-physician alignment are care continuum collaboration, effective measurements, and improved communication.
More collaborators. The domain of patient care is extending beyond the hospital. Among the initiatives getting attention over the next three years will be integrated delivery systems, which 51% of respondents will be pursuing. Nearly half (48%) say the will look to develop patient-centered medical homes and collaborative care ACOs. Riverview is establishing new communication channels and new work flows in concert with nursing homes that care for some of the hospital’s discharged patients as a way of reducing readmissions. Riverview’s Ford explains, "We want to have an interaction with the nursing homes instead of having them routinely sending patients back to the hospital."
More metrics. About metrics,
William B. Riley, MD, chief medical officer at Memorial Hermann Sugar Land (Texas), a 79-licensed hospital that is one of 11 in the Houston area, says, "More and more quality metrics will be demanded of the hospital, and more and more quality metrics will be demanded of the physicians in private practice." Memorial Hermann has drawn a line in the sand. "Electronic order entry is mandated," says report advisor Riley, "and we are mandating the use of evidence-based medicine and protocols. We are mandating in areas that we think are critical to success with healthcare reform, whatever form it takes."
More communication.
If hospital administration has a direction it wants physicians to take, communication can make the task easier. Riley observes that physicians respond to information. He says, "If you give physicians information and data, physicians will usually be on board, and they will appreciate being part of the process." Respondents expect to see increases in physician involvement in leadership activities in the next three years. While three-quarters (74%) of organizations expect increased leadership involvement for their employed physicians over the next three years, nearly half (47%) also expect increased involvement of independent physicians.
The power to negotiate
The nature of the hospital-physician relationship is in flux, prompted by changes in reimbursement. For Papoff and Vanguard, the answer is clinical integration: "One of the benefits of our clinically integrated program is that we can negotiate better contracts because we have a better product to sell. We are doing more direct contracting with payers now, because we can go to big purchasers of healthcare and demonstrate our quality data.
Everything is transparent and out on the table. We are able to negotiate better reimbursement rates, and physicians in our clinically integrated program have gotten bonus checks back at the end of the year for the last two years. That reinforces our belief that alignment works, and it works because it provides patients with higher quality of care, and you potentially can be compensated at a higher rate because of that."
Healthcare organizations are reconfirming their core staffing strategies and making adjustments. For those that have been holding back because of an environment of uncertainty, the good news is that there is less to be uncertain about. The bad news is that fence-sitters may be left behind. The industry is moving toward the value-based purchasing reimbursement model. Organizations have accepted that they are being asked to do more with less. Clinical teams, support staff, and executives are adjusting to new work rules.
Reprint HLR0912-3
This article appears in the September 2012 issue of HealthLeaders magazine.
This article appears in the August 2012 issue of HealthLeaders magazine.
We're on a journey here," says Robert Permut, MD, chief medical officer for Provena Health, a health system that operates six hospitals, 16 long-term care/residential facilities, and other health facilities in Illinois and Indiana. "It's constant gardening," says Douglas Luckett, chief operating officer for CaroMont Health, a health system based in Gastonia, N.C. Providing positive patient experiences involves doing a lot of little things right.
All told, 84% place patient experience among their top three priorities in the 2012 HealthLeaders Media Patient Experience Survey. "Eighty-four percent is a massive number," says Jeffrey Thompson, MD, CEO of Gundersen Lutheran, a not-for-profit healthcare system serving patients in 19 counties in Wisconsin, Iowa, and Minnesota. "Most will say you can only have several top priorities. The topic is really out there."
Adequate investments?
With this new survey data, we see that having a high position on the priority list does not necessarily qualify patient experience as a budget-worthy activity, though. More than half (58%) say they have not made specific patient experience investments, or cannot specify what the investment was. Thompson, an advisor for the Intelligence Report, says, "People are saying it is a high priority, yet so many have no investment." At Gundersen Lutheran, patient experience has its own line item. "Ten years ago it was in the same pool as quality," says Thompson, "but we split it out to get people to focus on it." That patient experience line item represents about 3% to 4% of the operating budget.
Whether they can count it or not, 85% of respondents say they have invested additional time and resources in the past 12 months to improve patient experience scores. Training and other staff-awareness activities were mentioned frequently. Some have contracted with third-party consultants to help the staff become more patient-centric. Others have added staff with specific patient-experience responsibilities. Several respondents mentioned that they are investing in staff incentives for good performance.
Motivated by money?
Only one-third of respondents (33%) say it is very important to tie compensation to patient experience measurements. Says Permut, an advisor for this report, "When you look at how important patient experience is going forward, I would have expected a higher percentage. At Provena Health, we have made patient experience a bonus opportunity for physicians. People are tracking both clinical quality and service quality, and it's intuitive to tie compensation to both."
Permut also reminds physicians that soon patients will be rating them the way they rate hospitals now. "In January 2013, there will be Physician Compare. This will be the first publicly reported data on physicians, which I expect to be somewhat similar to Hospital Compare."
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CaroMont's Luckett, the lead advisor for the Intelligence Report, credits a change in incentives at his facility to a single-year turnaround of hospitalist alignment toward the patient experience goal. There are two levels in bonus compensation, he says: One level is meeting the goal, one level is exceeding the goal. At CaroMont, the patient-experience performance bonus is based on group performance rather than individual performance. This year, the group-based tie-in is being tested with leadership in several additional departments.
Getting buy-in from nonemployed physicians can be challenging. Many contracts with independent physicians include performance metrics. However, as Provena's Robert observes, "Most of the time, they are the hard metrics, such as quality, complications, readmissions, and hospital-acquired conditions."
Thompson says Gundersen Lutheran has several tactics beyond compensation to help physicians improve their patient experience skills; among them are goal-setting, transparency in sharing performance results, and coaching. "People from our service excellence department accompany physicians on rounds. They observe the visit from start to finish, trying to figure out what could be done to improve the patient's view of the interaction."
ACCESS. INSIGHT. ANALYSIS. Patient Experience and HCAHPS—Little Consensus on a Top Priority
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Poor assessment about HCAHPS
More than half (54%) of respondents say they do not consider HCAHPS to be an effective measure of patient experience. Quite a few respondents do not like having "always" as a response choice. Says one, "The word 'always' sets the organization up for failure. Patients rarely mark anything as 'always' occurring." According to another, "Studies have demonstrated higher morbidity and mortality data with increasing patient/consumer satisfaction. That suggests that higher patient satisfaction does not necessarily translate to better care." One respondent recognizes that being hospitalized is stressful: "Because patients and families that are asked to participate in the survey at that time are stressed, sometimes their responses are driven by the stress associated with their situation."
On the other hand, nearly half (46%) say that HCAHPS is an effective measure of patient experience. "It is an effective measure of patient perceptions but should be only one of several listening tools employed by the hospital," says one. Another survey respondent offers, "HCAHPS scores help caregivers to prioritize and reach goals for patient experience."
Communication and consistency
Every single patient-staff interaction is a patient experience opportunity. The team responsible for patient experience should identify interactions that are predictable, such a patient arrivals, rounds, meal delivery, medication, preparation for procedures, and so on, and decide which training and education activities are appropriate for which staff groups.
It may be easy to underestimate the complexity of training for patient experience, since the domain for patient experience is so large and the responsibility is widely distributed. Synergies with other priorities such as clinical quality, safety, and patient care must be found, and can be found.
Reprint HLR0812-3
This article appears in the August 2012 issue of HealthLeaders magazine.
This article appears in the July 2012 issue of HealthLeaders magazine.
"I sense a data theme throughout the results," says Craig E. Samitt, MD, president and CEO of Dean Health System in Madison, Wis., a physician-owned integrated delivery system with 60 healthcare facilities in southern and central Wisconsin.
The 2012 HealthLeaders Media Clinical Quality and Safety Survey shows widespread use of electronic health records, which, for those who work to get it going, can provide a data foundation to be tapped to prevent errors and support clinical decisions. Three quarters of respondents are using EHRs now. One-quarter (28%) of those EHR users have taken the next step and use analytics for such applications as clinician alerts. Within a year, the number of EHR users who are also using analytics will double. Says Samitt, "If we presume that technology provides data and data gives us information to improve quality, it is a critical next step that organizations are moving to analytics, not just technology."
According to Chris Snyder, DO, chief medical informatics officer and chief quality officer at Peninsula Regional Medical Center, a 365-licensed-bed hospital in Salisbury, Md., "The value added from data is going to drive quality."
By and large, metrics associated with the development and testing of new medical procedures are process measures. The value-based purchasing model is designed to reward outcomes, though, so the healthcare industry seeks a different kind of measure.
"We can tick off and achieve some of the quality metrics," Samitt says, "but that doesn't necessarily mean that we are delivering higher-quality care. For example, you can test mammography rates for women for screening, but that is not an outcome measure; it is a process measure." Overall, 86% of respondents "Agree completely" or "Agree somewhat" that the industry needs more measures that address outcomes rather than processes.
A considerable percentage of the respondents—41%—does not know whether value-based purchasing will have a positive effect on clinical quality, and an additional 19% say VBP will not improve clinical quality. Stephen L. Moore, MD, chief medical officer at Englewood, Colo.–based Catholic Health Initiatives, a system with 76 hospitals and other facilities in 19 states, suggests that the PPACA's reliance on process measures is the reason that so many are uncertain.
"There have been a number of studies in the literature for the process measures we are using. Improvements in those numbers have not led to reductions in mortality, complications, or any measureable movement in outcomes-based performance," Moore says. "The survey results suggest that a large number of people are concerned, as I am, that process-measure issues that we have been focusing on to date are not clear enough indicators for outcome improvements."
Observing that 83% of respondents are addressing healthcare-acquired infections, either with a program that has achieved its goals (31%) or a program in which performance improvements are still being made (53%), Samitt once again draws our attention to the importance of the flow of information. "Healthcare organizations absolutely want zero defects, but it is hard to do in the absence of information," he says. "When information is available, organizations seek to improve." Only 14% of respondents place the prospect of penalties for hospital-acquired infections among their top three VBP challenges, indicating a high degree of confidence in addressing the issue.
Three quarters (74%) of respondents say that their tactic of sharing knowledge about patient-safety practices continues to deliver improvements or is delivering results in a stable and satisfactory fashion. One-half (52%) are seeing safety improvements as a result of continuing efforts to communicate better during handoffs. And just as clinical quality receives a boost from the flow of digital information, so does patient safety: one quarter (25%) say that their IT-based safety checks such as the electronic medication administration record have addressed safety in a satisfactory fashion, and another 40% say that improvements continue to be made.
Four-fifths (82%) of respondents either have a program under way or have a program in place that emphasizes accountability. More than half (53%) reward quality performance. An additional 33% are investigating how to reward quality performance.
Moore describes CHI's review of physician alignment and how that relates to safety initiatives. "In some areas, we have already realigned our structures such that our physicians are coleading service lines with our administrative personnel. We are examining all of our medical director contracts to make sure incentives are aligned with the performance outcomes we are looking for. For employed providers, we are realigning incentives by increasing the percentage of compensation based quality clinical outcomes."
Since healthcare reform challenges us to do more with less, we have to command our processes, procedures, and infrastructure. Some have considerable experience optimizing. Those who are new to the discipline may chafe a bit. Decisions will have to be made and actions will have to be taken with a great deal of precision. Those who are comfortable with data will have an advantage.
And as we shift from a volume-based to a value-based foundation, collaboration will matter more, and sharing data and sharing responsibility for positive outcomes will become more important. As Moore says: "We may have figured out how to care for folks once they get inside our walls, but we are going to be challenged to improve the quality of their care outside of our walls."
This article appears in the July 2012 issue of HealthLeaders magazine.
