January/February 2008

Practice Management Initiative Addresses Growth of Employed Physician Enterprise

While Catholic Health Initiatives has long provided support for the management of employed physician practices, this initiative has recently taken on new directions. Catholic Health Initiatives’ Practice Management Advisory Council (PMAC) is taking steps to achieve optimal performance for the system’s expanding employed practice enterprise.

“With 1,300 employed physicians, Catholic Health Initiatives has an opportunity to create greater efficiencies in the management of those practices,” said Claudia Eisenmann, president and chief executive officer of St. Joseph’s Hospital and Health Center, Dickinson, N.D., and chair of the PMAC. “We need to define best practices and create standardization where practical, while respecting the diversity of the market-based organizations.” Ten years ago, Catholic Health Initiatives’ employed mostly primary care physicians. Today, primary care physicians comprise less than half of the system’s employed physician enterprise. “We have growing numbers of hospital-based physicians, surgeons and specialists,” said Theresa Lewis, director of medical affairs and practice management for Catholic Health Initiatives. “During 2006, there were 55 different specialties in our employed physician enterprise. During 2008, we expect that number to grow to 70 different specialties.” Currently, 34 of Catholic Health Initiatives’ market-based organizations have employed physician practices. “Across health care, there is a definite trend away from independent practices and toward employed practices,” said Lewis. “As regulations, payer relations and other factors make practice management more complex, more physicians want to let hospitals manage their practices. It gives the physicians more time to take care of patients.” Implementing the 100 Day Plan Catholic Health Initiatives’ current focus on physician practice management is based on work that began in spring 2007. With the assistance of Navigant Consulting, a steering committee assessed the current state of practice management within the system. “Navigant visited four diverse markets across Catholic Health Initiatives — Lincoln, Neb.; Des Moines, Iowa; Great Bend, Kan.; and Nampa, Idaho — for an in-depth look at their employed practice management models,” said Lewis. “They also interviewed more than 100 stakeholders across the system. The steering committee reviewed Navigant’s recommendations and prioritized them into an action plan that we call the 100 Day Plan.” Central to the 100 Day Plan was the formation of the PMAC, which was launched in late October 2007. The PMAC is now guiding the implementation of the plan. Some of its elements have already been implemented, including the creation of tools for employed practice business plans and staffing ratios. These tools are now available via the Physician Practice Leadership Community on Inside CHI. Workgroups have also been formed to address recommendations for ambulatory care quality measures, physician compensation, financial reporting and revenue cycle improvement, practice acquisition and CHI Connect. “On a priority basis, the PMAC and its subgroups will address all of the many elements of practice management,” said Eisenmann. “All of the tools and standards we develop will be designed to provide support to the managers of our employed physician practices — essentially, we want to make their jobs easier.” Accommodating Continued Growth Lewis noted that the work of the PMAC is likely to evolve over time. “When the objectives in the 100 Day Plan are achieved, it will only be the start of the work to be done,” she said. “Our employed physician enterprise will continue to grow, and accommodating that growth will mean that the need for practice management tools will continue to evolve.” “This is truly some of the most important and exciting work that Catholic Health Initiatives can engage in right now,” said Eisenmann. “Experience shows that the health systems that are most closely aligned with their physician communities are the most successful. Our work in physician practice management demonstrates Catholic Health Initiatives’ commitment to a more comprehensive approach to physician alignment. I also have faith that the excellent practice managers and physician leaders we are fortunate to have throughout Catholic Health Initiatives will help us communicate and implement these initiatives.”