Barlow/McCarthy Blog

Check back often to hear from our talented team of consultants. Topics covered include: Physician Relations, Physician Recruitment, Practice Marketing, Medical Staff Development, Community Health Needs Assessments, etc.

  • By: Allison McCarthy, MBA | amccarthy@barlowmccarthy.com

    As clients share concerns about their onboarding process, credentialing tops the frustration list – with anxiety over start date delays and bad impressions demonstrated to the new recruit.

    Credentialing involves a myriad of procedures to grant provider privileges to practice at the hospital/facility and to participate in health plans.  Numerous steps must be completed in specific order, accompanied by the right documentation, for the provider to move from one stage to the next.

    Credentialing is often in the hands of small team, within a medical staff or credentialing office, with piles of documents to process and deadlines to fulfill. And, these individuals are not typically perceived as the epicenter of gold-standard customer service. Add to this most providers’ lack of knowledge about how to be credentialed. It’s a snafu just waiting to happen.

    So, I want to applaud those organizations that are striving to make credentialing a more pleasant experience.  Here are a few examples.

    A client group practice created a flow chart of the credentialing process (see below) – and reviews it with candidates during their onsite interview. They talk through the steps and timeline required to go from licensure through payer participation – advising candidates on their part in this effort.

    HCA MidWest outlines the credentialing process under the Careers section of their web site: http://mymidwestphysician.com/professionals/credentialing.dot – which also includes a link to the application portal to start the process. This electronic orientation saves them at least a few days by eliminating paper being mailed between the credentialing office and the provider. The provider application can also be monitored real-time to keep the process moving.

    One of my favorites is a fun video created by the team at Novant. Rather than have the providers read through a cover letter set of instructions, both visual and auditory senses are used to orient them to the step-by-step credentialing process. Plus, the provider gets to “feel” what it will be like to work at Novant in this very first post-recruitment step. https://vimeo.com/novanthealth/review/185648744/e1f38e108b

    Credentialing doesn’t have to be a negative experience. With some energy and creativity, there is much more than can be done to make it a positive encounter. Let’s begin to consider a new approach.

    Client Credentialing Flow Chart:

    Physician-timeline

     

    Blog, Physician Recruitment
  • By: Kriss Barlow, RN, MBA | kbarlow@barlowmccarthy.com

    The importance of establishing and growing relationships with intent is top of mind for great field teams. It’s all about the obligation of field staff to have a clear visit strategy for earning referral relationships. Most physician relations/sales teams work super hard on this part every day in every way.

    While we are grinding away to make relationships with intent happen in the practices, what about the health of internal relationships that are required for successful field sales? Internal relationships may support, neutralize or damage field success. Ask these five questions to determine the health of your internal relationships.

    1. Is there commitment from leadership? Many programs work beautifully as grassroots efforts, but not this one. Physician relations flounders without leadership support. Organizations that have some of the best success have top leaders closely aligned. Leaders seek out updates, opinions and results. They offer support and involvement. Physicians look at organizations with a healthy (or not so healthy) dose of skepticism. Top down actions and consistency of message are recognized and valued.

    2. Can we manage new business if we ask for it? Managing new business is about services and specialists, but it’s also about systems, process and functions to support the expectations of the referring physician.  Make sure the internal systems are established from the outside- the referring physicians’- perspective, not from what the internal stakeholders feel like they ought to find acceptable.

    3. Is physician-driven business a core strategy for the organization? For some organizations, growth of the ACO or the clinically integrated network is front and center. If this is the case, clarify roles and don’t assume. Many leaders still want the right volume growth as they develop the future state. Others may want field staff to help support ACO or CIN growth. Be clear about the business strategy and where you are best served. You can’t be all things to all people, so make sure you’ve clearly defined the expectations at the right level. (And make sure you don’t abandon your momentum practices and then expect to go back to the same level or relationship after a long gap).

    4. Can operations, IT, business development and marketing be counted on for support? Reminiscent of that old saying, “No man is an island,” effective programs forge strong internal relationships. While they won’t always completely understand the field role, they need to value and support it. Physician relations must initiate and encourage alignment and sharing in most cases.

    5. Are you aligned with the Employed Practice leaders? Did I save the best for last? For many teams, this is the final frontier of internal turf. Often, practice administrator’s want to manage the practices without physician relations involvement. If leakage, or in-network referral growth, is a hot topic for your employed groups, the organization will benefit from field staff assertively earning referrals through focused awareness, meetings and use of the portal or other tools to make sure the practices and doctors are aware of the network specialists. Assess where you are today and where you need to be with this one and then create a plan.

    How do your internal relationships stack up? It’s frustrating when you thought it was working only to hear of a little sabotage in the ranks. Get creative and find new ways to keep your pulse on the internal relationships the same as you do in the field. If there are barriers, make a business case for the impact and then start the communication process to make sure everyone is on the same page. The need for great internal sales never goes away.

    Blog, Physician Relations
  • By: Allison McCarthy, MBA | amccarthy@barlowmccarthy.com

    The Association of American Medical Colleges (AAMC) recently released the 2017 update to its Physician Supply and Demand Projections.  While demand still outweighs supply is still the overall conclusion, the shortfall is lower than previously projected.

    Researchers used various scenarios to compare demand/supply – testing many of the factors considered to be the “fix” to the pending physician shortage.

    Demand

    Supply
    Changing demographics Early or delayed retirements
    Improved care coordination Millennial hours worked
    Expanded use of retail clinics GME expansion
    Increased use of ACPs

    Population health improvements

    Key Findings 

    • In primary care, the use of nurse practitioners will increase the total supply of providers
    • Medical specialties also have increasing supplies with more physicians choosing internal medicine and pediatric subspecialties
    • Surgical specialties see no improvement as future attrition will meet or exceed the number of newly trained surgeons
    • Growth in the senior population will be the primary driver of physician demand – much higher than the demand for pediatric services
    • For all specialties, physician retirement decisions will have the greatest impact on supply with over one-third of today’s active physicians turning age 65+ within the next decade
    • The use of NPs and PAs will increase. By 2030, the ratio of physician-to-PAs will go from 7.2:1 to 3.5:1 and physician-to-NPs from 3.6:1 to 1.9:1
    • Population health improvements may actually increase the demand for physicians. By 2030 there will be 6.3 million more living adults who will require an additional 15,500 FTE physicians

    Every organization should assess the implications of these demand/supply dynamics on their own provider community.  Having a current medical staff development plan provides a baseline understanding of the local specialty gaps and pending retirements.  From there, these additional factors can be considered.

    1. What is the starting point with primary care physician-to-ACP ratios? What is the organization’s future goal and by when?  What is the tactical plan to reach that target?
    2. If medical specialties (other than psychiatry) are becoming easier to recruit, which ones would improve primary care physician demand if recruited? Which ones are needed for chronic care management or for the growing senior population?
    3. If physician attrition will have the greatest impact in the surgical specialties, does this change the list of physicians that need to be considered for transition planning?
    4. What percentage of your population is over age 65… over age 75? How does that compare to your region, state and nationally?  What services need to be considered to manage this population going forward?
    5. If one of the strategic service lines includes pediatrics, how will the organization address the decline in this population demographic?
    6. Do your physician recruitment priorities need to shift in any other way? If so, what advance work is needed to be ready for those searches.

    We’re here to help the organization work through these implications – whether its updating the medical staff development plan or conducting a facilitated strategy session using the existing plan as the framework.  Contact me at amccarthy@barlowmccarthy.com to discuss how we might help you improve your recruitment and retention positon for the future.

    Blog, Business Development, Physician Recruitment
  • By: Kriss Barlow, RN, MBA | kbarlow@barlowmccarthy.com

    In this era of sound bites and social media do you ever wonder if conversation will go the way of the dinosaur?  In my mind, texts and emails are great for providing factual detail, but they just can’t replace the nuance that comes with great dialogue. In physician relations, we assume conversation happens naturally and often it does. But, could it be better, in a way that is more valuable for the doctor? I am back to basics because from time to time we all benefit from attention to what it takes to have a meaningful, authentic conversation.

    1. Know your doctor before starting the conversation. In other words, genuinely learn more about them through data, their connections in your organization and reviewing past visits. Authentic connection begins with relevant conversation about their needs.
    2. Align your message.  Most doctors aren’t concerned about your need to boost referral numbers; their interest is what’s going on with them and how you can help improve the situation. When you come at a conversation focused on solving their practice needs, rather than achieving your goals, you’ll earn respect. When you’re consistently focused on their best interest, you’ll earn their trust — the cornerstone of every authentic conversation.
    3. Plan your approach in advance. Know what you want to say and where you want the conversation to go. At the same time, be ready to change course if the doctor wants to talk about something else. Your first objective, in every meeting, is to stay on track with the doctor’s needs. For example, a good way to start is, “Dr. Smith, I wanted to follow up on the employment questions you raised in our last meeting, but before I do, is there anything you want to make sure we discuss?”
    4. Be clear and specific. Two-way communication is only as good as the reply that comes back. Ambiguity on your part triggers a brief reply from them. On the other hand, asking a relevant and specific question launches a conversation. It also shows doctors that you respect their time. If you aren’t mindful of their time, if you don’t cut to the chase, busy doctors will tune you out well before you’ve said what you wanted to say.
    5. Personalize your questions. Authentic experiences happen when you inspire someone to think on a human level. Rather than asking about a doctor’s experience with your facility’s cardiology, make your question patient-focused, “Have you had any patients treated in our EP lab in the last couple of weeks?” Or, “With such a large elderly population have you seen an improvement in the recurrence of arterial fibrillation with the new procedure in our EP lab?” The same approach works if you are having a business conversation, “In thinking about that next partner in the practice, does the addition of a Fellow or practicing physician make the most sense to you?”
    6. Give your full attention.  How many times in the last week have you started a conversation only to be interrupted by a cell phone? It’s an instant conversation stopper and immediate rapport breaker. When you’re working hard to develop a relationship with a doctor, give the conversation your undivided attention. If you’re serious about understanding and meeting a doctor’s needs, then no text is worth the disruption.
    7. Be real. Surely, this seems obvious, but nothing is more destructive to a relationship than delivering a message that sounds “canned” or “contrived.” If your personalities don’t mesh or, for any reason, you can’t authentically engage in conversation, enlist someone in your organization to help out. If it doesn’t feel real to you, it’ll show.
    8. Be open, empathetic and engaged. Be open to other peoples’ opinions and willing to step in their shoes. Keeping conversation rolling requires that you pay attention, empathize and trust your own intuition. Your goal is to become someone people look forward to seeing, whether it’s because they feel better for the interaction, learn something or come away feeling inspired.
    9. Be timely.  The painful challenge of leaving enough time in your schedule so that you arrive and depart on time is a true sign of respect- or dis-respect. As well, we show respect when we offer timely follow up for the information they share. Consistent messages back from those involved in an issue to say, “We heard you” demonstrates a spirit of responsiveness that should happen in all conversations with those who help our organizations by sharing their perceptions of what works and does not.

    If you’re not feeling positive about your recent conversations in the practice, take notes on your past exchanges, study your “normal conversation patterns” and see what’s happening. For example, if the doctor just sees you as someone who stops in, asks how things are going and thanks them, you may need to work hard to establish a new pattern.

    Did any of the points above resonate with you? Do you have a colleague who might also value this information? If so feel free to share!

    Blog, Physician Relations
  • By: Allison McCarthy, MBA | amccarthy@barlowmccarthy.com

    I was recently in and out of LaGuardia Airport with a rental car for client work.  While I hadn’t experienced travel logistics in this location before, I certainly had expectations based on prior experience.

    After deplaning, I asked at the Welcome Center where to find the rental car shuttle given the lack of signage or other direction. The representative asked which vendor and then directed me to the “purple bus.”  I assumed this would take me to the rental car facility, but the bus dropped us off on a neighborhood street.  No signage. No communication.  And only because I saw another traveler walk toward a shuttle bus did I realize I needed to do the same.  Ultimately it required two buses to get to the rental car facility, along with frustration and being perturbed.

    I wondered if physician prospects are similarly dismayed when trying to identify practice openings with some health care systems.  Go to the web site, find the Careers page, and look for more information.  Except what is presented is some generic text and a button that says, “Apply Now.” When clicking the button, you’re then asked to complete a form and provide contact information – still no information on what positions are available or the ability to email or call someone to get the details.  Just a blind form to complete to get anything meaningful.

    Airports like LaGuardia likely have so much volume there is little concern about being user-friendly.  But health care systems today must be inviting to physician prospects to win in this competitive recruitment environment.  With so many opportunities available to physicians, these clinicians don’t need to work very hard to find something of interest.  Any organization not making it easy to provide practice opportunity information will be easily bypassed for other more welcoming organizations.

    As hospitals and groups consolidate into health systems, I often find these larger entities have diluted their visibility in the physician recruitment market. It’s not intentional. The problem is that IT and Marketing have so many other priorities that enhancing a Physician Careers page falls to the bottom of the list.

    While the rental car agencies around LaGuardia may not need to worry about being user-friendly, health care systems working to recruit doctors must be.

    Blog, Physician Recruitment