physician liaison program - wild apricot · physician liaison program joan brewer, rn referral...
TRANSCRIPT
Physician Liaison Program
Joan Brewer, RN
Referral Relations Manager
Billings Clinic
Billings, MT
Organizational Highlights
Employ 3,750 employees
Group practice with 280 Physicians, 90
PA/NPs
Clinic & Hospital
•Joint Commission Accredited
•Magnet Designation for Nursing Excellence in 2006
and re-designation in 2011
Multi-specialty Physician Clinic
•900,000 patient encounters
•10 clinic locations
Hospital & Sub Acute Care
•285 Licensed Beds
•14,500 hospital admissions/year
•743,000 Outpatient Registrations
•Level II trauma center
•42,000 patient ED visits/year
Psychiatric Services •Youth and Adult
•Hospital – IP & OP
•Behavioral Health Clinic
Aspen Meadows
•90-Bed Long Term Care and 55-bed
Assisted Living Facility
•Sub-Acute Care
Research •Center for Clinical Translational Research
•Clinical research
Billings Clinic Foundation
•Over $100 million raised
•Over $48 million in current assets
•Over $69 million granted to Billings Clinic
Health Care, Education and Research
Over 50 Physician Specialties • Allergy & Immunology
• Cardiovascular Services
– Cardiology
– Electrophysiology
– Interventional Cardiology
• Cardiovascular Surgery
• Dermatology
– Mohs Surgery
• Emergency Medicine
• Endocrinology
• Facial Plastics &
Reconstructive
Surgery
• Family Medicine
• Gastroenterology
• General Surgery
• Geriatrics
• Hospital Medicine
• Infectious Diseases
• Internal Medicine
• Metabolic/Bariatric Surgery
• Nephrology
• Neurology
• Neurosurgery
• Obstetrics & Gynecology
– Maternal-Fetal Medicine
– Reproductive
Endocrinology & Infertility
(IVF)
• Occupational Medicine
• Oncology (Cancer Center)
– Medical & Hematology
– Gynecologic Oncology
– Radiation Oncology
• Ophthalmology
• Orthopedics & Sports
Medicine
• Otolaryngology
– Audiology
• Pathology
• Pediatrics
– Neonatology
– Pediatric Ophthalmology
– Pediatric Pulmonary
– Pediatric Neurology
– Pediatric Oncology
– Pediatric Cardiology
– Pediatric
Gastroenterology
• Physical Medicine &
Rehabilitation
• Podiatry
• Psychiatry
• Pulmonary, Critical Care &
Sleep Disorders
• Radiology
• Rheumatology
• SameDay Care
• Thoracic Surgery
• Vascular Surgery
• Urology
Health Care, Education and Research
Health Care, Education and Research
Physician Outreach Specialties
Allergy
Cardiology
Dermatology
Facial Plastics
Gastroenterology
Gynecologic Oncology
Nephrology
Neurology
Reproductive Medicine
Maternal-Fetal Medicine
Oncology
Ophthalmology
Orthopedics
Otolaryngology – ENT
Pediatric Cardiology
Pediatric Diabetes
Pediatric Pulmonary
Pediatric Gastroenterology
Podiatry
Pulmonary
Urology
Telemedicine at Billings Clinic
• 40 partners in 29 communities
• 4,823 conferences in FY13 served 27,062 participants
• By avoiding travel, participants saved an estimated $4,300,000 in
out-of-pocket expenses
• 61 Billings Clinic providers regularly use telemedicine
• Offerings include:
Allergy
Burn follow-up visits
Cardiology
Dermatology
Dietary Education
Endocrinology
Geriatrics
Genetic Counseling
Infectious Diseases
Naturopathic consults
Pulmonary
Rheumatology
Reproductive
Medicine/Fertility
Diabetic Education
Medication Assistance
Metabolic Surgery
• patient education
• pre and post- op
surgical consults
Neonatology
Nephrology
Neurology
Oncology/Hematology
Orthopedics
PM & R
Pediatrics
Gastroenterology
Podiatry
Psychiatry
Health Care, Education and Research
Successful Startup of Physician Liaison
Programs
Goals for Today
• Explore the pre–program planning process and define the Physician Liaison scope and capacity
• Describe differences between a referral relations program vs. physician relations vs. sales program
• Identify key “must haves” for successful programs
• Align outreach with organizational strategies and ensure service lines are “outreach-ready”
Health Care, Education and Research
Pre Start up
• What is the organizational Goal behind the
development of the role/position?
• What is the need?
• Who will support the role?
• What are the tools available for the role?
• Will the role be relationship based or sales based?
• How will success be evaluated?
Health Care, Education and Research
Scope Creep
Health Care, Education and Research
Health Care, Education and Research
Why are Referral Relations valuable?
• Referral Relations positions have proven ROI by targeting
identified providers and developing a relationship that allows
the referring provider to have a voice in how referrals are
managed.
• Deeper Hospital-Physician collaborations are needed for
clinical quality improvement, utilization & cost control, care
continuum integrations and population health management.
• Leverage of high quality network, limit of financial exposure,
and monitoring and managing performance. » 21754, the Advisory Board, 2010 p10-13.
Health Care, Education and Research
How does Billings Clinic define
Referral Relations?
• Accountability for Referral Relations
program and communication processes.
• Develop, coordinate and distribute
communication and tools to support the
flow of referrals and communication back
to the referring providers.
• Develops and provides strategy support to
administrative and service line leadership.
Health Care, Education and Research
How does Billings Clinic define
Referral Relations?
• Gather and share local and regional
marketing intelligence.
• Support the development and
implementation of marketing and planning
strategies.
Health Care, Education and Research
How does Billings Clinic define
Referral Relations?
• Establishing, maintaining and enhancing
organizational relationships with referring
physicians and other healthcare providers.
• Establishing, maintaining and enhancing
organizational relationships with
organizations in local and regional service
areas.
Health Care, Education and Research
Health Care, Education and Research
Goal
Facilitate New and Strengthen Existing
Referral Relationships
Must Haves
Referral Relations Physician Relations Marketing Relations
• Listening Skills Listening Skills Listening Skills
• Tenacity Tenacity Tenacity
• Internal C suite Internal C suite Internal C suite
Support Support Support
• Organizational Organizational Organizational
Readiness Readiness Readiness
• Great Boss Great Boss Great Boss
Referral Relations, Physician Relations, Marketing Relations
Referral Relations Physician Relations
• Connector for all * Connector for Referral Sources Physicians
• Long Term * Long Term
• Established Internal * Physician Openness
Relationships Key to to relationship
Success Building Key to Success
• Clinical +Sales * Clinical
Marketing Relations
• Program Connector
• Short Term-More Successful if long term relationship established
• External Relationship Key to Success
• Sales
Health Care, Education and Research
Health Care, Education and Research
What are the tools of the Physician
Liaison?
• Access to the EMR
• Access to Point Persons
• Access to Administration
• Access to physicians that share the same
vision
Health Care, Education and Research
What are the tools of a physician
liaison?
• Trust
– Don’t promise the moon, unless you can
assure delivery
– Don’t throw your internal colleagues under the
bus.
– Remember* There is always more to the story
– Bring back the good stuff
– Follow up, Follow up, Follow up
Health Care, Education and Research
What are the tools of the physician
liaison?
• Data is our friend
– Administration needs it, physicians love it
– Make friends with the analysts
– Find out who else is tracking and trending
data
– Look at and investigate CRM products
Health Care, Education and Research
Planning your future
• Develop a plan for the year/quarter and
month
• Assure it aligns with the strategic goals of
the organization
• Develop processes that help and not
hinder. Keep them flexible enough to allow
growth and change.
Physician Liaison Outreach Program
PeaceHealth Oregon West Network
Susan Blane, MPH, CMPE
Director, Market Development
Strategy, Innovation and Development
34 © 2011 PeaceHealth
The PeaceHealth Mission
We carry on the healing mission of Jesus Christ by promoting
personal and community health, relieving pain and suffering,
and treating each person in a loving and caring way.
35 © 2011 PeaceHealth
About PeaceHealth • Founded by the Sisters of St. Joseph of Peace, PeaceHealth is a not-for-
profit health care system with medical centers, critical access hospitals,
medical group clinics and laboratories located in Alaska, Washington and
Oregon.
• Has provided exceptional medicine and compassionate care to Northwest
communities for more than a century.
• PeaceHealth consistently receives national recognition for innovations in
patient-centered care, patient safety, health care technology and cost
efficiency.
• During FY2012, PeaceHealth provided patient care to these communities
through more than
– 78,000 inpatient admissions
– 743,000 outpatient registrations
– 1.2 million patient encounters
36 © 2011 PeaceHealth
In the beginning….
• 2006: Director recruited to launch program around a
technology acquisition and build department ongoing
• 2007: Budget allowed for one additional hire
• 2008: New Flagship hospital opens in August, economy
tanks in October
• 2009 thru 2011: Outreach focus on retention –
– 1 person,
– 7500 physicians
– 37,000 square miles
© 2011 PeaceHealth 37
Oregon Hospital Landscape
PSA
SSA
© 2011 PeaceHealth 38
2011 – Introduction of Third Party Data
39 © 2011 PeaceHealth
…and then there was light
Environmental Changes
• New CEO in 2012
• Transition from holding company to integrated
networked System
• Shift of focus from cost containment to growth
40 © 2011 PeaceHealth
The Proposal • 1 White Paper (3 page Narrative)
• 1 Spreadsheet (10 worksheets)
– Market Share Scenarios summarized by years 1 thru 5 w/ forecast by each
add’l liaison added
– Analysis of referral source and targets
– Outmigration Analysis
– Growth Opportunities
– One time setup costs
– Ongoing costs
– Summary by year
– Executive Summary
• Countless Powerpoints (network leadership, system leadership,
stewardship, boards)
41 © 2011 PeaceHealth
APPROVAL – January 2013
42 © 2011 PeaceHealth
43 © 2011 PeaceHealth
44 © 2011 PeaceHealth
Implementation Phase
• Creation of New Positions
• HR approval of job descriptions
• Approval of Budget Variance
• Organizational Integrity Audit
• Compensation for Physicians
• Increased demands on Design & Marketing
• Increased demands on CME Department
• Interviews
45 © 2011 PeaceHealth
Program Structure
• 3 liaisons
• Assigned Geographic Territories
– by primary, secondary and tertiary service areas
– By zip code
– Contains approx 2500 physicians per area
– Use Crimson Market Advantage to refine targets
• Sub Assignment by System of Care
Access PeaceHealth ED Trauma Telemedicine
Surgery Neuroscience CardioVascular Ortho
Community Based
Care Womens Pediatrics Behavioral Health
46 © 2011 PeaceHealth
Basic Training
• Every Possible Resource
– Other Programs
– Service Line Leadership
– Professional Societies
– Purchased Consulting
• Training Must Haves
– Organizational
– Strategic
– Message
– Visit Planning and Structure
47 © 2011 PeaceHealth
Outreach True North
• Referral decisions are based most often on relationships
between the referring physicians and the specialists.
• Primary care physicians (PCPs) recommend specific
specialists for 86% of referrals.
• Survey Says:
– personal knowledge of the specialist ranked highest
– followed by quality of prior feedback
– specialist’s technical capacity
– appointment availability
Sources: Halley MD. The Primary Care-Market Share Connection: How Hospitals Achieve CompetitiveAdvantage. Health Administration Press: 2007; Forrest CB et al.
Primary care physician specialty decision making: patient, physician, and health care system determinants. Med Decis Making 2006;26:76−85;Forrest CB et al. Family
physicians’ referral decisions: results from the ASPN referral study. J Fam Practice 2002;51:215−222.
48 © 2011 PeaceHealth
Issue Resolution
• One Voice – majority of issues flow through one to two
people within outreach department
• Starts with System of Care Leadership
• Most frequently:
– Missing Records
– Discharge report
– Ease of Referral
– Communication
START
Liaison
initiates
contact with
physician/
group
Forward to
Director of
Market
Development
Yes
No
Liaison
evaluates
issue,
identifies
responsible
party
Forward
to responsible
ops leadership
(Can I solve
this issue?)
Yes
Responsible ops
leadership resolves
issue & facilitates
communication of
resolution
Responsible
party notifies
Market Dev of
issue
resolution
END
No
Liaison receives
issue &
documents in CRM
Ops
determines
best course of
action &
timeline for
resolution
Ops notifies
Market Dev
that issue is in
progress to be
resolved
Liaison tracks
‘pending’ status
& identifies follow
up date based on
timeframe
Liaison
evaluates
resolution
progress (Was
issue resolved
in timeframe?)
Yes
No
Liaison
notifies Mar Dev
Director to request
immediate action
Did mgmt
respond within
24 hours?
Yes
MarDev
Director
notifies
appropriate
Executive
Team member
No
ET member
provides required
support to resolve
issue
Responsible
party notifies
Market Dev of
issue
resolution
END
Responsible party
resolves issue &
facilitates
communication of
resolution
50 © 2011 PeaceHealth
Communication Flow
51 © 2011 PeaceHealth
Access PeaceHealth • Create a fully integrated patient transfer center, bed placement and
consultation service
• RN Case managers field calls from beginning to end, ensuring
communication between transferring facility, admitting physician, oncall
specialists, hospitalists and bed placement. Web-based with real-time
updating/editing
• Central Logic supported:
– HL7 Interface with credentialing system
– Configurable reporting
– Full auditing of changes
– HIPAA compliant paging/texting
– 24/7 support
52 © 2011 PeaceHealth
Outreach Future
• New Provider Onboarding
• Evidence Based and Value Based Care
• Customer Service Excellence
Thank You!
• Joan Brewer RN, BSN
• Referral Relations Manager
• Billings Clinic
• (O) 406 435-8447
• (C) 406 633-0161
• Susan Blane, MPH, CMPE
• Director, Market Development
• PeaceHealth Oregon West Network
• 541-686-6856 desk
• 541-520-4216 cell & text