“Extending” the physician
Technology is one way to address physician productivity. Labor distribution, decidedly low-tech, is another. Believe it or not, physicians aren’t always crazy about the idea of delegating some of their simpler patient care tasks. That’s why deciding how to encourage physicians to spend their time on high-value pursuits is the secret to optimizing clinician labor, says Kent Wallace, president and chief operating officer of Nashville-based Vanguard Health Systems, a for-profit health system with 28 hospitals in five states.
“Many like using physician extenders, but there’s another camp of physicians who say it takes a lot of time for them to get in sync [to train] physician assistants. They’re not sure it helps them speed up the practice,” he says. “We’re looking for how to get the most out of that physician practice from a productivity and service standpoint, and primary care visits are changing.”
Although the concept of labor optimization is low-tech, a low-tech concept often translates into a high-tech measurement system. Wallace says Vanguard is flexible on how both its employed and affiliated physicians achieve productivity goals, but that the goals include baselines for quality, patient satisfaction, and patient experience. If the physicians are not meeting those goals, physician extenders are a natural part of the conversation in how to do better.
“Their practices are not dictated by the corporate office. They talk with our physician executive and our business executive, and if that plan creates value for the practice over time, we are flexible with how they do their clinical work,” he says. “Intellectual capital is the ultimate resource. We want to make sure that is utilized efficiently.”
On the physician side, he says, they acknowledge they are going to be measured, and they don’t really mind as long as they agree with what’s being measured, are involved in the metrics, and have input.
“This is not a for-profit medicine thing,” he says. “In physician-owned practices that are sophisticated, they use measurements of efficiency and service just as we do.”
One of the main metrics Vanguard measures is primary care patient turnover. But they also judge their physicians on Healthcare Effectiveness Data and Information Set measures and even whether they’ve achieved the government’s definition of “meaningful use” of technology. But many of the measures it uses depend on whether a physician is able to delegate simple, repetitive tasks so that the majority of his or her time is spent on activities that actually require a physician. It’s as simple as that.
But how has that measurement changed in recent times?
“Once we employ a physician, they have a year to build their practice, but you can pretty much tell after a year whether they really want to be part of the team,” Wallace says. “We meet with them about the measurements a lot more often than we used to, and we let them know how they’re doing so there are no surprises. After that, if there’s no fit, we move more quickly to sever those relationships.”
This article appears in the December 2011 issue of HealthLeaders magazine.