New Value Equation: An Executive. Retention & Productivity

Transcription

1 Best Practice Staffing Models For The New Value Equation: An Executive Discussion On Compensation, Retention & Productivity T h e O P E N M I N D S M a n a g e m e n t B e s t P r a c t i c e s I n s t i t u t e W e d n e s d a y, A u g u s t 1 4, : 3 0 p m 3 : 4 5 p m K e n C a r r, S e n i o r A s s o c i a t e, O P E N M I N D S 15 Lincoln Square, Gettysburg, Pennsylvania info@openminds.com

2 Agenda I. Aligning Staffing Models With Value-Based Care II. Staffing Model Case Study Lori Schmidt, Director of Behavioral Health, HealthPartners Jeremy Gatto, Clinical Social Worker, HealthPartners III. Question & Discussion 2018 OPEN MINDS 2

3 Aligning Staffing Models With Value-Based Care 2018 OPEN MINDS 3

4 Talent Needs In Health & Human Services Increased competition for highly-skilled clinical professionals physicians, registered nurses, physicians, and therapists Increased competition for specialized administrative staff medical assistants, billing and posting clerks, medical and health services managers, and technologyrelated staff Increased competition for executive leadership talent New business model transition to focus on value and not exclusively volume Workforce adequacy is a competitive challenge in health care, and involves: Having an adequate number of professionally qualified staff Having the right technical skills for the movement to value-based contracting Having the right leadership staff 2018 OPEN MINDS

5 Four Key Compensation Plan Goals 1. Align With Strategy Objectives Performance Culture Staff Motivation Quality & Results Planned Financial Outcomes What is your target profit? 2. Promote Staff Satisfaction & Engagement Equitable & Fair Opportunity For Hungry Employees 3. Compliance With Payer & Legal Requirements The Stark Law prohibits physician referrals for certain designated health services to an entity where there is a financial relationship (Section 1877 of the SSA) Contract Compliance Documentation, Coding, Outcomes Legal Requirements 4. Financial Stability & Growth Drives Financial Results What are your revenue drivers? Shares Financial Outcomes Sharing a portion of the excess (profit) both drives results and creates staff engagement 2018 OPEN MINDS 5

6 Top Factors Influencing Recruitment & Retention According to interviews with provider organizations and two top recruitment firms within the health care field, the top five factors influencing recruitment and retention include: Merritt Hawkins Fills more permanent physician jobs than any other search firm, leading the industry in annual revenue and the number of successful permanent physician placements Placed in excess of 200 psychiatrists in past two years more than any other search firm Psychiatry is the second most prevalent physician search Jackson Physician Search Specializes in the permanent recruitment of physician and advance practice providers across the U.S. Four decades in the industry, including predecessor Jackson & Coker First search firm to use direct mail, and then an all technology approach Compensation Opportunity To Spend Time With Patients Staff Support That Allows Work To License Quality Of Work Life Balance Geographic Location 2018 OPEN MINDS

7 Balancing Organizational & Staff Needs Organizational Needs Maintain Organizational Values Achieve Revenue Goals Provide Flexibility to Address Unexpected Events Ensure Transparent Processes Staff Needs Security (Sufficient Income) Self-Esteem Fairness Flexibility 2018 OPEN MINDS

8 Three Compensation Models Employee Low Risk High Risk Fixed Salary Base Plus Incentive or Bonus Pure Productivity Employer Low Results High Results 2018 OPEN MINDS 8

9 Fixed Salary Guaranteed Income Reliable income for employee (low risk) Concrete information for organizational budgeting and forecasting No ability to drive organizational results in the short term (compensation is not a factor in driving performance) The compensation structure of the organization reflects the average length of employment longer term employees earn more than newer employees regardless of whether their performance is better Poor performers need to be coached (pushed) out of the organization Key Characteristics: Salaries are based on market surveys Compensation system has a number of tiers based on salary ranges of groups of positions with similar pay Annual reviews determine annual salary increases Salary tiers are upgraded periodically to reflect market changes in wages 2018 OPEN MINDS 9

10 Base Plus Incentive Total Compensation May Vary Increased compensation risk for employees is offset by additional compensation opportunity Requires a shift in culture focus on initiative and results Both productivity and quality goals are important in creating the compensation structure Risks to organization: Challenge of creating a performance culture Balancing productivity, quality results, and employee satisfaction Implementing accurate, real-time information reporting to support the compensation system EHR, payroll, accounting Projecting results and managing cash flow Key Characteristics: Salary may be a percentage of market (for instance 85%) with incentive bonus to exceed market Salary may be an advance on total compensation with productivity and quality measures to earn the remaining compensation Service and business drivers may include revenue, quality outcomes, or payer contract requirements 2018 OPEN MINDS 10

11 Pure Productivity Model Compensation Not Guaranteed Most complex compensation model to plan and execute Goal is enhanced productivity and results Planning and monitoring is needed to prevent unintended results - overutilization of services, poor customer service, missed service opportunities Same risks as Hybrid model, but more intensive: Challenge of creating a performance culture Balancing productivity, quality results, and employee satisfaction Implementing accurate, real-time information reporting to support the compensation system EHR, payroll, accounting Projecting results and managing cash flow Key Characteristics: Staff paid only for the quantity and quality of service delivered Compensation drivers and measures are clearly defined in the employment agreement Information system configured to provide timely, accurate results since compensation will need to be calculated and paid quickly 2018 OPEN MINDS 11

12 Measuring Productivity Standard Units Fixed Units Service Hours Sessions Census Fixed units provide a comparative standard for setting targets and measuring results: Easy to measure Standard measures for productive time can be calculated total hours less PTO, holidays, meeting time, etc. Challenge: Some services are more complex than others, so time spent in some services does not have the same value as time spent in other services Productivity Estimator Hours Per Year 2,080 - Annually Holidays (80) - 8 Plus 2 Floating Holidays PTO (120) - 3 Weeks Team Meetings (171) Hour Meetings per Week Documentation & Other (285) - 1 Hour Per Day Hours For F2F Services 1,424 - Productivity % 68% Staff Number of Staff 20 Total Hours Per FTE Per Month 173 Productivity % 68% Available Hours 2,373 Clients Number of Clients 3,164 Average Service Hour Per Client 0.75 Total Hours Required 2, OPEN MINDS 12

13 Measuring Productivity Worked Relative Value Units (RVUs) (RVUs) Time Mental Effort & Judgement Intensity & Patient Risk Created by CMS to set rates to move away from variable and arbitrary fees to a standardized process that takes into account costs and service complexity CMS rates are based on physician work (RVUs), practice expenses and professional liability costs The physician work portion (RVUs) is used to compare productivity between services and create compensation models Each service procedure has a set RVU weight based on time, mental effort and judgement, and service intensity/patient risk Provider productivity is measured by adding the RVUs for each patient encounter The RVU method can be used with the Base Plus Incentive or Pure Productivity compensation models 2018 OPEN MINDS 13

14 Understanding RVUs Procedure Code Description RVU Psychiatric Diagnostic Evaluation Psychiatric Diagnostic Evaluation With Medical Services Individual Therapy 30 Minutes Individual Psychotherapy W/ Patient 30 Minutes Individual Psychotherapy W/ Patient -45 Minutes Individual Psychotherapy W/ Patient 60 Minutes Outpatient Office Visit New Low Outpatient Office Visit New Medium Outpatient Office Visit - New - High Outpatient Office Visit Established - Low Outpatient Office Visit Established - Medium Outpatient Office Visit Established - High OPEN MINDS 14

15 RVU Examples Base Plus Incentive Agreement Base Salary $80,000 Compensation Per RVU $5.00 Annual Compensation Base Salary $80,000 Annual Encounters 2,400 Annual RVUs 5,000 Total Compensation $105,000 Pure Productivity Incentive Agreement Base Salary $0 Compensation Per RVU $21.00 Annual Compensation Base Salary $0 Annual Encounters 2,400 Annual RVUs 5,000 Total Compensation $105,000 $80,000 + (5,000 x $5.00) = $105,000 5,000 x $21.00 = $105, OPEN MINDS 15

16 Team Considerations Set productivity targets by team, and tie the incentives to team performance Integrate into Base Salary Plus Incentive or Pure Productivity Models Promotes cooperation and teamwork Ensures group accountability for each team member to do their part Incentives are calculated from a pool based on a calculated outcome some as profit for a service 2018 OPEN MINDS 16

17 Tactics For Quality Provider Retention Create an effective incentive-based compensation system (drive performance and quality, while allowing providers to take ownership of their outcomes and financial results) Ensure that the entire compensation package salary, bonus, benefits facilitates organizational sustainability and staff work/life balance and retention of organizational talent Identify opportunities for flexibility, including the optimization of telehealth service and other technology that leverages provider resources Ensure a balance between quality time spend with patients and educate providers on the relationship of services, quality and reimbursement focusing on strategies that allow all professionals to work at the top of their license (i.e. teams, bonus pools) 2018 OPEN MINDS

18 Staffing Model Case Study Lori Schmidt, Director of Behavioral Health, HealthPartners Jeremy Gatto, Clinical Social Worker, HealthPartners 2018 OPEN MINDS 18

19 Best Practice Staffing Models For The New Value Equation: An Executive Discussion On Compensation, Retention & Productivity 2018 OPEN MINDS MANAGEMENT BEST PRACTICES INSTITUTE August 15, 2018

20 22,500 employees 1,500,000 members 1,000,000 patients

21 HealthPartners System 1,700 physicians 50 primary care locations 55+ specialties 60+ dentists 22 locations 7 hospitals

22 Behavioral Health Regions Hospital 100 Beds, ED Pod, IOP, Partial Hospitalization Out Patient BH Clinics 9 locations Therapists 68 FTE MDs 12 FTE Psychiatrist.8 FTE Dev Peds APRN 10.4 FTE Telehealth.8 FTE

23 Manage finances Pay for actual work Supports higher productivity rates Based on community/national standards

24 Model To Fit Practice Models Full Productivity Base plus productivity Productivity plus add on Factors EHR Measuring Provider focus Communication

25 Balancing Productivity Based Pay Financial Staff Engagement & Clinical Care

26 Sustainable Financial Performance Shared risk between department and individual Individual Target Salary Semi Annual Payout surplus Stable Pay check Quality Incentives Department Budget to WRVU goals Support scheduling and other administrative tasks Consistent output Shift conversation to quality

27 WRVU production Salary Draw Compensation Plans WRVU Goal x Conversion Factor = Annual Target Salary ex x $30 = $90,000 annual target salary Pay Rate is adjusted to % of Salary Draw Surplus paid out semi-annually Deficit is managed by supervisor and staff (ex. increase appointments, decrease % draw)

28 Example Monitoring Report RATE Total WRVU WRVU Goal WRVU Surplus (Deficit) Total Earned Total Paid * Monthly Surplus (Deficit) Jan $ (18) $6,930 $5,890 $1,040 Feb $ (13) $7,110 $6,043 $1,067 Mar $ $8,550 $7,267 $1,283 TOTAL $22,590 $19,200 $3,390 * Based on 85% Salary Draw

29 Practice Design New Provider Ramp-up period and guarantee Based on 45 minute therapy session (90834) Schedule 95% patient contact (38 hours/week) Based on 15% late cancel/no-show rate Goal aprox. 32 session/week

30 Performance Based Pay Two incentives based on quality outcomes 1. Depression Outcomes measured by PHQ-9 2. Patient Satisfaction Survey Results

31 Performance Based Pay Depression Outcomes measured by PHQ-9 Minnesota Community Measures (MNCM) Response/Remission Rates during 6 month window Average at the group level Benchmark set by organization % of Salary Incentive

32 Performance Based Pay Patient Satisfaction Survey Results 8 question survey Composite score of 4 question related to effective provider communication Individual provider score GOAL: 90% positive rating Provider coached and given resource for improvement % of Salary Incentive

33 Performance Based Pay Considerations Establish baselines Not one size fits all within specialties Ex. Adult vs. Child Providers Group vs. Individual Incentives Simple and adjustable Finance & Clinical data available Monthly reporting

34 Additional Benefits Of Model Steady pay check and benefits Compensation plan is shared Staff engaged in development (APRN) Flexibility to individual preferences Focused on clinic and financial incentives Motivates provider Individual responsibility to manage time off Pay for project work Work/life balance (ex. Lunch!)

35 Provider Satisfaction: Sustainable Engagement

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37 Provider Satisfaction Provider Retention 90% Retention Rate over 30 months 2 did not return from maternity leave; 1 left for smaller part-time private practice Staff Longevity Current avg. length of employment 10 yrs 4 therapists 25+ year.

38 Challenges Technology to support calculations EHR should integrate WRVU/Billings Payroll and annual payouts Retirements, LOA and pay for time off resulting deficits CMS shifts and payers lag in change Outcome Allows for productivity based model to pay in a salary based format.

39 Lori Schmidt, JD Director of Behavioral Health Services HealthPartners Jeremy Gatto, MSW, LICSW Clinical Manager for Behavioral Health Regions- HealthPartners

40 Questions & Discussion 2018 OPEN MINDS 40

41 Turning Market Intelligence Into Business Advantage OPEN MINDS market intelligence and technical assistance helps over 550,000+ industry executives tackle business challenges, improve decision-making, and maximize organizational performance every day 15 Lincoln Square, Gettysburg, Pennsylvania