Decision Making and Next Steps: The Multi-Dimensional Due Diligence Tool

Part 5 of our series “Should I Stay or Should I Let It Go?” 

In Part 1 of our series Medical Practice Consolidation & Physician Practice Viability,  we discussed medical practice consolidation trends and the pandemic’s impact on the healthcare system and physicians in practice. We offered a practice viability self-assessment and recommended performance improvement actions to “Stay the Course.” In Part 2 Partnering with Others, we highlighted a variety of partnership options for physicians to consider including investor-owned companies that offer new models of clinical practice as alternatives to the fee-for-service treadmill. Part 3 Physician Partnerships with Health Systems discussed the dynamics of these ventures from a health system’s perspective within the context of an ongoing pandemic.  Part 4 Accountable Care and Physician-Health System Partnerships described the impact of accountable care and value-based reimbursement on physician-health system relationships including Clinically Integrated Network (CIN) and Accountable Care Organization (ACO) vehicles, as well as physician-led, private equity-backed ACO options which are allowing more physicians and their practices to remain independent and participate in value-based care transformation.

For physicians in practice, “Should I Stay or Should I Let it Go?” is such an important question even in normal times. In Part 5 Decision Making and Next Steps: The Multi-Dimensional Due Diligence (MD-DD™) Tool, we conclude our series by offering a practical decision-making framework for physicians contemplating their next steps in a potential partnership during these challenging times made even more urgent by the pandemic.

Decision Making and Next Steps

During 2020, “The Year of the Pandemic,” many physicians in private practice have been challenged with keeping their doors open and the lights on for their patients. “Should I Stay or Should I Let It Go?” is such a big question. Given the challenges over the years in the healthcare environment, this year is certainly not the first time physicians have asked themselves this question. Yet how does a physician decide to take the next steps toward partnership?

When considering a move from autonomous private practice to partnering with others, for example, another provider, medical group, health system or health services company, there are four key elements to evaluate:

• The Patient as Consumer
• Clinical Operations
• Revenue Cycle Management
• Organizational Culture Assessment

Using the Multi-Dimensional Due Diligence (MD-DD™) Tool offers physicians a practical framework for evaluating potential partners along each of these important dimensions.

The Patient as Consumer

Patients are increasingly savvy consumers of medical care looking for ease of access, a positive patient experience, affordable costs, flexible and safe locations, and convenient channels of communication and treatment with their physicians, such as telemedicine. Patients and their families are spending a record amount of money on co-insurance and deductibles, so they expect “value” for their health care dollar. They are increasingly looking for physicians who get great reviews on the Internet and in whom they can place their trust. A recent study showed that 69% of patients select or avoid physicians based on Internet reviews, such as Health Grades.²⁶   When it comes to the patient-as-consumer, how does the potential partner stack up?

Clinical Operations

Clinical operations in a physician’s current practice may be challenging. However, when joining another organization, it is critical to determine how supported and well run are medical practice operations. Are clinical and non-clinical operations efficient? How are patient panels managed, and are panel sizes realistic?  Are the right patients being seen at the right time by the right provider?  Are physicians and their clinical team members working at the top of their licenses? Is there adequate electronic health record (EHR) support along with useful, easy-to-access data to support clinical decision-making? Do physicians have input into EHR functionality and upgrades? Answering these clinical operations questions using the MD-DD™ Tool provides key insights for physicians as they evaluate potential partnerships.

Revenue Cycle Management

Efficient revenue cycle management (RCM) is a basic expectation when considering a new business partner. However, many organizations underestimate the complexity of medical practice revenue cycle challenges.  RCM begins at the moment of contact when a patient reaches out to the organization or is proactively contacted by the organization to schedule a visit with a physician.

How well an organization manages its access services and customer relationships determines how effectively it can bill and collect revenue. And when it comes to payor contracting, are physician payments a priority? Often in larger health systems, high-dollar services (e.g., inpatient admissions, surgeries, high-end diagnostic procedures) are prioritized over smaller dollar physician office visits.  If the physician’s new partnership arrangement is based in part on collected revenues in this scenario, s/he may be disadvantaged if the partnership organization does not efficiently capture and collect fee-for-service physician charges. The MD-DD™ Tool carefully assesses RCM capabilities including where a potential partner lands on the value-based reimbursement continuum.

The COVID-19 pandemic has accelerated the recognition of value-based reimbursement to shore up and stabilize reimbursement dollars in medical practices. When taking a next step toward partnership, physicians should evaluate the position of the organization on the value-based payment continuum.  A partnership where physicians can be paid for increasing patient access, improving quality, and reducing costs is preferable to an organization that pays physicians solely based on volumes, which is wasteful and increasingly will not be reimbursed or accepted by patients, for whom a volume-based approach means not only more visits and procedures which they may question as well as greater out-of-pocket costs.

Organizational Culture

Assessing the culture of another medical group, a health system, or a health services company lies at the heart of the Multi-Dimensional Due Diligence (MD-DD™) Tool. For example, does the organization share the same values as the physician?  Is there a partnership philosophy or is the physician a “hired hand”?  Is there adequate and effective physician leadership so physicians have an advocate at the senior decision-making level? Is there a culture of collaboration and engagement so organizational goals are aligned? Although it is an important consideration, compensation should never be considered first when making a move. Indeed, by joining another organization, physician salaries can be supported and remain relatively stable, versus the uncertainty and risk in private practice. Using the MD-DD™ Tool, compensation plans are reviewed for cultural factors including fairness and equitability, as well as viability.  Finally, how committed is the potential partner to physician well-being?  A 2019 survey by the American Academy of Family Physicians of 5,000 physicians in multiple specialties showed that only 31% of their organizations prioritized physician well-being. ²⁷ How does the potential partner stack up when it comes to supporting a culture of health and well-being for physicians and the care team?

CONCLUSION

The healthcare environment has never been more challenging for physicians and their practices than during this pandemic. The economic uncertainty created by the COVID-19 crisis is unprecedented in modern times and threatens the viability of many independent medical practices. Physicians are questioning whether they can or should remain independent or take the plunge and partner with others. Whether a potential partner is another medical group, a hospital or health system, a clinically integrated network or ACO, or a new innovative, investor-backed health services company, physicians should carefully evaluate their next steps from more than a single financial angle. Using the practical decision-making framework offered by the Multi-Dimensional Due Diligence (MD-DD™) Tool, physicians can answer with confidence that critical question: “Should I Stay or Should I Let It Go?”

ABOUT THE AUTHORS

Amanda Hopkins Tirrell, MBA, FACHE

For over 30 years, Amanda Hopkins Tirrell, MBA, FACHE has partnered with physicians in academic medical centers, integrated healthcare delivery systems and medical group practices across the country. An energetic change agent with a reliable track record in transformation, operations management and establishing a culture of patient service excellence, Ms. Hopkins Tirrell is a knowledgeable advisor and mediator in developing collaborative alliances and partnerships with physicians, hospitals and community organizations.

Based in North Augusta, South Carolina, Ms. Hopkins Tirrell is President and Founder of Hopkins Tirrell & Associates, LLC a health care management consulting practice offering strategic and operational management solutions to health systems, academic medical centers and physician practices. Consulting services include clinical strategic planning, patient access redesign, behavioral health solutions, physician engagement and network development. Physician practice advisory services include business growth, revenue cycle management and contracting strategy, as well as individualized leadership development, career planning and compensation strategy.

Most recently, Ms. Hopkins Tirrell served as technology strategy advisor for Mass General Brigham’s Chief Information & Digital Officer. As a member of the CIDO’s digital transformation team, she focused on senior stakeholder engagement and digital patient experience transformation to include digital front door redesign and CRM technology implementation to support access improvement and call center optimization. Key deliverables included developing the Digital Patient Experience Strategic Plan & Roadmap and Governance Strategy & Implementation Plan.

Ms. Hopkins Tirrell holds an MBA in health care management from the Wharton School and is a Fellow in the American College of Healthcare Executives.

Contact: (413) 427-4714 (cell) — email: Amanda@hopkinstirrell.com

Saria Saccocio, MD, FAAFP, MHA

Dr. Saria Saccocio is the Chief Medical Officer for Essence Healthcare, of Lumeris.

Dr. Saccocio has demonstrated a consistent history of leading award-winning programs and improving patient care and safety across the continuum as a Chief Medical Officer for health care delivery systems, including on the payer and health system environments. She received her Doctor of Medicine from the University of Florida, and her Executive Master of Health Administration from the University of North Carolina-Chapel Hill. She completed her Family Medicine residency at the University of Miami before opening her own solo family practice. She continues to serve patients at the Greenville Free Medical Clinic.

Becker’s Hospital Review has recognized Dr. Saccocio as one of the top 100 Hospital and Health System CMOs to Know and has been elected to the Alpha Omega Alpha Medical Honor Society. Her extensive civic involvement has included serving with many national, state, and local community organizations such as: the Modern Healthcare Women Advisory Board, Pisacano Leadership Foundation, South Carolina Hospital Association, United Way of Greenville County; Greenville Free Medical Clinic, the South Carolina Academy of Family Physicians, and is an Alum of the Women’s Leadership Institute and the Diversity Leadership Institute and Women of Distinction for Women’s Basketball at Furman University.

Contact Dr. Saccocio at:  Saria.Saccocio@gmail.com

REFERENCES

Part 5 – Decision Making and Next Steps: The Multi-Dimensional Due Diligence (MD-DD™) Tool

26. Pandemic Recovery: Gearing Up for Business Development and Marketing, Strategic Healthcare Marketing Association Webinar (May 2020)
27. “Top 5 Approaches to Physician Satisfaction,” L. Hegwer, Healthcare Executive (July/Aug 2020)