Leadership in today's evolving physician group practice organizations — especially as hospitals return to the business of purchasing physician practices in order to further their integration strategies — requires a diverse array of skills and experience. Many of these organizations are being newly launched or expanded by most hospitals and hospital systems and are less traditional and predictable than in the past. For today's dynamic and rapidly expanding physician organizations, this means quickly finding cutting-edge leaders who have considerable knowledge in multiple disciplines and not just the hospital provider side; thus, the process may be extremely challenging.
• Hands-on operations experience. Most of the group practice leadership positions today are a result of acquisitions and newly created strategies for physician integration, accountability and improved patient care delivery. The ideal candidate needs hands-on group practice operations and development experience, since he or she is ultimately responsible to provide all of the key business services in order to retain the physician customer by ensuring both the provider's and hospital's profitability.
• Financial and accounting expertise, plus good, solid, general business acumen. This includes revenue generation options, fee establishment, coding, billing, accounts receivables management, information technology/EMR assistance, scheduling and staffing just to name a few. All are different in a physician practice than in a hospital setting, so again having a practice management executive is a must.
• Understanding of the significance of evidence-based medicine and its implementation. Group practice leaders must thoroughly understand the concept of evidence-based medicine and its role in today's physician-hospital relationships. The ability to work with physicians and the hospital to implement usable and effective strategy that binds physicians and hospitals together to seek out the greatest outcome for the patient while working to control costs will be a central role in today's managed practice environment.
• Understanding of the possible impact of accountable care organizational structure and the role this will play in the delivery of healthcare should this model become largely incorporated into healthcare delivery.
• Strategic planning, business development and marketing skills.
• Knowledge of staffing and human resource functions, including policies and procedures, training, mentoring, etc.
• Managed care contracting experience and knowledge of current industry and regional trends around practice and referral patterns.
• Information systems and vendor relations to either lead a conversion or select a new system as the organization grows and attempts to integrate smoothly with the variety of hospital and other group practices' systems that are not likely to "speak" to each other currently.
• Training and the ability to implement these programs.
• Data tracking, analysis and implementation, including clinical pathways, care/case management and outcomes measures, specific to the variety of specialties being recruited.
• Strong physician relations skills and an ability to develop rapport with and/or educate physicians as well as to develop both formal and informal physician leaders for the long haul.
• Effective communication skills at all levels and the proven ability to use metrics and data to implement meaningful physician behavior changes.
• Strong negotiation, facilitation and collaboration skills.
• Entrepreneurial, decisive and a risk taker.
• Continual learner who stays abreast of marketplace changes.
When talking with candidates, ask for specific accomplishments in each area. Seek details and examples of accomplishments that provide a clear picture of his/her understanding of various practice and specialty situations, but also past successes from which he/she can draw.
Learning about the candidate's basic expertise can build a solid foundation for secondarily determining who has the best chemistry with the existing physicians and administrative team. Check references to verify these attributes.
Specific multispecialty group practices need a strong practice leader who is a self-starter with a full understanding of physician referral and practice patterns, physician compensation issues, good contract negotiation skills, personnel management skills, IT and political savvy, goal-setting and an entrepreneurial approach.
The group practice leader must be able to "do it all" — to be equally as good at strategizing as at implementing — usually with minimal staff support and resources. He or she must like autonomy and be an independent thinker who will not be swayed easily by individual physicians but at the same time be able to work across today's highly matrixed systems.
He or she must also be able to build consensus among physicians and enlist support to help the practice move toward its mutual goals and merge them with those of the hospital and/or system. This individual may have never set foot in a hospital or corporation, but he or she probably has 5 to 10 years or more of hands-on practice management experience. Some practices are finding that either a certified public accountant or a individual with a master's in business administration often makes an excellent fit in terms of additional specialized credentials.
For any entity purchasing physician practices the incoming executive must be able to help blend the independent practice mentality with the new "leaner/meaner" corporate style that results in profitability for all parties and ultra-efficient, high quality, documentable and accountable, patient care.
A leader in this setting must readily command respect and engender trust across a wide range of areas and be proven to manage multiple sites from afar.
Someone with a strong general business background, who is a systems thinker and can see how pieces can fit together without duplication, and who has the ability to see beyond — but not overlook — the day-to-day details is an excellent choice in this type of leadership role.
Assuming that systems are interchangeable — thinking that group practices can always be run with hospital or other pre-existing information systems and the like.
Example: A large hospital in the Midwest purchased multisite, specialty physician practices, took the personal computers that were working fine out of the physicians' offices, brought in new computers and provided no training to office personnel. One rural practice alone dropped more than $30,000 in lost billings because of coding errors, lost files, etc., in the first quarter.
Under-hiring — Promoting from within for the sake of "politics" rather than seeking qualified candidates with specific and proven group practice, business, leadership and financial experience.
Example: An independent group practice in the South, that grew from seven to more than 20 members in a two-year period, promoted an office manager to group practice leader. The office manager had no managed-care experience, no strategic planning skills and lacked the systems integration orientation to reposition the group for growth. As a result, the group's competitors partnered with the only local hospital, nearly putting the group out of business. In fact, the group was acquired by the larger group, but only after all of the physicians' incomes fell more than 40 percent.
Rushing the process — Focusing on bringing in more practices before the initial planning, analysis or structural foundations are in place.
Example: A for-profit hospital system started buying practices before appropriate valuations were complete. The corporate executives had the independent hospital executives telling them which practices to buy. Therefore, the corporate office inherited too many unprofitable and diverse practices with diverse practice styles, hampering its ability to effectively blend or successfully manage them.
Too much attention to sheer numbers — Total bottom-line orientation.
Example: A PHO director, who was asked to be the interim manager for an MSO until an MSO director could be hired, was enrolling physicians in too many plans too quickly, resulting in so much red tape for the physicians that several of them needed to take an entire extra day off to keep up with the avalanche of increased paperwork for the providers. Because they were salaried, the physicians now only worked a three-day week, and the MSO was losing both patients and money.
In all of these examples, serious mistakes and many turn-around situations could have been avoided by finding the right leader early on for the start-up, before so much long-term damage was allowed to occur.
You can develop your own physician organization leader if you have the option of a longer learning curve, but this takes time in a market characterized by immediacy and an often overwhelming potential to lose large amounts of market share and money quickly.
Success in finding the best leader to come in from the outside for your physician organization can be achieved by realizing that very few candidates have all the skills and experience necessary to effectively lead today's practices, and the competition for these individuals is fierce. These candidates are in great demand from not only the competitors in your own segment of the market, but also from other independent groups in the marketplace.
A nontraditional approach to seeking leaders — doing your due diligence by looking outside the traditional hospital environment for a candidate with an entrepreneurial spirit, strong physician relations skills, analyzing your specific model needs, determining your growth objectives at the outset and being willing to explore individuals with transportable skills may result in your making the correct decision initially and, therefore, avoiding monumental financial and integration obstacles down the road.
Robin Singleton serves as executive vice president and practice leader for DHR International’s National Healthcare Practice. She is a well-recognized and respected consultant in both the non-profit and for-profit healthcare sectors. Based in the firm’s Atlanta office, Ms. Singleton has conducted hundreds of senior level executive searches over a career span of 30 years solely in the healthcare industry.
General leadership skills for medical group leaders
Finding the right individual to lead your physician organization or employed physician group must start with determining the answers to some basic questions: What type of organization or practice model will the individual be leading? How will this affect the type of person selected to lead the organization? How knowledgeable is the individual regarding the needs of today's generation of physicians and the paradigm shift that has led to greater demands for a work/life balance that has not existed in the past?• Hands-on operations experience. Most of the group practice leadership positions today are a result of acquisitions and newly created strategies for physician integration, accountability and improved patient care delivery. The ideal candidate needs hands-on group practice operations and development experience, since he or she is ultimately responsible to provide all of the key business services in order to retain the physician customer by ensuring both the provider's and hospital's profitability.
• Financial and accounting expertise, plus good, solid, general business acumen. This includes revenue generation options, fee establishment, coding, billing, accounts receivables management, information technology/EMR assistance, scheduling and staffing just to name a few. All are different in a physician practice than in a hospital setting, so again having a practice management executive is a must.
• Understanding of the significance of evidence-based medicine and its implementation. Group practice leaders must thoroughly understand the concept of evidence-based medicine and its role in today's physician-hospital relationships. The ability to work with physicians and the hospital to implement usable and effective strategy that binds physicians and hospitals together to seek out the greatest outcome for the patient while working to control costs will be a central role in today's managed practice environment.
• Understanding of the possible impact of accountable care organizational structure and the role this will play in the delivery of healthcare should this model become largely incorporated into healthcare delivery.
• Strategic planning, business development and marketing skills.
• Knowledge of staffing and human resource functions, including policies and procedures, training, mentoring, etc.
• Managed care contracting experience and knowledge of current industry and regional trends around practice and referral patterns.
• Information systems and vendor relations to either lead a conversion or select a new system as the organization grows and attempts to integrate smoothly with the variety of hospital and other group practices' systems that are not likely to "speak" to each other currently.
• Training and the ability to implement these programs.
• Data tracking, analysis and implementation, including clinical pathways, care/case management and outcomes measures, specific to the variety of specialties being recruited.
• Strong physician relations skills and an ability to develop rapport with and/or educate physicians as well as to develop both formal and informal physician leaders for the long haul.
• Effective communication skills at all levels and the proven ability to use metrics and data to implement meaningful physician behavior changes.
• Strong negotiation, facilitation and collaboration skills.
• Entrepreneurial, decisive and a risk taker.
• Continual learner who stays abreast of marketplace changes.
When talking with candidates, ask for specific accomplishments in each area. Seek details and examples of accomplishments that provide a clear picture of his/her understanding of various practice and specialty situations, but also past successes from which he/she can draw.
Learning about the candidate's basic expertise can build a solid foundation for secondarily determining who has the best chemistry with the existing physicians and administrative team. Check references to verify these attributes.
Specialized leadership skills
The general leadership skills and core competencies outlined above are the undergirding of any good practice management executive, regardless of the practice model. However, today's organizations require a second tier of specific leadership skills, depending on which kind of practice they will be managing.Specific multispecialty group practices need a strong practice leader who is a self-starter with a full understanding of physician referral and practice patterns, physician compensation issues, good contract negotiation skills, personnel management skills, IT and political savvy, goal-setting and an entrepreneurial approach.
The group practice leader must be able to "do it all" — to be equally as good at strategizing as at implementing — usually with minimal staff support and resources. He or she must like autonomy and be an independent thinker who will not be swayed easily by individual physicians but at the same time be able to work across today's highly matrixed systems.
He or she must also be able to build consensus among physicians and enlist support to help the practice move toward its mutual goals and merge them with those of the hospital and/or system. This individual may have never set foot in a hospital or corporation, but he or she probably has 5 to 10 years or more of hands-on practice management experience. Some practices are finding that either a certified public accountant or a individual with a master's in business administration often makes an excellent fit in terms of additional specialized credentials.
For any entity purchasing physician practices the incoming executive must be able to help blend the independent practice mentality with the new "leaner/meaner" corporate style that results in profitability for all parties and ultra-efficient, high quality, documentable and accountable, patient care.
A leader in this setting must readily command respect and engender trust across a wide range of areas and be proven to manage multiple sites from afar.
Someone with a strong general business background, who is a systems thinker and can see how pieces can fit together without duplication, and who has the ability to see beyond — but not overlook — the day-to-day details is an excellent choice in this type of leadership role.
Misconceptions and pitfalls to avoid
Unfortunately, in most new medical group models it is common to see mistakes that could be avoided with the right individual at the helm. Here are some common mistakes to avoid:Assuming that systems are interchangeable — thinking that group practices can always be run with hospital or other pre-existing information systems and the like.
Example: A large hospital in the Midwest purchased multisite, specialty physician practices, took the personal computers that were working fine out of the physicians' offices, brought in new computers and provided no training to office personnel. One rural practice alone dropped more than $30,000 in lost billings because of coding errors, lost files, etc., in the first quarter.
Under-hiring — Promoting from within for the sake of "politics" rather than seeking qualified candidates with specific and proven group practice, business, leadership and financial experience.
Example: An independent group practice in the South, that grew from seven to more than 20 members in a two-year period, promoted an office manager to group practice leader. The office manager had no managed-care experience, no strategic planning skills and lacked the systems integration orientation to reposition the group for growth. As a result, the group's competitors partnered with the only local hospital, nearly putting the group out of business. In fact, the group was acquired by the larger group, but only after all of the physicians' incomes fell more than 40 percent.
Rushing the process — Focusing on bringing in more practices before the initial planning, analysis or structural foundations are in place.
Example: A for-profit hospital system started buying practices before appropriate valuations were complete. The corporate executives had the independent hospital executives telling them which practices to buy. Therefore, the corporate office inherited too many unprofitable and diverse practices with diverse practice styles, hampering its ability to effectively blend or successfully manage them.
Too much attention to sheer numbers — Total bottom-line orientation.
Example: A PHO director, who was asked to be the interim manager for an MSO until an MSO director could be hired, was enrolling physicians in too many plans too quickly, resulting in so much red tape for the physicians that several of them needed to take an entire extra day off to keep up with the avalanche of increased paperwork for the providers. Because they were salaried, the physicians now only worked a three-day week, and the MSO was losing both patients and money.
In all of these examples, serious mistakes and many turn-around situations could have been avoided by finding the right leader early on for the start-up, before so much long-term damage was allowed to occur.
You can develop your own physician organization leader if you have the option of a longer learning curve, but this takes time in a market characterized by immediacy and an often overwhelming potential to lose large amounts of market share and money quickly.
Success in finding the best leader to come in from the outside for your physician organization can be achieved by realizing that very few candidates have all the skills and experience necessary to effectively lead today's practices, and the competition for these individuals is fierce. These candidates are in great demand from not only the competitors in your own segment of the market, but also from other independent groups in the marketplace.
A nontraditional approach to seeking leaders — doing your due diligence by looking outside the traditional hospital environment for a candidate with an entrepreneurial spirit, strong physician relations skills, analyzing your specific model needs, determining your growth objectives at the outset and being willing to explore individuals with transportable skills may result in your making the correct decision initially and, therefore, avoiding monumental financial and integration obstacles down the road.
Robin Singleton serves as executive vice president and practice leader for DHR International’s National Healthcare Practice. She is a well-recognized and respected consultant in both the non-profit and for-profit healthcare sectors. Based in the firm’s Atlanta office, Ms. Singleton has conducted hundreds of senior level executive searches over a career span of 30 years solely in the healthcare industry.
More Articles on Physician Practice Management:
Navigating Physician Practice Acquisitions, Post-Transaction Compensation
How Hospitals Can Maximize Revenue From Their Physician Networks