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Tips for Ambulatory and Service Line Optimization

“There may be no faster death of a great idea or business than a dysfunctional team”, said Daniel Newman from Principal Analyst of Futurum Research and the CEO of Broadsuite Media Group.

Over the last 15 years, hospitals have acquired or employed clinicians and other ambulatory services. Unfortunately, not all employment arrangements are part of a good strategic plan and end up with disgruntled employees, broken systems, ineffective leadership, and a lack of overall alignment of physicians, advanced practice providers (APPs) and hospital administration.

As Daren Martin, PhD, CEO & Founder of The Global Company Culture Association said, “When a big vision meets a dysfunctional system, the dysfunctional system wins every time. Fix the system and success will flourish!”

Signs of Dysfunction within a Service Line 

Within the healthcare industry, dysfunction may look different based on the role an individual has in the organization. The following are some common perspectives as voiced from physicians, APPs, and hospital administration.

From Physicians:

  • Our roles on committees are powerless; our opinions are not taken into consideration.
  • We are kept in the dark on key issues related to recruitment, policy changes, practice structure changes, finances, etc.
  • Nobody tells us how much money we make for the hospital.
  • Despite all the money we make for the hospital, we can’t get supplies/medications/implants approved to provide better care because “they cost too much.”
  • I would never in a million years transition my practice to that EMR.
  • The hospital administration doesn’t care about our obligations to our patients in our outpatient practice. We are spread too thin between the office and hospital.

From APPs:

  • The physicians and administration do not value what we do for the practice.
  • The physicians would rather have APPs, who are clinicians with less training and qualifications, cover the physicians’ hospital obligations so they can make more money in the office / have more weekends off.
  • APPs chose this profession to have a better work-life balance than physicians, and we should be treated as such. We don’t get paid like physicians do.
  • The physicians tell us what we are more easily replaced than they are.
  • Anytime a physician leaves the group, we are asked to pick up the slack.
  • There is no consideration of the non-revenue generating work that we do, such as fielding calls from the office staff, triaging patient concerns, medication refills, entering in orders for procedures, etc.
  • The physicians expect us to enter all their orders and do all their refills for them while they see patients. How are we supposed to see 20 patients/day?

From Hospital Administration:

  • This group can’t be held accountable to transition to a more appropriate type of coverage model.
  • The physicians are too busy counting their work Relative Value Units (wRVUs) to think about participating in activities that benefit the group.
  • Every legacy physician wants to create their own one-off deal; we’ll never be able to transition to a standard.
  • That physician only cares about producing their base wRVU threshold; forget trying to get them to do anything above and beyond.
  • If a (senior) physician isn’t producing, condense their work week and think of where we can move them to free up space for someone else.

Healthcare organizations find themselves perplexed by the question, “What is the vision and the end goal? How do we align our resources and efforts to achieve our vision?”

Getting a Service Line Back on Track

In answering these questions, the organization’s objectives and changes to processes need to be clearly communicated and planned collectively with the physician leaders and impacted clinicians to help align expectations and establish clear goals.

The following four areas are the best places to start when determining the next steps for getting a healthcare system or service line back on track:

  • Strategic Alignment
    • Vision & strategic direction
    • Physician workforce, leadership, and alignment of strategies
  • Operational Alignment
    • Governance, operational & infrastructure needs
    • Payment models, including bundled payments
  • Improvement
    • Quality, service & cost
    • Performance metrics
  • Competitive Landscape
    • Competitive positionings and new service offerings
    • Volume & financial projections

Contact Us

Although the areas above may seem straightforward these are the areas that are typically not agreed to, communicated about, nor clearly understood by hospitals, ambulatory partners, and clinicians. Blue & Co., LLC’s Physician and Hospital Operations team offers detailed solutions for Ambulatory and Service Line Optimization to help drive healthcare organizations forward in a manner that promotes positive change, accountability, and focus on the organization’s vision.

For more information about how Blue & Co., LLC can help your organization achieve its vision and Ambulatory and Service Line Optimization, contact Tony Javorka or your local Blue & Co. Advisor.

Tony Javorka, CPA, Director

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