16 Key Questions for Your Heart Program in the New Year

Thursday, January 7, 2016 | Larry Sobal

“Yesterday, all my troubles seemed so far away . . . ” That iconic opening line sung by Paul McCartney seems to sum up the first few days of the New Year; 2015 is in the past and 2016 is too new to know what types of challenges (or opportunities) it will bring. As promised, today I will talk about the key questions that CVSL programs should be asking themselves to assess their current status and potential going forward.

Although MedAxiom works with hundreds of heart programs across the country, the organization is rooted in its original principle of the CVSL community helping one another—we get to see many common and uncommon themes. That being said, the questions below are typical in the sense that answering “Yes” to most or all will generally have a correlation with successful and progressive heart programs. Answering “No” to many of these will usually be correlated with heart programs that are spending most of their energy overcoming daily challenges vs. being focused on advancement.

For purposes of this list, the questions apply to both heart programs as well as individual cardiology and/or cardiothoracic surgery practices, which may be independent or embedded into a CV service line through some form of contractual alignment or employment.

Here are the 16 questions to ask yourself now.

Organizational. Mike Carlson, an attorney who has helped hundreds of cardiology practices align with their respective hospital/system partners over the past decade said it best: “When your governance isn’t right, you’re likely to be miserable every day.”  

1. Is your organizational model functioning effectively in terms of setting clear vision and strategy?
2. Is your governance process physician led?
3. Do you have a leadership dyad that leverages a physician and administrative leader so that together this team functions as an effective partnership?
4. Do you have a formal succession plan to ensure future leadership is being developed and is ready to step in and serve?

Operations. It’s been said that “Culture eats strategy for lunch.” Aside from ineffective governance, the other thing most likely to determine whether you have joy or misery each day is how well your operations function. Nothing drags down morale as fast as when people spend all day battling broken processes and ineffective systems.

5. Do you have a balanced and comprehensive set of information that tells you how well your operations are performing in terms of key processes, financial results, and service?
6. Is your clinic access a differentiating feature so that patients can get in to be seen on a timely basis, particularly urgent requests from your referral base or patients with acute symptoms?
7. Likewise for non-clinic CV operations, do your cath labs, CV OR’s, cardiac diagnostics, and inpatient units run like well-oiled machines with effective throughput balanced with flexibility to handle those unexpected surprises?
8. In an era of revenue scarcity, are your revenue cycle processes effectively making sure you are coding properly and being paid for all the work being performed (both in the clinic and hospital) with a minimal number of insurance denials?

Clinical.  If there were one area that you can't afford to be less than stellar, it's in the clinical arena. While various sources of external data suggest there is a wide range of clinical performance across the U.S., I've rarely been to a heart program that didn't think it was performing well. Can everybody be above average?

9. Similar to #5 above, do you have the information you need to tell you how you are performing clinically, incorporating both your own internal data and the growing list of external sources such as registries, QRUR reports and other metrics?
10. Have you successfully discussed, adopted and implemented clinical guidelines and/or appropriate use criteria where there is external evidence (or local consensus) on the best methods of providing care or where you have gaps compared to external benchmarks?
11. Do individual clinicians (physicians and advanced practice providers) receive data regarding their clinical performance along with a structured process to discuss the data and understand/address outliers?
12. Do you survey the satisfaction of your patients and referring physicians to understand their perspective of your clinical performance?

Transformational. Martin Luther King Jr. offered these inspirational and transformational words: “If you can't fly then run, if you can't run then walk, if you can't walk then crawl. But whatever you do, you have to keep moving forward.”  These final questions can help you assess whether you are moving forward or stagnating.

13. Do you have organizational experience and competency in using teams to assess and achieve lasting and measurable change in operational and clinical processes and outcomes?
14. As reimbursement begins to change from fee-for-service to one of the many value-based models, do you know your current performance and where you need to be in the future to be successful in these contracts?
15. Have you realigned your compensation and incentive plans so that they support the behaviors necessary to be successful in the future?
16. Have you built or do you have access to the analytics to synthesize population data to understand patient risk stratification and use predictive methods to guide care plans?

There you have it, my sweet 16. Obviously, there are hundreds of possible questions that can be used to study your program/practice performance, but these should be a good start. If you are already MedAxiom member, are you taking full advantage of the many resources MedAxiom offers to help you address any areas where you are not an emphatic “Yes”? And if you are not a MedAxiom member, why not? Our community is very willing to share its successes; we can help you access the information you need to learn how to be better.

What are your biggest challenges for 2016? What keeps you from moving forward? Let me know and I’ll see how we can help.

P.S. Back to yesterday . . . over the holidays I read the book No Easy Day by former Navy Seal Mark Owen. In the book, he points out the Navy Seal motto, “The Only Easy Day Was Yesterday.” In this era of health care, I couldn't agree more.

 

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Larry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. As part of his current role, Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

 

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