“Building the Physician Organization(a large, established medical group)

After some years experience with an
integrated health system, you apply for a post as executive director of a new
moderate-sized physician organization attached to one of the systems
hospitals. You will be interviewed by a panel of the governing board, including
several physicians representing primary and referral specialties. About a week
before the interview, the spokesperson for the search committee tells you:
We want to build a group that attracts the best doctors and makes
quality a habit. We want a say in our destiny. And we want to make competitive
incomes, and take paying patients from all forms of insurance. Weve gotten
everybody signed up, both legally and emotionally, on those ideas.

We think we have good doctors, and we have good malpractice
records, thank heaven. But we havent really gotten into some important
questions we know well have to address, such as how big we should be, how we
should control our referral specialist numbers, and what specialties we ought
to include.
We copied the hospitals credentialing system verbatim, and were
not sure thats all we need because it doesnt do much for outpatient care.
Some doctors think we should have specialty departments like the hospital,
others want geographic directors or leaders, and frankly a lot would like total
autonomy.
Now we are in the pay-for-performance era. The system is giving us
HEDIS reports, a bunch of patient satisfaction data, and some process measures
like scheduling delays. Were doing okay on these, but the system says they
want benchmark performance on a bunch of them within three years. They also
give us cost reports that show we are a little over the system average for many
common problems. They want overall costs down 15 percent in two years. Some of
our doctors think these goals are impossible, but the system shows us data from
other cities and competitive information where the goals have already been met.
We think were going to have to meet those goals, but honestly I dont have a
clue how well do it.
Tell us how we should organize to get all this done.
From your experience with the system, you know the search
spokesperson outlined the right agenda. The market is demanding cost and
quality improvement, and the system will not tolerate much failure on the
goals. You decide to outline your response in detail, making sure you hit all
the points and give answers that will get you the job as well as establish a
basis for doing the work.
Building the
Physician Organization(a large, established medical group) After some years experience with an
integrated health system, you apply for a post as executive director of a new
moderate-sized physician organization attached to one of the systems
hospitals. You will be interviewed by a panel of the governing board, including
several physicians representing primary and referral specialties. About a week
before the interview, the spokesperson for the search committee tells you: We want to build a group that attracts the best doctors and makes
quality a habit. We want a say in our destiny. And we want to make competitive
incomes, and take paying patients from all forms of insurance. Weve gotten
everybody signed up, both legally and emotionally, on those ideas. We think we have good doctors, and we have good malpractice
records, thank heaven. But we havent really gotten into some important
questions we know well have to address, such as how big we should be, how we
should control our referral specialist numbers, and what specialties we ought
to include. We copied the hospitals credentialing system verbatim, and were
not sure thats all we need because it doesnt do much for outpatient care.
Some doctors think we should have specialty departments like the hospital,
others want geographic directors or leaders, and frankly a lot would like total
autonomy. Now we are in the pay-for-performance era. The system is giving us
HEDIS reports, a bunch of patient satisfaction data, and some process measures
like scheduling delays. Were doing okay on these, but the system says they
want benchmark performance on a bunch of them within three years. They also
give us cost reports that show we are a little over the system average for many
common problems. They want overall costs down 15 percent in two years. Some of
our doctors think these goals are impossible, but the system shows us data from
other cities and competitive information where the goals have already been met.
We think were going to have to meet those goals, but honestly I dont have a
clue how well do it. Tell us how we should organize to get all this done. From your experience with the system, you know the search
spokesperson outlined the right agenda. The market is demanding cost and
quality improvement, and the system will not tolerate much failure on the
goals. You decide to outline your response in detail, making sure you hit all
the points and give answers that will get you the job as well as establish a
basis for doing the work. “