At this year’s June CSA House of Delegates meeting, the inaugural class of CSA UCI Leadership for Healthcare Management participants presented the projects they have been completing this year. During the past eight months the participants have been learning leadership skills from the UCI Paul Merage School of Business Faculty, as well as leaders from the CSA. The topics covered included: Value, Leading Change, Financial Management, Strategy, Policy, Emotional Intelligence, Power and Influence, Critical Thinking, and Team-based care, as well as interviews with industry leaders.
Under the leadership of Dr. Phillip Richardson, CSA created the CSA UCI Leadership Course to provide tools to future leaders within California to help fix problems in healthcare and be “part of the solution”. With additional leadership tools, California anesthesiologists can work to make things better in their operating room, department, hospital, healthcare system, state and nation. We believe that with physician leadership, especially from anesthesiologists, can improve our healthcare system so that Californians will receive better care and increased value.
In creating the leadership program, CSA recognized the importance of mentorship and building relationships. As such, each participant was paired with a CSA mentor throughout the program and worked through various exercises.
Some of the presentations included:
Ultrasound Billing – The team identified multiple problems with the billing and coding of Ultrasound exams. They also identified key stakeholders and decision makers, and obtained data to support their proposed changes. After obtaining buy-in, they implemented several changes to a) notify coders when an exam was done and b) automate uploading of images into the EMR. They hope to automatically synch the images with the correct chart and CPT code. They also hope this more effective ultrasound coding will be adopted for the ICU teams as well.
Another team looked at surgeon infection rates and how to minimize surgical site infections (SSI). This team obtained data regarding the various surgeons and were able to identify one surgeon with a higher rate. They also noted that this surgeon used a specific type of dressing that none of the other surgeons utilized. Through the steps of change management, they hope to bring this surgeon’s SSI rate back down to a similar rate of the other surgeons.
Another team addressed the number one issue in healthcare today – staffing. Post Covid, there is a staffing shortage. It is essential to identify and offer what new employees or partners want at various stages in their careers. This facilitates recruitment and makes groups as appealing as possible to the broadest number of potential staff. Finding new talent to match the needs of the practice also involves good networking, good communication, and having a digital footprint. In addition, groups need to spend time on retention once they find great talent. Enhancing physician wellness is an important consideration in this regard. By being appealing to a broad audience, and thinking long term, a group will be more successful in recruitment and retention of new partners.
One group looked at Financial Implications of not billing in preoperative clinics and financial implications from delays or patient complications from preoperative clinics. One private practice group which has multiple hospitals under their purview has the patient complete a one-page questionnaire at the time of case booking, which is evaluated by an anesthesiologist for clearance or further workup. This reduced same day cancelations to zero. An academic institution implemented a similar model, also reducing same day cancelations from 10% to nearly zero. Unfortunately, time spend in preop evaluations is poorly funded and needs either institutional or surgical support. As such, they will next approach the institution for appropriate funding.
One physician worked on insurance contract negotiations. They recognized that while Medicare/MediCal is non-negotiable, managed Medicare/MediCal is negotiable. They found the current reimbursement was unsustainable and tried to partner with the health plans and facility. Unfortunately, the health plans and facility rejected a partnership. So, knowing their BATNA (best alternative to a negotiated agreement), they gave notice that they would no longer be able to care for those patients so those patients would need to seek care at the hospital instead. At that point, the health plans and facility chose to negotiate and partner with the anesthesia group in a mutually beneficial manner.
As a result of the mentorship and internal evaluation process, one participant recognized that their current role was not going to help them achieve their goals. After much reflection and discussion, they approached their department chair with a proposal for a new position aligning their vision, mission and values with the institution. The chair created the new position, based on its success, they are now considering expanding the position throughout the hospital, not just within the department of anesthesiology.
In short, the material covered and utilized in this leadership has helped anesthesiologists in California to 1) enhance billing for their department and possibly the hospital 2) help decrease SSIs 3) improve staffing to attract anesthesiologists to California and ensure adequate coverage for Californians 4) improve utilization by decreasing same day cancelations, and 5) negotiate to ensure appropriate compensation for care of the most vulnerable 6) modify their career pathway.
If you are ready to learn leadership skills and help your O.R., department, hospital, system, state or nation make things better, sign up for the next CSA UCI leadership course starting in November.
Flyer for more information click here.
Interest list to sign up for the class starting in November click here.
Any questions please email Phillip Richardson @ Richardson.MD.MBA@gmail.com