Restructure Restructure Medical StaffMedical Staff

Phase IIPhase II

Medical Staff HistoryMedical Staff History

1909 first Medical Staff was created 1909 first Medical Staff was created to monitor quality in hospitalsto monitor quality in hospitals

NO SIGNIFICANT CHANGE IN THIS NO SIGNIFICANT CHANGE IN THIS STRUCTURE IN 100 YEARSSTRUCTURE IN 100 YEARS

Medicine now changing at rapid rateMedicine now changing at rapid rate Pay-for-performance is Pay-for-performance is HEREHERE Current structure not agileCurrent structure not agile

PreludePrelude In 2000, at a Greeley Medical Staff Leadership In 2000, at a Greeley Medical Staff Leadership

Conference, we learned that most hospital have a Conference, we learned that most hospital have a two-year term for medical staff leaderstwo-year term for medical staff leaders

Looked at Medical Staff structures nation-wide and Looked at Medical Staff structures nation-wide and in our areain our area

Rapid turnover of medical staff leaders and senior Rapid turnover of medical staff leaders and senior administration pointed to need for longer termsadministration pointed to need for longer terms

We also researched with Health Care Advisory We also researched with Health Care Advisory Board and had initial planning retreat in January Board and had initial planning retreat in January with medical staff and Board.with medical staff and Board.

We have had two subcommittee planning meetings We have had two subcommittee planning meetings in February and March of 2006 to develop OUR in February and March of 2006 to develop OUR planplan

We found the best structure was at Northwest We found the best structure was at Northwest Hospital and adopted it as our initial frameworkHospital and adopted it as our initial framework

Prelude Cont.Prelude Cont.

2002 we implemented phase I of 2002 we implemented phase I of restructurerestructure

Started two-year terms for senior medical Started two-year terms for senior medical staff leadership, and created the Joint staff leadership, and created the Joint Operations CommitteeOperations Committee

We held off on phase II, due to financial We held off on phase II, due to financial concerns in early 2003concerns in early 2003

We have had 6 months where we have We have had 6 months where we have had a retreat and planning subcommittee had a retreat and planning subcommittee researching and revising our structureresearching and revising our structure

Subcommittee MembersSubcommittee Members

Ed EissmannEd Eissmann Tom SmithTom Smith Eli SaikalyEli Saikaly Kevin ClayKevin Clay Jeff WinninghamJeff Winningham Pat RyanPat Ryan Art GrossmanArt Grossman Ival SalyerIval Salyer Larry NicolovLarry Nicolov Jim BrevigJim Brevig Todd GundersonTodd Gunderson Larry SchecterLarry Schecter Janice HalladayJanice Halladay Bob McKnightBob McKnight Ruth FelthousRuth Felthous Judy GoodJudy Good Yvonne StraderYvonne Strader Sridar ChalakaSridar Chalaka

A Possible SolutionA Possible Solution

Unified Medical Staff ModelUnified Medical Staff Model Goal is to combine and streamline Goal is to combine and streamline

the medical directors as well as the the medical directors as well as the medical staff departments where medical staff departments where appropriate and practical to meet appropriate and practical to meet the rapid changes in healthcarethe rapid changes in healthcare

StructureStructure(Provisional)(Provisional)

CMOPRESIDENT/

MEDICAL STAFF

MedicineDivision

*Hospitalists*FP, IM*Medical Specialties*ED*Radiology*Oncology Services

*Gen Surgery*Surg Specialties*Ortho*Pathology*Anesthesia

*OB*FP-OB*Midwives*Peds*Hospitalists*Neonatology

*FP, IM*Peds*Specialists*Ambulatory MDs

Surg DivisionFamily Services

DivisionAmb/Opt.

Services Division

*MEC will review structure and adjust as needed

*Specific specialties will elect their representative to work with section medical director.*Obligatory established contractual reporting requirements will be honored.

STRUCTURE DRAFTDRAFT

CMO

Internal MedicineDivision DirectorHospital Based

Surgery Division DirectorFamily Services Division

Director

Outpatient ServicesDivision Director

Non-hospital based

President Medical Staff

Section Medical Director

Cancer ServicesCardiologyEDHospitalistsIntensivistsSpecialists (see list)

Section Medical Director

AnesthesiaCardiacGeneral SurgeryOrthoPathologyVascularSpecialists (see list)

Section Medical Director

Children's CenterFP- OBMidwivesOBNeonatologyPeds/Hospitalists

Section Medical Director

FPIMPediatricsSpecialists(see list)

SPECIALTIES- DEFINEDSPECIALTIES- DEFINED

MEDICALMEDICAL Behavioral HealthBehavioral Health FPFP IMIM NephrologyNephrology NeurologyNeurology RehabRehab Sleep LabSleep Lab Other as definedOther as defined

SURGICALSURGICAL ENTENT GIGI GYNGYN HandHand Oto-MaxOto-Max PlasticsPlastics UrologyUrology

SPECIALTIES- DEFINEDSPECIALTIES- DEFINED

Out Patient Non-Hospital basedOut Patient Non-Hospital based Allergy/ImmunologyAllergy/Immunology Behavioral Health (OP)Behavioral Health (OP) DermatologyDermatology EndocrinologyEndocrinology RheumatologyRheumatology Others as definedOthers as defined

Structure Cont.Structure Cont.

Ambulatory/Out Pt. Services DivisionAmbulatory/Out Pt. Services Division 300 MDs on Staff only practice in their offices300 MDs on Staff only practice in their offices

Create link to offices to assure that smooth Create link to offices to assure that smooth transition of care from inpatient to outpatient.transition of care from inpatient to outpatient.

There will continue to be specialty-specific There will continue to be specialty-specific recommendations for privileging by the recommendations for privileging by the Chairs/Directors of each section. (already Chairs/Directors of each section. (already doing this)doing this)

Does this do away with Does this do away with the Medical Staff the Medical Staff

Leadership?Leadership? Absolutely not !Absolutely not ! Medical Staff Leaders will still be Medical Staff Leaders will still be

delegated quality and credentialing by delegated quality and credentialing by the Board of Directorsthe Board of Directors

Medical Staff leadership will work Medical Staff leadership will work closely with hospital administration closely with hospital administration and senior clinical leadership on and senior clinical leadership on operational issuesoperational issues

Medical Staff will actually have more Medical Staff will actually have more input with the proposed new structureinput with the proposed new structure

Where Are We Now?Where Are We Now?

Senior Medical Staff Leadership, Senior Medical Staff Leadership, two-year termstwo-year terms

““Super” Medical DirectorsSuper” Medical Directors Created Joint Operations CommitteeCreated Joint Operations Committee

Proposed Changes for Proposed Changes for Phase IIPhase II

Division ChiefsDivision Chiefs MedicineMedicine SurgerySurgery Family ServicesFamily Services Ambulatory /Out Pt. MDsAmbulatory /Out Pt. MDs

Division ChiefsDivision Chiefs Two year terms, renewable (Conclusion of Two year terms, renewable (Conclusion of

extension, 6 months prior to expiration of extension, 6 months prior to expiration of contract)contract)

Nominated by Joint Operations (Board, Admin, Nominated by Joint Operations (Board, Admin, Medical Staff)Medical Staff)

Selection – may be nominated by division - and Selection – may be nominated by division - and Interview ProcessInterview Process

Final Candidate presented to DivisionFinal Candidate presented to Division Approved by Division by simple majorityApproved by Division by simple majority Initially ratified by MEC and Hospital Initially ratified by MEC and Hospital

AdministrationAdministration Report to President of Medical Staff on medical Report to President of Medical Staff on medical

staff concernsstaff concerns Report to CMO for operational issuesReport to CMO for operational issues

Selection of Division Selection of Division ChiefsChiefs

Need to be an Active member of Need to be an Active member of Medical Staff in good standingMedical Staff in good standing

Medical Staff and administrative Medical Staff and administrative experience preferredexperience preferred

Active 1/2 –time practice in communityActive 1/2 –time practice in community If no internal candidate can be found If no internal candidate can be found

and Medical Staff, Board, and and Medical Staff, Board, and Administration agree; then, an outside Administration agree; then, an outside search would be started (e.g., Family search would be started (e.g., Family Services)Services)

Division Chiefs Division Chiefs (continued)(continued)

Responsibilities:Responsibilities: Dyad model with Clinical Director for Dyad model with Clinical Director for

operationsoperations Member of Credentials, MSQRC, Joint Member of Credentials, MSQRC, Joint

Operations and MECOperations and MEC Responsible for QA, credentialing, and Responsible for QA, credentialing, and

strategic planning in their divisionstrategic planning in their division Chair Quarterly QA for their division, and Chair Quarterly QA for their division, and

present issues to MSQRCpresent issues to MSQRC Implementation of policies for MECImplementation of policies for MEC Have at least quarterly Division MeetingsHave at least quarterly Division Meetings

Chief Responsibilities Chief Responsibilities (continued)(continued)

Meetings with Section Directors at Meetings with Section Directors at least quarterly or as neededleast quarterly or as needed

Time commitment 1/3 to 1/2 timeTime commitment 1/3 to 1/2 time Compensation based on description Compensation based on description

and market equivalentand market equivalent Annual ‘360 Review’Annual ‘360 Review’

Section Medical Section Medical DirectorsDirectors Combines current medical directors with section Combines current medical directors with section

chairs where appropriatechairs where appropriate No additional medical directorships at section levelNo additional medical directorships at section level Responsible for QA, Credentialing, and planning in Responsible for QA, Credentialing, and planning in

their sectiontheir section Recommend clinical privilege criteria to Division Recommend clinical privilege criteria to Division

ChiefChief Two-year term (may be renewed similarly to Two-year term (may be renewed similarly to

Division Chiefs)Division Chiefs) Attend division QA Meetings, and other Attend division QA Meetings, and other

appropriate meeting as neededappropriate meeting as needed Dyad Model with Clinical Director/Manager for Dyad Model with Clinical Director/Manager for

operationsoperations

Section Medical Section Medical Directors Cont.Directors Cont.

Nominated by MEC and/or section, and Hospital Nominated by MEC and/or section, and Hospital AdministrationAdministration

Selection and Interview processSelection and Interview process Candidate presented to SectionCandidate presented to Section Confirmed by simple majority of section vote Confirmed by simple majority of section vote Ratified by MEC and Hospital AdministrationRatified by MEC and Hospital Administration Work closely with clinical administration on issues in Work closely with clinical administration on issues in

their areatheir area Compensation, hourly for medical staff issues plus Compensation, hourly for medical staff issues plus

medical director feesmedical director fees Report to Division ChiefReport to Division Chief Annual evaluation by sectionAnnual evaluation by section Not all sections will have their own medical directorNot all sections will have their own medical director

Division StructureDivision Structure

MedicineMedicine HospitalistsHospitalists Medical SpecialtiesMedical Specialties EDED RadiologyRadiology Oncology ServicesOncology Services

SurgerySurgery General SurgeryGeneral Surgery OrthopedicsOrthopedics Surgical Sub-Surgical Sub-

SpecialtiesSpecialties PathologyPathology AnesthesiologyAnesthesiology

Division StructureDivision Structure

Family ServicesFamily Services OB/GynOB/Gyn Peds (In-pt)Peds (In-pt) FP-OBFP-OB MidwivesMidwives Specialty Services Specialty Services

from Children'sfrom Children's

Community Community Out-pt FPsOut-pt FPs Out-pt IMOut-pt IM Out-pt PedsOut-pt Peds Out-pt SpecialtyOut-pt Specialty

New MECNew MEC

MembershipMembership Four, elected Senior Medical Staff - Four, elected Senior Medical Staff -

votingvoting Four Division Chiefs - votingFour Division Chiefs - voting Hospital Senior AdministrationHospital Senior Administration Hospital Board RepresentationHospital Board Representation Credentials Chair - votingCredentials Chair - voting MSQRC Chair - votingMSQRC Chair - voting

How Do We Compare?How Do We Compare?

Recently, several Medical Staff Recently, several Medical Staff leaders, Board and Administration leaders, Board and Administration attended a governance seminarattended a governance seminar

Our proposed new structure was Our proposed new structure was reviewed by Linda Haddad, a leading reviewed by Linda Haddad, a leading consultant on Medical Staff Issuesconsultant on Medical Staff Issues

She was very complimentary of our She was very complimentary of our structure structure

We are actually ahead of the curveWe are actually ahead of the curve

Election of Future* Election of Future* Division ChiefsDivision Chiefs

Nominated by MEC, or divisionNominated by MEC, or division Interview and selection processInterview and selection process Candidate presented to DivisionCandidate presented to Division Voted on by Division (see above)Voted on by Division (see above) Need to meet qualifications of Need to meet qualifications of

Division Chief as outlined previouslyDivision Chief as outlined previously

Question?Question? How do we elect Division ChiefsHow do we elect Division Chiefs

Nominated by Nominating committee or Nominated by Nominating committee or division, Approved by simple majoritydivision, Approved by simple majority

Ratified by MEC and Hospital AdministrationRatified by MEC and Hospital Administration They will have two year contracts, with annual They will have two year contracts, with annual

reviewreview They will have dual reporting to President They will have dual reporting to President

Medical Staff and CMOMedical Staff and CMO They will work closely with clinical directorsThey will work closely with clinical directors Compensated by HospitalCompensated by Hospital Officers will be elected as usual as well as Officers will be elected as usual as well as

members of MSQRC and Credentialsmembers of MSQRC and Credentials

Potential Cost Off-setsPotential Cost Off-sets

Potential reduction in current Potential reduction in current medical director positions/hoursmedical director positions/hours

Potential reduction in hours paid for Potential reduction in hours paid for meeting attendance by medical staffmeeting attendance by medical staff

Stipend from Medical Staff for Stipend from Medical Staff for medical staff issuesmedical staff issues

Benefits for HospitalBenefits for Hospital Aligns Medical Staff leadership to Aligns Medical Staff leadership to

effectively meet challenges in our rapidly effectively meet challenges in our rapidly changing marketchanging market

Establishes a leadership pool of MDs that Establishes a leadership pool of MDs that will be responsible to implement will be responsible to implement operational issues with the medical staffoperational issues with the medical staff

Has the potential to return much more on Has the potential to return much more on the investment, due to easier the investment, due to easier implementation of operational issuesimplementation of operational issues

Creates the framework for true Creates the framework for true partnership with the medical staff partnership with the medical staff

Benefits for the HospitalBenefits for the Hospital

Potential savings based on Chiefs Potential savings based on Chiefs becoming champions:becoming champions:

Decreased Average Length Of StayDecreased Average Length Of Stay Decreased resource utilization through Decreased resource utilization through

standardizationstandardization Improved compliance with Core Measures Improved compliance with Core Measures

and Pay-for-Performance measuresand Pay-for-Performance measures Improved Regulatory ReadinessImproved Regulatory Readiness Potential performance incentive programsPotential performance incentive programs

Next StepsNext Steps

Change Bylaws (Bylaws Committee Change Bylaws (Bylaws Committee working on new changes)working on new changes)

Vote on by Medical Staff (early Fall)Vote on by Medical Staff (early Fall) If approved by Medical Staff, set up If approved by Medical Staff, set up

the interview process for Division the interview process for Division Chiefs and Section Medical DirectorsChiefs and Section Medical Directors

Target Implementation around Target Implementation around January 2007January 2007