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Physician-Hospital Alignment |
Medical Staff Planning for a Regional Referral
Center and a Hospital under Construction
Client Profile: A mid-Atlantic regional healthcare system anchored by a 400-bed acute care regional referral center, with construction underway for a new 100-bed acute care community hospital
Project Type: Medical staff planning and development
Challenge: Assist the client to determine its medical staff needs both for its expanding role as a regional referral center with several clinical centers of excellence, and for the opening of a new 100-bed hospital in a rapidly growing adjacent community.
DGA Solution and Results: DGA conducted a comprehensive quantitative analysis of the services area’s overall need for physicians, and a qualitative assessment of the System’s internal physician resource needs based upon strategic goals, clinical program needs and physician staffing requirements for the new community hospital.
We employed extensive physician and management interviews and surveys to better understand perceptions of community and hospital need and to confirm strategic initiatives and program priorities. We utilized existing inpatient utilization projections for the new hospital to estimate physician staffing requirements.
Within the flagship hospital, targets for specialty-specific physician recruitment were developed for each of the new Centers of Excellence as well as other existing clinical programs. The recruitment targets took into account estimated deficits in community physicians, as well as specific program needs and expected physician retirements.
We laid out specialty-specific recruiting priorities by year for a five-year planning period for both hospitals, with over 156 physicians. In addition, DGA estimated annual physician development costs (salary subsidies less revenue offsets) based on the recommended recruitment schedule.
As a result of this engagement, the client has initiated an aggressive recruitment effort that is based upon a comprehensive physician development blueprint.
Joint Venture Development of an
Ambulatory Surgery Center
Client Profile: A community hospital that is part of a health system
Project Type: Business planning and joint venture development
Challenge: Plan for and create a joint venture ownership structure for a freestanding ambulatory surgery center that the client was in the process of acquiring. Special challenges of the process included the need to re-license the surgery center, which had not been operational for a year and had relinquished its license. In addition, financial projections were complicated by delays in the acquisition process, which endangered physician support and made physician participation potential a delicate issue.
DGA Solution and Results: DGA performed preliminary analyses to evaluate the proposed joint venture’s financial feasibility. We conducted a series of presentations for the general physician community on the joint venture’s financial potential, structural alternatives and on development and operational issues.
A physician steering committee was formed to work with hospital management in the development and structuring of the joint venture ownership entity. DGA facilitated regular steering committee meetings to explore potential physician participation opportunities, joint venture structural elements, and ASC licensure, startup and ongoing management.
We also produced periodic newsletters to the physician community designed to inform and to maintain project momentum.
Ultimately, the terms of the joint venture operating agreement and related offering were negotiated, and hospital management distributed the private offering memorandum. DGA further supported this process through production of a business plan to assist hospital management in obtaining necessary health system approvals for the joint venture.
The offering proved successful, and the joint ventured surgery center is now licensed and operational with promising physician participation and support.
Comprehensive Assessment
Of Physician Community Needs
Client Profile: Multi-hospital system serving a population of 1.2 million
Project Type: Physician community needs assessment
Challenge: Conduct specialty-specific community physician need assessment to support the client’s physician recruitment initiatives. The client’s strategic plan identified a recruitment goal of 113 physicians in various specialties over a five year period. The client’s intent was to structure financial assistance arrangements, when necessary and appropriate, to support selective recruitment efforts while complying with federal guidelines for community need determination.
DGA Solution and Results: DGA conducted 15 separate specialty-specific community need studies requested by the client. Our standards-based methodology resulted in a finding of physician deficits in all of the studies conducted. Based on our findings, the client is proceeding with physician recruitment efforts. Financial assistance is being provided to support recruitment in selected cases.
We also prepared a policy document and methodology to guide the future assessments of community need for physicians, in order to maintain compliance with federal regulatory guidelines. This document has been adopted by the system’s board of directors as the guiding instrument in on-going physician recruitment efforts.
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