An Alignment of Goals - Changing the Referring Patterns of Physician Partners

Otherwise known as "Melting the Glacier"

Much has been written in graduate schools and current healthcare periodicals about the strategic importance of data. It is especially rewarding when new data presented to surgeon partners results in a sustained increase in volume across a number of specialties.

At Surgical Hospital of Munster (SHM), the post flood volume of early 2009 was not sufficient to cover both inpatient and outpatient costs. Our largest shareholder and greatest source of patient referrals for surgery and medical admissions has always been the Hammond Clinic. The clinic generates at least 75% of our volume. However, there are four other hospitals in the immediate Northwest Indiana area. Hammond Clinic physicians and surgeons are on staff at these hospitals as well in order to service all the medical needs of their patients where the medical condition dictates, and to be responsive to referrals from non-Hammond Clinic practitioners.

In searching for the next level of volume at SHM, the question arose - are we receiving all of the surgeries that the Hammond Clinic is capable of scheduling? If not, why? Regent Surgical Health, as the managing partner, developed a few models and generated some estimates, but it was clear that the only accurate source of information would be the data generated from the Hammond Clinic's own billing system. Keenly aware that this is privileged information, I was prepared to have my request to review this data rejected.

The request was not rejected and it was not diluted. All surgical activity by surgeon at each facility, by procedure, was provided. Our partners exhibited as much enthusiasm for learning from the numbers as we had expressed. Using this information we established a process to track scheduling patterns. The month of May 2009 served as our baseline and each month thereafter has served as the trendline by surgeon.

In total, we found that only 47% of all surgeries and medical admissions generated by the Hammond Clinic were being scheduled at SHM. The first conclusion derived from our analysis made it clear that we would never receive 100% of the surgeries generated by the Hammond Clinic because we do not provide cardiac services, obstetric services, or emergency services. SHM was designed with these limitations in mind and there was nothing further to discuss.

Our second conclusion was the goldmine. Even with our limitations, the data proved that we could substantially increase the percentage of cases being referred from the clinic. There is no magic maximum number at SHM because surgeons are called to see patients that are already inpatients at other hospitals with a number of medical conditions that the surgeon warrants best treated at the big box facility. However, I estimated that our maximum was in the range of 75% - 78%. By December 2009, we had increased the percentage of referred cases to 72%.

How was the improvement accomplished? We employed a dual strategy. At the Board level, a frank and open discussion ensued about the patterns of individual surgeons and what might be influencing their behavior. The physician leaders took the information back to their own internal meetings with the specialists to educate them and to share with them our common goals. As the CEO, I also conducted individual meetings with surgeons to find out what we could do to secure more of their surgeries.

What the physician leaders of the Hammond Clinic and I learned is that there are controllable issues, such as more refined scheduling, investment in the replacement of old equipment or in new technology, personnel management, or even adding a new payor contract. Then there are uncontrollable issues such as major capital expenditures that do not provide a return on investment, rotation of employed surgeons within the group, etc. We worked hard to improve the controllable issues in order to bring more cases into the facility.

The rate of achievable surgeries has slipped a bit in early 2010, but we now have a process and a tool to respond to any slippage in a timely manner, because our Goals are correctly aligned.

Paul Skowron, CEO
Surgical Hospital of Munster
P. 219.836.5102
F. 219.836.4493