Physician Liaison Program

Joan Brewer, RN

Referral Relations Manager

Billings Clinic

Billings, MT

Organizational Highlights

Employ 3,750 employees

Group practice with 280 Physicians, 90

PA/NPs

Clinic & Hospital

•Joint Commission Accredited

•Magnet Designation for Nursing Excellence in 2006

and re-designation in 2011

Multi-specialty Physician Clinic

•900,000 patient encounters

•10 clinic locations

Hospital & Sub Acute Care

•285 Licensed Beds

•14,500 hospital admissions/year

•743,000 Outpatient Registrations

•Level II trauma center

•42,000 patient ED visits/year

Psychiatric Services •Youth and Adult

•Hospital – IP & OP

•Behavioral Health Clinic

Aspen Meadows

•90-Bed Long Term Care and 55-bed

Assisted Living Facility

•Sub-Acute Care

Research •Center for Clinical Translational Research

•Clinical research

Billings Clinic Foundation

•Over $100 million raised

•Over $48 million in current assets

•Over $69 million granted to Billings Clinic

Health Care, Education and Research

Over 50 Physician Specialties • Allergy & Immunology

• Cardiovascular Services

– Cardiology

– Electrophysiology

– Interventional Cardiology

• Cardiovascular Surgery

• Dermatology

– Mohs Surgery

• Emergency Medicine

• Endocrinology

• Facial Plastics &

Reconstructive

Surgery

• Family Medicine

• Gastroenterology

• General Surgery

• Geriatrics

• Hospital Medicine

• Infectious Diseases

• Internal Medicine

• Metabolic/Bariatric Surgery

• Nephrology

• Neurology

• Neurosurgery

• Obstetrics & Gynecology

– Maternal-Fetal Medicine

– Reproductive

Endocrinology & Infertility

(IVF)

• Occupational Medicine

• Oncology (Cancer Center)

– Medical & Hematology

– Gynecologic Oncology

– Radiation Oncology

• Ophthalmology

• Orthopedics & Sports

Medicine

• Otolaryngology

– Audiology

• Pathology

• Pediatrics

– Neonatology

– Pediatric Ophthalmology

– Pediatric Pulmonary

– Pediatric Neurology

– Pediatric Oncology

– Pediatric Cardiology

– Pediatric

Gastroenterology

• Physical Medicine &

Rehabilitation

• Podiatry

• Psychiatry

• Pulmonary, Critical Care &

Sleep Disorders

• Radiology

• Rheumatology

• SameDay Care

• Thoracic Surgery

• Vascular Surgery

• Urology

Health Care, Education and Research

Health Care, Education and Research

Physician Outreach Specialties

Allergy

Cardiology

Dermatology

Facial Plastics

Gastroenterology

Gynecologic Oncology

Nephrology

Neurology

Reproductive Medicine

Maternal-Fetal Medicine

Oncology

Ophthalmology

Orthopedics

Otolaryngology – ENT

Pediatric Cardiology

Pediatric Diabetes

Pediatric Pulmonary

Pediatric Gastroenterology

Podiatry

Pulmonary

Urology

Telemedicine at Billings Clinic

• 40 partners in 29 communities

• 4,823 conferences in FY13 served 27,062 participants

• By avoiding travel, participants saved an estimated $4,300,000 in

out-of-pocket expenses

• 61 Billings Clinic providers regularly use telemedicine

• Offerings include:

Allergy

Burn follow-up visits

Cardiology

Dermatology

Dietary Education

Endocrinology

Geriatrics

Genetic Counseling

Infectious Diseases

Naturopathic consults

Pulmonary

Rheumatology

Reproductive

Medicine/Fertility

Diabetic Education

Medication Assistance

Metabolic Surgery

• patient education

• pre and post- op

surgical consults

Neonatology

Nephrology

Neurology

Oncology/Hematology

Orthopedics

PM & R

Pediatrics

Gastroenterology

Podiatry

Psychiatry

Health Care, Education and Research

Successful Startup of Physician Liaison

Programs

Goals for Today

• Explore the pre–program planning process and define the Physician Liaison scope and capacity

• Describe differences between a referral relations program vs. physician relations vs. sales program

• Identify key “must haves” for successful programs

• Align outreach with organizational strategies and ensure service lines are “outreach-ready”

Health Care, Education and Research

Pre Start up

• What is the organizational Goal behind the

development of the role/position?

• What is the need?

• Who will support the role?

• What are the tools available for the role?

• Will the role be relationship based or sales based?

• How will success be evaluated?

Health Care, Education and Research

Scope Creep

Health Care, Education and Research

Health Care, Education and Research

Why are Referral Relations valuable?

• Referral Relations positions have proven ROI by targeting

identified providers and developing a relationship that allows

the referring provider to have a voice in how referrals are

managed.

• Deeper Hospital-Physician collaborations are needed for

clinical quality improvement, utilization & cost control, care

continuum integrations and population health management.

• Leverage of high quality network, limit of financial exposure,

and monitoring and managing performance. » 21754, the Advisory Board, 2010 p10-13.

Health Care, Education and Research

How does Billings Clinic define

Referral Relations?

• Accountability for Referral Relations

program and communication processes.

• Develop, coordinate and distribute

communication and tools to support the

flow of referrals and communication back

to the referring providers.

• Develops and provides strategy support to

administrative and service line leadership.

Health Care, Education and Research

How does Billings Clinic define

Referral Relations?

• Gather and share local and regional

marketing intelligence.

• Support the development and

implementation of marketing and planning

strategies.

Health Care, Education and Research

How does Billings Clinic define

Referral Relations?

• Establishing, maintaining and enhancing

organizational relationships with referring

physicians and other healthcare providers.

• Establishing, maintaining and enhancing

organizational relationships with

organizations in local and regional service

areas.

Health Care, Education and Research

Health Care, Education and Research

Goal

Facilitate New and Strengthen Existing

Referral Relationships

Must Haves

Referral Relations Physician Relations Marketing Relations

• Listening Skills Listening Skills Listening Skills

• Tenacity Tenacity Tenacity

• Internal C suite Internal C suite Internal C suite

Support Support Support

• Organizational Organizational Organizational

Readiness Readiness Readiness

• Great Boss Great Boss Great Boss

Referral Relations, Physician Relations, Marketing Relations

Referral Relations Physician Relations

• Connector for all * Connector for Referral Sources Physicians

• Long Term * Long Term

• Established Internal * Physician Openness

Relationships Key to to relationship

Success Building Key to Success

• Clinical +Sales * Clinical

Marketing Relations

• Program Connector

• Short Term-More Successful if long term relationship established

• External Relationship Key to Success

• Sales

Health Care, Education and Research

Health Care, Education and Research

What are the tools of the Physician

Liaison?

• Access to the EMR

• Access to Point Persons

• Access to Administration

• Access to physicians that share the same

vision

Health Care, Education and Research

What are the tools of a physician

liaison?

• Trust

– Don’t promise the moon, unless you can

assure delivery

– Don’t throw your internal colleagues under the

bus.

– Remember* There is always more to the story

– Bring back the good stuff

– Follow up, Follow up, Follow up

Health Care, Education and Research

What are the tools of the physician

liaison?

• Data is our friend

– Administration needs it, physicians love it

– Make friends with the analysts

– Find out who else is tracking and trending

data

– Look at and investigate CRM products

Health Care, Education and Research

Planning your future

• Develop a plan for the year/quarter and

month

• Assure it aligns with the strategic goals of

the organization

• Develop processes that help and not

hinder. Keep them flexible enough to allow

growth and change.

Physician Liaison Outreach Program

PeaceHealth Oregon West Network

Susan Blane, MPH, CMPE

Director, Market Development

Strategy, Innovation and Development

34 © 2011 PeaceHealth

The PeaceHealth Mission

We carry on the healing mission of Jesus Christ by promoting

personal and community health, relieving pain and suffering,

and treating each person in a loving and caring way.

35 © 2011 PeaceHealth

About PeaceHealth • Founded by the Sisters of St. Joseph of Peace, PeaceHealth is a not-for-

profit health care system with medical centers, critical access hospitals,

medical group clinics and laboratories located in Alaska, Washington and

Oregon.

• Has provided exceptional medicine and compassionate care to Northwest

communities for more than a century.

• PeaceHealth consistently receives national recognition for innovations in

patient-centered care, patient safety, health care technology and cost

efficiency.

• During FY2012, PeaceHealth provided patient care to these communities

through more than

– 78,000 inpatient admissions

– 743,000 outpatient registrations

– 1.2 million patient encounters

36 © 2011 PeaceHealth

In the beginning….

• 2006: Director recruited to launch program around a

technology acquisition and build department ongoing

• 2007: Budget allowed for one additional hire

• 2008: New Flagship hospital opens in August, economy

tanks in October

• 2009 thru 2011: Outreach focus on retention –

– 1 person,

– 7500 physicians

– 37,000 square miles

© 2011 PeaceHealth 37

Oregon Hospital Landscape

PSA

SSA

© 2011 PeaceHealth 38

2011 – Introduction of Third Party Data

39 © 2011 PeaceHealth

…and then there was light

Environmental Changes

• New CEO in 2012

• Transition from holding company to integrated

networked System

• Shift of focus from cost containment to growth

40 © 2011 PeaceHealth

The Proposal • 1 White Paper (3 page Narrative)

• 1 Spreadsheet (10 worksheets)

– Market Share Scenarios summarized by years 1 thru 5 w/ forecast by each

add’l liaison added

– Analysis of referral source and targets

– Outmigration Analysis

– Growth Opportunities

– One time setup costs

– Ongoing costs

– Summary by year

– Executive Summary

• Countless Powerpoints (network leadership, system leadership,

stewardship, boards)

41 © 2011 PeaceHealth

APPROVAL – January 2013

42 © 2011 PeaceHealth

43 © 2011 PeaceHealth

44 © 2011 PeaceHealth

Implementation Phase

• Creation of New Positions

• HR approval of job descriptions

• Approval of Budget Variance

• Organizational Integrity Audit

• Compensation for Physicians

• Increased demands on Design & Marketing

• Increased demands on CME Department

• Interviews

45 © 2011 PeaceHealth

Program Structure

• 3 liaisons

• Assigned Geographic Territories

– by primary, secondary and tertiary service areas

– By zip code

– Contains approx 2500 physicians per area

– Use Crimson Market Advantage to refine targets

• Sub Assignment by System of Care

Access PeaceHealth ED Trauma Telemedicine

Surgery Neuroscience CardioVascular Ortho

Community Based

Care Womens Pediatrics Behavioral Health

46 © 2011 PeaceHealth

Basic Training

• Every Possible Resource

– Other Programs

– Service Line Leadership

– Professional Societies

– Purchased Consulting

• Training Must Haves

– Organizational

– Strategic

– Message

– Visit Planning and Structure

47 © 2011 PeaceHealth

Outreach True North

• Referral decisions are based most often on relationships

between the referring physicians and the specialists.

• Primary care physicians (PCPs) recommend specific

specialists for 86% of referrals.

• Survey Says:

– personal knowledge of the specialist ranked highest

– followed by quality of prior feedback

– specialist’s technical capacity

– appointment availability

Sources: Halley MD. The Primary Care-Market Share Connection: How Hospitals Achieve CompetitiveAdvantage. Health Administration Press: 2007; Forrest CB et al.

Primary care physician specialty decision making: patient, physician, and health care system determinants. Med Decis Making 2006;26:76−85;Forrest CB et al. Family

physicians’ referral decisions: results from the ASPN referral study. J Fam Practice 2002;51:215−222.

48 © 2011 PeaceHealth

Issue Resolution

• One Voice – majority of issues flow through one to two

people within outreach department

• Starts with System of Care Leadership

• Most frequently:

– Missing Records

– Discharge report

– Ease of Referral

– Communication

START

Liaison

initiates

contact with

physician/

group

Forward to

Director of

Market

Development

Yes

No

Liaison

evaluates

issue,

identifies

responsible

party

Forward

to responsible

ops leadership

(Can I solve

this issue?)

Yes

Responsible ops

leadership resolves

issue & facilitates

communication of

resolution

Responsible

party notifies

Market Dev of

issue

resolution

END

No

Liaison receives

issue &

documents in CRM

Ops

determines

best course of

action &

timeline for

resolution

Ops notifies

Market Dev

that issue is in

progress to be

resolved

Liaison tracks

‘pending’ status

& identifies follow

up date based on

timeframe

Liaison

evaluates

resolution

progress (Was

issue resolved

in timeframe?)

Yes

No

Liaison

notifies Mar Dev

Director to request

immediate action

Did mgmt

respond within

24 hours?

Yes

MarDev

Director

notifies

appropriate

Executive

Team member

No

ET member

provides required

support to resolve

issue

Responsible

party notifies

Market Dev of

issue

resolution

END

Responsible party

resolves issue &

facilitates

communication of

resolution

50 © 2011 PeaceHealth

Communication Flow

51 © 2011 PeaceHealth

Access PeaceHealth • Create a fully integrated patient transfer center, bed placement and

consultation service

• RN Case managers field calls from beginning to end, ensuring

communication between transferring facility, admitting physician, oncall

specialists, hospitalists and bed placement. Web-based with real-time

updating/editing

• Central Logic supported:

– HL7 Interface with credentialing system

– Configurable reporting

– Full auditing of changes

– HIPAA compliant paging/texting

– 24/7 support

52 © 2011 PeaceHealth

Outreach Future

• New Provider Onboarding

• Evidence Based and Value Based Care

• Customer Service Excellence

Thank You!

• Joan Brewer RN, BSN

• Referral Relations Manager

• Billings Clinic

• (O) 406 435-8447

• (C) 406 633-0161

• Jbrewer2@billingsclinic.org

• Susan Blane, MPH, CMPE

• Director, Market Development

• PeaceHealth Oregon West Network

• 541-686-6856 desk

• 541-520-4216 cell & text

• SBlane@peacehealth.org