011 Am09 Presentations Maddux

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1 Leveraging Your Leveraging Your Clinical Leadership Clinical Leadership Franklin W. Maddux, MD Franklin W. Maddux, MD FACP FACP Saturday, March 21, 2009 Saturday, March 21, 2009 RPA Annual Meeting RPA Annual Meeting

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Transcript of 011 Am09 Presentations Maddux

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Leveraging Your Clinical Leveraging Your Clinical LeadershipLeadership

Franklin W. Maddux, MD FACPFranklin W. Maddux, MD FACPSaturday, March 21, 2009Saturday, March 21, 2009

RPA Annual MeetingRPA Annual Meeting

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Healthcare & Industry DisclosuresHealthcare & Industry Disclosures• Healthcare Board AffiliationsHealthcare Board Affiliations

– Specialty Care Services GroupSpecialty Care Services Group– HIT Services GroupHIT Services Group– Hospital Clinical Services GroupHospital Clinical Services Group– Renal Physicians AssociationRenal Physicians Association– Mid Atlantic Renal CoalitionMid Atlantic Renal Coalition– Diabetes Care of AmericaDiabetes Care of America

• Industry AffiliationsIndustry Affiliations– Fresenius Medical Care (Contract)Fresenius Medical Care (Contract)– Amgen (Research sponsorship)Amgen (Research sponsorship)

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AcknowledgementsAcknowledgementsin Preparing This Presentationin Preparing This Presentation

• Dugan W. Maddux, MD FACPDugan W. Maddux, MD FACP

• Kay Lane - SCSGKay Lane - SCSG

• Nancy Armistead – MARCNancy Armistead – MARC

• Janet Lynch – MARCJanet Lynch – MARC

• Terry L. Ketchersid, MD - HITSGTerry L. Ketchersid, MD - HITSG

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The Landscape of HealthcareThe Landscape of Healthcare• National Health Expenditures & their share of gross domestic productNational Health Expenditures & their share of gross domestic product

1990 1990 $717 B$717 B 12.4% of GDP12.4% of GDP20042004 $1,878 B$1,878 B 16% of GDP16% of GDP

• In 1992 women represented 36% of medical school graduates and 49% by In 1992 women represented 36% of medical school graduates and 49% by 20072007

• Number of patients receiving dialysis increased 55% between 1997 and Number of patients receiving dialysis increased 55% between 1997 and 20072007

• Since 1996, one baby boomer has turned 50 every seven secondsSince 1996, one baby boomer has turned 50 every seven seconds• In an AARP study, manufacturer price for 169 brand name drugs since 2001 In an AARP study, manufacturer price for 169 brand name drugs since 2001

increased by 50.5% by 2007; compared to a general inflation rate of 19%increased by 50.5% by 2007; compared to a general inflation rate of 19%

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Is Nephrology in a Period of Change?Is Nephrology in a Period of Change?

• New Conditions for CoverageNew Conditions for Coverage• Bundled ESRD Facility PaymentBundled ESRD Facility Payment• Dialysis Facility ConsolidationDialysis Facility Consolidation• New Incentives from PayersNew Incentives from Payers• Health Information TechnologyHealth Information Technology

– Electronic PrescribingElectronic Prescribing– Patient SafetyPatient Safety– P4R P4R P4P P4P P4Q P4Q

• Expanding patient population at riskExpanding patient population at risk• Higher costs of running the practiceHigher costs of running the practice

YOU BET WE ARE!!YOU BET WE ARE!!

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What Does the Nephrology What Does the Nephrology Practice of the Future Look Like?Practice of the Future Look Like?

-What does it look like now?What does it look like now?-What is driving CHANGE?What is driving CHANGE?-What will be different?What will be different?

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Stories Recently HeardStories Recently Heard

• The The “Survival”“Survival” Story Story• The The “Stretched too thin”“Stretched too thin” Story Story• The The “Covering 18 hospitals”“Covering 18 hospitals” Story Story• The The “Exhausted Heap”“Exhausted Heap” Story Story

Each represents a clinical reality in Each represents a clinical reality in the life of a nephrologistthe life of a nephrologist

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Current StateCurrent State

What Nephrology Practice What Nephrology Practice Looks Like NowLooks Like Now

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Dialysis Patients per FTE Nephrologist

60

65

70

75

80

85

2005 2007

RPA 2007 Benchmarking Survey

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Dialysis Facilities per FTE Nephrologist

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

2005 2007

RPA 2007 Benchmarking Survey

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Practice Staff per FTE Nephrologist

1

1.5

2

2.5

3

3.5

4

2005 2007

RPA 2007 Benchmarking Survey

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Providers per FTE Nephrologist

1

1.1

1.2

1.3

1.4

2005 2007

RPA 2007 Benchmarking Survey

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Nephrology SERVICESNephrology SERVICESClinic, Dialysis Unit, Hospital and Clinic, Dialysis Unit, Hospital and ……Beyond…Beyond…

Dialysis EducationDialysis Education 81%81%

ESA AdministrationESA Administration 78%78%

Flu VaccinationFlu Vaccination 77%77%

PneumovaxPneumovax 66%66%

Hepatitis VaccinationHepatitis Vaccination 49%49%

ResearchResearch 40%40%

Iron AdministrationIron Administration 38%38%

Renal U/SRenal U/S 24%24%

Vein MappingVein Mapping 19%19%

Vascular DopplerVascular Doppler 14%14%

RPA 2007 Benchmarking Survey

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Characteristic Characteristic “DNA”“DNA” of the Physician of the PhysicianHow Physicians Train?... What is Natural to Physician’s? …How Physicians Train?... What is Natural to Physician’s? …

• CompassionCompassion• Attitude of InquiryAttitude of Inquiry• Intellectual PursuitIntellectual Pursuit• Analytical PerspectiveAnalytical Perspective• Decision Making NeedDecision Making Need• Desire to ControlDesire to Control• Leadership by ExampleLeadership by Example

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What is Driving Change?What is Driving Change?-Demand from PatientsDemand from Patients-Demand from PayersDemand from Payers-Demand from ProvidersDemand from Providers

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Patient Demand in aPatient Demand in aA World of Chronic IllnessA World of Chronic Illness

USRDS, 2008 Atlas

In U.S. adults, chronic kidney disease (CKD) is more prevalent than either congestive heart failure or diabetes, and the prevalence of CKD appears to have grown over a period of approximately fifteen years.

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USRDS CKD Patient BreakdownUSRDS CKD Patient Breakdown

USRDS, 2008 Atlas

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Prevalence of GFR <60 ml/min/1.73mPrevalence of GFR <60 ml/min/1.73m22

NHANES participants age 20 & older

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Payer DemandPayer Demand• Value Based Purchasing Value Based Purchasing – CMS– CMS• Comparative Effectiveness Research Comparative Effectiveness Research – Congress– Congress• Physician Quality Reporting Initiative (PQRI) Physician Quality Reporting Initiative (PQRI) – CMS– CMS

– P4R P4R P4P P4P P4Q P4Q• HIT Adoption & Utilization Momentum HIT Adoption & Utilization Momentum - Congress- Congress

– Safe HarborSafe Harbor– e-Rx Incentivee-Rx Incentive– Stimulus PackageStimulus Package

• Medical Home/Neighborhood Delivery Model Medical Home/Neighborhood Delivery Model - ACP- ACP

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The Science ofThe Science ofProcess & Outcome MeasurementProcess & Outcome Measurement

• Developing processes of care for populations Developing processes of care for populations of patients (e.g.- Structured CKD Care)of patients (e.g.- Structured CKD Care)

• Measuring & Quantifying the delivery of careMeasuring & Quantifying the delivery of care

• Determining how individual outcomes are Determining how individual outcomes are influenced by the care processes deliveredinfluenced by the care processes delivered

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Provider DemandProvider Demand

• Nephrology Workforce ChangesNephrology Workforce Changes– DemographicsDemographics– Expectations of professionExpectations of profession– Professional OrganizationProfessional Organization– Longevity expectations of practice lifeLongevity expectations of practice life– Life – Work balanceLife – Work balance– Comfort with technologyComfort with technology– Relationships with health industryRelationships with health industry

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Future StateFuture State

How Physician Leadership How Physician Leadership Must Transform the Must Transform the

Practice of NephrologyPractice of Nephrology

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The Goddess DurgaThe Goddess Durgaandand

The Practice of NephrologyThe Practice of Nephrology

A representation of the Hindu goddess depicted with multiple arms

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The Future NephrologistThe Future NephrologistThe nephrologist will need eight arms The nephrologist will need eight arms

instead of two. Six of these eight arms will instead of two. Six of these eight arms will be from members of the clinical care team be from members of the clinical care team that supports a structured care approach that supports a structured care approach

for patients with kidney disease.for patients with kidney disease.

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Transformational LeadershipTransformational Leadership

• Leader sets & communicates a visionLeader sets & communicates a vision• Stimulates followers through mentoring and Stimulates followers through mentoring and

coachingcoaching• People oriented and participative stylePeople oriented and participative style• Success comes through sustained commitmentSuccess comes through sustained commitment• Skilled at linking individual needs to Skilled at linking individual needs to

organizational missionorganizational mission

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Leading a Care TeamLeading a Care Team

TeamsTeams A small group of people working A small group of people working together toward a common purpose.together toward a common purpose.

TeamTeamworkwork An environment in the larger An environment in the larger organization that creates and sustains organization that creates and sustains relationships of trust, support, respect, relationships of trust, support, respect, interdependence, and collaboration.interdependence, and collaboration.

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Team LeadershipTeam Leadership• Nephrologists lead in 3 primary care environmentsNephrologists lead in 3 primary care environments

• The Dialysis FacilityThe Dialysis Facility• The Medical PracticeThe Medical Practice• The Clinical Care TeamThe Clinical Care Team

• HospitalHospital• Vascular Access CenterVascular Access Center

• Each has a different focus; but each involves extending beyond oneselfEach has a different focus; but each involves extending beyond oneself

““No executive has ever suffered because his subordinates were No executive has ever suffered because his subordinates were strong and effective.” strong and effective.” --Peter Drucker--Peter Drucker

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Attributes of Physician LeadersAttributes of Physician Leaders

• Exceptionally strong analytical capabilitiesExceptionally strong analytical capabilities• Ability to compete in a rigorous environmentAbility to compete in a rigorous environment• Capacity to live & learn in a diverse communityCapacity to live & learn in a diverse community• Aptitude to connect theory and realityAptitude to connect theory and reality• Propensity to problem-solve in real timePropensity to problem-solve in real time

-- Charles Vest (MIT)

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LeadersLeaders ManagersManagersDo the right thingsDo the right things Do things rightDo things rightNurture FollowersNurture Followers Supervise SubordinatesSupervise Subordinates

Have a vision for the futureHave a vision for the future Address daily issuesAddress daily issuesReinventReinvent ReorganizeReorganizeMentorMentor InstructInstruct

Set Direction & VisionSet Direction & Vision Implement Plan DetailsImplement Plan DetailsSell the VisionSell the Vision Tell The VisionTell The Vision

Break rulesBreak rules Make rulesMake rulesUse ConflictUse Conflict Avoid ConflictAvoid ConflictAccept RisksAccept Risks Minimize RiskMinimize Risk

Value AccountabilityValue Accountability Rely on AuthorityRely on Authority

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In SummaryIn Summary• Nephrology practices must prepare for Nephrology practices must prepare for changechange in the in the

style of care delivery and the measures of successstyle of care delivery and the measures of success

• The nephrologist should The nephrologist should avoid becoming the avoid becoming the bottleneckbottleneck to growth and development of his/her to growth and development of his/her practicepractice

• Nephrologists are well positioned to use their Nephrologists are well positioned to use their leadership skillsleadership skills to build a robust practice in which a to build a robust practice in which a care team delivers chronic disease care to a larger care team delivers chronic disease care to a larger population of kidney disease patientspopulation of kidney disease patients