Creating Fellowships to Expand Recruitment Options James Heffernan Neda Daneshvar
Our Case Discussion Process Background Case study Fellowship program description Develop your own model Discussion 2
Patient Care Quality & Safety Innovation Clinician Support Value Community MGH/MGPO Overview Pillars of the MGPO MGH 1811 Corporation MGPO Lead Physician clinical activity & medical management Billing/finance/compliance Practice improvement (service quality & access) Advocacy & communication Jointly with MGPO/MGH Quality & Safety Information systems Marketing, network, & clinical development Contracts MGH Lead Philanthropy Grants Space planning & facility 3
MGPO Spotlight MGPO Participating Physicians by Clinical Department Surgery Urology Anesthesia Dermatology Practice Model Primarily an employed physician model <50 private practice MDs Demographics PCPs: approx. 230 Specialists: approx. 2,600 Radiology Rad Onc Psychiatry Medicine PMR Pathology Orthopaedics OMFS Pediatrics Neurosurgery Neurology Emergency OB/GYN Milestone: Revenue projected to be more than $1B Demographics 1995 2000 2010 2012 2013 2014 2016 MGPO Physicians 936 1,733 2,376 2,412 2,656 2,752 2,838 Bureau of Labor Stats National % Female 27.3% 30.4% 37.8% 33.8% 40.2% 41.8% 42.4% 37.9% 4
Partners HealthCare System Overview Founded in 1994 by Brigham and Women's Hospital and Massachusetts General Hospital, Partners HealthCare includes eight community and four specialty hospitals, a managed care organization, a physician network, community health centers, home care and other healthrelated entities. Our AMCs are teaching affiliates of Harvard Medical School. 6,500 physicians 9,100 nurses 200+ residency and fellowship programs $1.6 billion in research funding $12 billion annual operating budget 73,000 employees, largest private employer in Massachusetts 5
Partners HealthCare: Description of Population Served Covered lives: 800k Discharges: 177k ATO: 30k Inpatient surgery: 50k Day surgery: 73k Emergency visits: 388k 17k annual transfers to MGH, BWH (18% of all admits) Length of stay: 5.3 days for non-transfers 8.3 days for transfers Cost per case: 20k for non-transfers 34k for transfers 90% of transfer cases result in financial loss 40% of inpatient mortality 200m invested in community benefits in 2017 Medicare Next Gen ACO Medicaid ACO MGH won the AHA Foster McGaw award for best hospital community benefits program in 2016 6
Leadership Development Across Industries 3M Amazon Anheuser-Busch British Petroleum Coca-Cola Dell DuPont Emerson General Electric GlaxoSmithKline IBM Intel Johnson & Johnson L Oreal Mars, Inc. Medtronic Novartis Raytheon Roche Siemens Unilever 7
Live Content Slide When playing as a slideshow, this slide will display live content Poll: Where do you and/or your organization hire new recruits?
Live Content Slide When playing as a slideshow, this slide will display live content Poll: Does your organization have a fellowship program?
Live Content Slide When playing as a slideshow, this slide will display live content Poll: On a scale of 1-10, how important is increasing diversity in your management team?
Case Study 1. What is the value proposition of a finance fellowship? How does the organization benefit? How does the Fellow benefit? 2. How would the program fit into the organizational culture? 3. How do you engage busy team members in supporting/training fellows? 4. What types of programs/projects should fellows work on? 11
Fellowship Structure Physician Compensation (4 months) Business Intelligence (6 months) Physician Analytics (5 months) Professional Billing (4 months) Budget & Financial Planning (5 months) Business Transformation (4 months) Billing Compliance (4 months) Fellowship structure consists of 7 rotations (4-6 months each, with overlap) that provide a comprehensive view of financial operations over the 18-month fellowship term 13 fellowship preceptors serve as fellowship mentors and project advisors Fellows have opportunities to complete projects with CFO, and to pursue areas of interest outside of core rotations Fellows are given autonomy and ownership over organizationally impactful projects The CFO meets with fellows on a bi-monthly basis Fellows are invited to attend senior leadership meetings Fellows build a community with peers in the region through regular activities such as a Fellows Journal Club and engage with interns each summer to drive future interest in the fellowship program 12
Fellowship Structure Month Orientation Office of the SVP of Finance Physician Compensation Business Intelligence 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Varies by Projects and Meetings Physician Analytics Budgeting and Financial Planning Professional Billing Office Business Transformation Billing Compliance and Coding 13
Fellowship Selection Process Recruitment Set up online application through National Administrative Fellowship Centralized Application Service (NAFCAS) Post fellowship position to career boards for various CAHMEaccredited masters programs Applicants submit resume, cover letter, personal statement, graduate transcript(s), and three letters of recommendation Fellowship Selection Committee reviews all submitted application materials and selects subset of applicants for phone interviews Phone Interviews Rotating groups of 3-4 Fellowship Selection Committee members are scheduled for 20-minute phone interviews with each candidate Candidates are asked a uniform set of questions to assess core competencies as defined by Selection Committee Selection Committee reconvenes to determine which candidates should be invited for onsite interviews Onsite Interviews Fellows are invited to a Welcome Dinner with Fellowship Selection Committee on the evening preceding the interview day The interview day is packed with lectures and tours for fellowship candidates, including a lunch and reception at the end of the day Each candidate is pulled out of regular events to complete a 45- minute panel interview with the Selection Committee 14
Sample Projects Drug Chargemaster Multi-Year Financial Pro Forma Business Plans for New Ventures Departmental Compensation Plan Analysis Analysis of Revenue Opportunities within Primary Care Analysis: Financial Impact of New Parental Leave Policies under Consideration 15
Project Spotlights Drug Chargemaster This project addressed a pressing need to be more specific about how we were charging for drugs, and to avoid losing money due to underpriced drugs. Each year, the new fellow completes this project and improves upon the work of the fellow before them by asking new questions and contributing fresh perspectives. Multi-Year Financial Projection Each year the fellow completes a 5-year projection for the financial performance of various clinical areas. The clinical areas of focus change from year to year, and fellows are able to introduce novel ideas and interesting questions each year. Analysis: Financial Impact of New Parental Leave Policies Recently, we reevaluated our maternity leave policy and expanded it into a more general parental leave policy. The fellow completed an analysis of the financial impact of the new policy on the organization and wrote an executive summary for the presidents and vice presidents of the hospital and physician organization. 16
Live Content Slide When playing as a slideshow, this slide will display live content Poll: What is the average experience of your finance managers when you recruit them?
Fellowship Program Budget Item Budget: Month 1 12 Budget: Month 12-18 Salary $66,000 $36,000 Assumed clinical resident rates (PGY2 and PGY4) Notes Fringe $19,800 $10,800 Assumed 30% of salary Conferences $2,400 $1,200 Professional Organization Memberships $850 $850 Assumed current HFMA and ACHE rates Recruitment-Related Expenses Selection Committee Meetings $350 Assumed 12 members Hotels $1,200 Assumed 4 final candidates Flights $2,000 Assumed 4 final candidates Interview Dinner $1,300 Assumed 20 attendees Interview Day Meal(s) $400 Assumed 20 attendees Cocktail Reception at Fellowship End $1,600 Assumed 18 attendees Total $94,300 $50,450 Budget total for a single fellow across 18 months is roughly $144,750. 18
Your Turn! Create Your Own Model Goals/ Outcomes Funding Barriers Program Management Audience Mentors Champions/ Sponsors Departments for Rotation
If you don t teach it, it s as if you never learned it. Torch 20
Outcomes Intended The fellowship has helped develop a reliable pipeline of talented individuals in financerelated areas who train within the organization Fellows develop a strong network of mentors that continue to support them long after the fellowship program is complete The growth in the number of applicants each year is a testament to the increasing popularity of healthcare finance as a career choice Unintended Preceptors are strongly committed to the fellowship program and remain deeply involved in the selection process each year The fellowship has increased engagement between departments as preceptors discuss fellows progress and performance The fellowship program has served to improve diversity within the organization 21
Feedback I characterize my fellowship at the MGPO as the closest I've come to a professional shortcut... The program couples wide-range exposure with deep dives in analysis, decision-making across institutions, and presentations to executive leadership. Most meaningfully, the fellowship launched lifelong mentorship and peer relationships that continue to impact my values and projects. It's an unparalleled introduction to top leadership of the most complex of businesses, and I couldn't speak more highly of the experience. Carly Stockdale, 2009-2010 Fellow The MGPO Finance Fellowship provided me the opportunity to explore an untapped inkling towards healthcare finance within a cultivating and challenging environment. The projects and opportunities throughout my tenure helped me realize the true breadth of the healthcare finance field beyond anything I could have gained in any other administrative fellowship or job setting. I am beyond grateful to the MGPO for providing such an amazing experience and introduction to the field. Lauren McManemin, 2015-2016 Fellow The fellowship has been a great experience for both parties: staff and fellows. The program expands horizons for accepted individuals and provides great opportunities for those just entering the field. Fellows come with a lot of energy and willingness to take on tough projects, and are always wonderful additions to the team. They have all been a helpful extra set of hands throughout the years. Nan Jones, Senior Director, Physician Analytics & Business Intelligence 22