1. Teaching Practice Management: Giving Residents the Skills Needed to be Successful in the Real World David Lick M.D., FAAFP Marie Baloga, MSN/MSA, FACHE Theresa Peters, BA

2. Disclosures None of the presenters have any conflicts of interest to disclose

3. Objectives By attending this session participants will be able to: 1.Identify multiple practice management skills residents need to be successful after graduation 2.Describe different teaching strategies to creating a successful practice management curriculum. 3. Identify resources within their own program and institution for teaching practice management. 4. Describe the cycle time that residents need to prepare for their job search and resources that can be provided to assist in the selection process.

4. ACGME Requirements Family Medicine Program Requirements (effective 7/2007): “Residents must receive at least 100 hours of management and leadership instruction to include both the didactic and the practical settings.” Similar in proposed revisions to requirements Sounds simple enough…

5. ACGME Requirements Should prepare residents to assume leadership roles in their practices, communities, and the profession of medicine FMC must be the primary site for teaching this and should serve as an example for future practices Must receive reports of individual and practice productivity, financial performance, patient satisfaction, and clinical quality and have training to analyze these reports

6. ACGME Requirements Must attend business meetings with faculty and staff Must participate in quality improvement projects Should include training to provide leadership for a clinical practice, hospital medical staff, professional organizations, and community

7. ACGME Requirements Should include instruction in billing, budgets, staffing, new technologies, marketplace value, customer satisfaction, clinical quality, tort liability and risk management, scheduling systems, computers, alternative practice models, employment law, public relations, media training, and personnel management

8. Where to start?

9. History of Practice Management at Beaumont Original Curriculum (~1999): Practice Management rotation (one month) Residents visited offices of graduates Guides from pharmaceutical companies No structured objectives

10. Evolution of Practice Management at Beaumont Residency Assistance Program (now RPS) -Residency to Reality program Individual lectures (informed consent, etc.) Understanding our own office (PI projects, spend time with staff, etc.) Beaumont University (leadership, running effective meetings, etc.) Medicine and Law CD’s Third Thursday Workshops (contracting, coding, personal finance)

11. Evolution of Practice Management at Beaumont Weave the curriculum throughout all three years of residency Take advantage of non-physician expertise in FMC and hospital system Benefits: Office staff felt they were contributing to residents’ education Leadership viewed this curriculum as important

12. Where We Are Now Practice Management rotation at the end of the PGY2 year (“the bolus”) Educational sessions and experiences throughout all three years (“the drip”)

13. Practice Management Rotation Goals and Objectives (Handout A) Outcome: Tools/resources for a successful job search Practice management skills and resources for future success Recognize need for physician leadership in healthcare delivery for the future

14. Practice Management Rotation Preparing for a Job Search – Assessment – Shadowing in practices – Action plan – Establishing goals – Writing a cover letter and curriculum vitae – Interviewing skills – Recruitment firms – Contracts

15. Practice Management Rotation Preparing for a Job Search – Assessment 1. “14 Alternative Practice Styles” James M. Giovino Family Practice Management, Feb. 2001, Vol 8, No. 2, pages 33-8 2.Opportunity Assessment and Evaluation Tool National Association of Physician Recruiters – WWW.NAPR.ORG and info@napr.org PHYSICIAN PRACTICE SEARCH GUIDE WWW.NAPR.ORGinfo@napr.org 3. Shadowing to Compare and Contrast Graduate Physician Practices (Handout B)

16. Practice Management Rotation Preparing for a Job Search (continued) Action Plan for the Job – Starts Year 1 Personal and Professional Goals (Corporate Director/HR) – Specific, Measurable, Achievable, Realistic, Timely Writing CVs and Cover Letters – Samples of exceptional and poorly written CVs – www.careers.ucr.edu www.careers.ucr.edu – www.free-resume-tips.com www.free-resume-tips.com – www.mimom.org – Visit the “Candidates” section www.mimom.org

17. Practice Management Rotation Preparing for a job search (continued) The Interview Process (Director of Human Resources) – Mock interviews with all residents – Questions and scoring process Meet a recruiter Review of contract lecture

18. Practice Management Rotation Risk Management Focus on Office Communications and Administrative Systems, Malpractice – Manager, Physician Practice Assessment Services “Risk Management Principles & Commentaries for the Medical Office” 1-800-621-8335 – Physician Office Risk Management outline (Handout C) – Real world scenarios – Beaumont University Crucial Conversations; Grenny, Patterson, McMillan and Switzler

19. Practice Management Rotation Medical Legal Curriculum – “Law & Medicine” What Every Physician Should Know 1-800-808-8525 – ELM – Educating Healthcare Providers about Risk and Patient Safety – case based www.elmexchange.com (consider funding through your insurance trust) www.elmexchange.com

20. Practice Management Rotation Clinical Operations (Nursing Supervisors) – Departmental objectives, metrics and audits – Quality and safety – Staffing – Hiring and managing people (case studies) – Managing clinical activities (OB, Mental Health Services) – Managing ancillary services – The Electronic Medical Record

21. Practice Management Rotation Clerical Operations (Office Manager) – Appointments, scheduling, phone management – Electronic Medical Record – Patient discharge process – Billing and coding – Service Excellence Reports read online

22. Practice Management Rotation Growth and Financial Success (Hospital Directors) – Strategic Planning (Handout D) The Well-Managed Healthcare Organization, Seventh Edition, by Kenneth R. White, PhD, FACHE and John R. Griffith, FACHE – Mission/Vision/Values An analogy to bricks and mortar Compare and contrast healthcare and non- healthcare – Annual Goals and Objectives Development and alignment of system, hospital and family medicine center Share a copy from your hospital

23. Practice Management Rotation – Capital equipment process A case study for decision-making – Annual budgeting process Introduction to the Financial Management of Healthcare Organizations, Fifth Edition, by Michael Nowicki, EdD, FACHE, FHFMA – Reading financial statements – Meaningful Use/Incentives – Marketing plan Share samples Draft for a practice

24. Practice Management Rotation Coding Sessions (Physician Led with Coding and Billing Staff) – Inpatient billing – Outpatient billing – Collections – Negotiating provider contracts – Managed Care – Audits Accuracy of CPT Evaluation and Management Coding by Family Physicians Mitchell S. King, MD, Lisa Sharp, PhD, and Martin S. Lipsky, MD JABFP May–June 2001 Vol. 14 No. 3 Coding Newsletters

25. Practice Management Rotation Continuous Performance Improvement – Basic Performance Improvement lecture PDCA, LEAN, KAIZEN Application to sentinel events – Project summary (Handout E) “Stop Rising Healthcare Costs Using Toyota Lean Production Method” Robert W. Chalice

26. Practice Management Rotation Health Care Reform - NEW – Lecture with Residency Director (source: Kaiser Family Foundation Health Reform Source) Accountable Care Organization and the Patient Centered Medical Home (PCMH) - NEW – Meet with Beaumont Physician Partners staff – Emmi – patient education video http://www.beaumont.edu/family-medicine- center-sterling-heights – Quality and Usage data (Review individual physician data) – Capabilities for a PCMH

27. Practice Management Rotation Credentialing (Chief of Family Medicine) – Beaumont Credentialing process – Quality metrics – Leadership opportunities – Professional organizations – Tips for taking the boards

28. Practice Management Rotation Summary Session – Presentation “The Reality of Primary Care Compensation” http://www.theabfm.org/about/stats_us.aspx – MGMA 2011 Report “Physician Compensation and Production Survey” mgma.com – Resource list of financial planners and attorneys – Medical practices observations (compare and contrast – Handout A) – Law Curriculum case studies and quizzes – Hand in Transitioning to success quizzes for: Practice Selection Insurance Contracts Benchmarking Practice Operations – Complete coding exercises – Complete quality audits

29. Practice Management Rotation Summary Session includes Individualized appointments to review: - Cover letters -CVs -Interview suggestions -Personal and professional goals Next Steps -Appointment with Beaumont recruiters -Letters of intent/contracts

30. Begins July PGY1 year Orientation Sessions (Insurance 101, billing, etc.) Spend Time with FMC Workgroups in Orientation Coding Sessions (all three years) Didactic Noon Lectures (Health care reform, PCMH etc.) Third Thursday Workshops (contracting, coding, contracting, etc.) ~3 per year Longitudinal Curriculum

31. Daily Huddles (preceptors, MA’s) Monthly Team Meetings – Service Excellence, LEAN, PCMH Quarterly Full Center Meetings Bimonthly Family Medicine Business Meetings System-wide Practice Management Lecture (yearly)

32. Longitudinal Curriculum Leadership and Professional Development – Hospital committees – Chiefs development – Performance improvement – Turning Doctors into Leaders by Thomas H. Lee; Harvard Business Review April, 2010 Family Medicine Business Meetings Support in the Job Search and Practice Placement

33. Resources Resources within the Organization – Department directors Articles and Publications Websites Physician Practices of Graduates to Support Rotations List of Financial Planners List of Attorneys Recruiters within the Organization

34. Challenges Resident Schedules – reminders Coordination with Lectures and Patient Care Employed Practice Scheduling Deliveries Vacations Connecting the Dots Technology and Teaching Methods Changes in Healthcare

35. Competency Completion of Assignments – Law and Medicine quizzes – Residency to reality quizzes – Cover letter and CV draft – Performance improvement summary – Audits – Feedback from directors – Evaluations

36. Handouts A. Goals and Objectives B. Strategic Planning Definitions C. Office Questionnaire D. Performance Improvement Project Summary E. Office Risk Management

37. Objectives By attending this session participants will be able to: 1.Identify multiple practice management skills residents need to be successful after graduation 2. Describe different teaching strategies to creating a successful practice management curriculum. 3. Identify resources within their own program and institution for teaching practice management. 4. Describe the cycle time that residents need to prepare for their job search and resources that can be provided to assist in the selection process.

38. Questions?