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    David N. Gans
    David N. Gans, MSHA, FACMPE

    Before joining MGMA as chief operating officer in late 2019, Ron Holder, MHA, FACMPE, FACHE, spent more than 20 years in academic and large integrated delivery systems in a variety of administrative leadership roles.

    His experience as vice president of operations for the Temple region of Baylor Scott & White Health, validates that Holder can “walk the talk” of health system management.  Among his responsibilities was bringing physicians and other providers into the Baylor Scott & White system. As part of years of growth that involved hundreds of physicians across the system, Holder said his area of responsibility involved hiring around 30 physicians and adding another 40 physician assistants and nurse practitioners, growing the practice to more than 220 physicians and 80 advance practice providers.

    Holder says that a clinical training partnership with the Texas A&M Health Science Center College of Medicine is one of the exciting parts of working at the health system. “We got to see the future stars, future healthcare providers being trained,” Holder says. “I love being around that coaching and teaching.”

    Physician leadership potential

    One of the strategies that Holder and others at Baylor Scott & White used to recruit new doctors was the pitch of understanding them and letting them work in a physician-led organization.

    “There are physicians in prominent positions of leadership all throughout the organization,” Holder says. “Back when I joined Scott and White Clinic and even now, there's a physician at the head of Scott and White Clinic, which is a subset of the physician practices there, and having a physician executive leader is attractive to a lot of physicians. Physicians have a multitude of career growth opportunities,” including directing residency or fellowship programs.

    “Stability, security and predictability are attractive to physicians, where it's not necessarily contingent upon your own private practice’s revenue cycle efforts or short-term emergencies as to how much you get to take home in any given month,” Holder adds.

    But recruiting the perfect candidate poses its own set of challenges when independent practice still appears quite appealing to many physicians.

    “You are hoping and want to hire a unicorn. You want to hire a physician who has good outcomes, you want to hire a physician that is productive, you want to hire a physician that has great patient satisfaction scores, who can develop a rapport with other physicians, members of the team, respect the staff that work there [and] have an interest in making the business of the medical practice successful,” Holder says, noting a conundrum. If a physician possesses all those skill sets and wants to maximize all of them, you have to ask, “why wouldn’t you be in private practice?”

    One of the advantages for the health system in bringing that new physician in is potentially having less of a ramp-up period for the doctor to establish a panel and have that doctor see close to a full patient load from the start.

    “A lot of times when you join big health systems, they're hiring a physician because they already have a demand for that number of physicians, and you walk in the door and you have a patient panel or you have business patients to see,” Holder says. “That is a boon that sometimes you may not think about.”

    Culture makes the difference

    Another key factor in making those “unicorns” want to work in your organization is the practice culture across multiple aspects of the organization, and health system executives should recognize how their own skills help build the culture.

    “Failed communicators expect everybody else to adjust to them,” Holder notes. “A good communicator finds out, when you're having one-on-one conversations with people, how is the best way to communicate?” For executives, that means understanding what physicians hope to get out of being part of the organization and helping them be successful.

    Physicians “have to be in alignment with the culture, and they also have to be a part of continuing to build and refine the culture, because they are viewed by the staff as the leaders of a clinical team, and those staff have to see it modeled,” Holder says. “It can't just be spoken; it has to be modeled.”

    The culture also is reflected in how leaders evaluate taking on more value-based payment agreements and investing in nonphysician providers, such as nurse navigators and patient coordinators, to make it clear that some investments will not have an immediate payoff.

    The value of a strong dyad leadership structure cannot be understated in such a situation. “I’ve been extremely lucky to work in dyad relationships for the majority of my career, where on paper, maybe I'm working for the physician leader, but the majority of the ones I've worked with really saw it as a partnership,” Holder says. “And there have been ones where it has been a true partnership, with regards to being peers with the physician leader of the group.”

    In those relationships, it’s crucial for administrative and physician leaders to support decisions together. “You can get into spirited debate behind closed doors, but once you walk out and you’re with the rest of your organization, you’re unified,” Holder says. Without that unity, “destructive” cultures can take root, Holder cautions.

    The patient engagement factor

    The transition to a focus on team-based care can help break a mindset that’s overly focused on “sick care, as opposed to keeping people healthy,” Holder says. “The patient has to be a willing participant with the healthcare team in order for that value to work and to stay healthy, instead of requiring sick care.”

    Building patient engagement is helped with burgeoning telehealth services such as virtual visits and remote patient monitoring, which gives physicians and other clinical team members new opportunities to manage patient behaviors.

    Health systems are building mobile health programs just to follow up on patients after their hospital discharge. At Baylor Scott & White, Holder notes there were in-home visits by physicians or nurse practitioners, as well as partnerships with EMTs to check on patients a couple days post discharge.

    MGMA’s role in transforming healthcare

    Holder notes that MGMA has been an important part of his career journey, and that the Association “is in a position of alignment with where people want to see healthcare go.”

    That path includes ensuring that “care can be provided easier, faster, cheaper and with similar outcomes in an ambulatory setting instead of having to be in a hospital,” Holder says.

    In his new role as chief operating officer, Holder notes that the Association will “continue to grow and increase our engagement and make sure that we have a preferred place to work, so that it translates to better experiences for our members, better experiences for our partners, better experiences for anybody that's involved with the healthcare journey and ultimately making better care for the patients.”

    “There's tremendous opportunity for us to help practices — individual practices, private practices, group practices — to be successful, but also at organizations, because the successful integrated delivery systems or hospitals that employ physicians. … The ones that are the most successful recognize that, even though we're part of one system, there are elements to physician practices that are different,” Holder says. “And we have to have experts and knowledgeable people managing those practices, as well as the resources to do so.”

    David N. Gans

    Written By

    David N. Gans, MSHA, FACMPE

    David Gans, MSHA, FACMPE, is a national authority on medical practice operations and health systems for the Medical Group Management Association (MGMA), the national association for medical practice leaders. He is an educational speaker, authors a regular Data Mine column in MGMA Connection magazine and is a resource on all areas of medical group practice management for association members. Mr. Gans retired from the United States Army Reserve in the grade of Colonel, is a Certified Medical Practice Executive and a Fellow in the American College of Medical Practice Executives.

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