H u m a n Re s o u r c e M a n a g e m e n t

PIH Health Physicians

PRACTICE PROFILE

Growing pains: Onboarding new physicians

B
y mid-2011, William Stimmler, MD, president of PIH Health Physicians in Whittier, Calif., knew he had a problem with retaining new providers. A physician assistant left after just six months, and complaints about credentialing, benefits and billing snafus were frequent. Some start dates were even postponed because insurance provider numbers and other essential paperwork had not been processed. The joint operating committee with the groups hospital also put a high strategic priority on expanding the integrated systems primary care network and adding specialties, which added pressure. The plan called for adding 45 new practitioners over a 12-month period, Stimmler recalls. We knew we had to do better to keep physicians satisfied and improve retention. To identify issues, a group physician service analyst conducted a survey of the groups onboarding practices. Responses from 13 recently hired physicians and 11 department administrators in clinical and administrative services uncovered strengths and weaknesses as outlined in the following anonymous quotes: Documents were requested multiple times even though I sent them immediately. I felt like I had to be in charge of my own credentialing. [There is a] lack of leadership failure of any one person to take responsibility for the process. At this time I do not believe that any department has been given the resources, time or expectations to accomplish this in a high-performing manner. On the plus side, physicians were generally satisfied with the recruitment process and the organization as a whole, despite confusion experienced after they were hired. I think, for the most part, people are hardworking but with a lack of direction, one physician wrote. There is an enormous amount of potential here if the cards are played right, he added.
2013 MGMA-ACMPE. All rights reserved.

Addressing the issues

Stimmler and his team took the insights to heart. PIH hired an experienced practice management consultant to launch an onboarding process-improvement effort. We needed to get it up and running as quickly as possible. The goal was creating an efficient onboarding process designed for continuous improvement, says Stimmler, who knew a performance-improvement model would best serve physicians. Working closely with administration in human resources, credentialing, the business office and clinical operations, the team

By Adrienne Hill, MHA; and Rose Wagner, MHS, RN

It was the smoothest, most organized onboarding the medical group has ever done.
outlined the existing process and its gaps and identified five key areas for improvement: Due diligence Frequent delays were experienced for document gathering, such as tax records, asset documents, physician contracts, job descriptions and pay grades. These are critical to evaluate and close the deal and integrate operations into the group. The team drew up comprehensive lists of all required documents to ensure all relevant information is shared and transparent to both parties. Documenting deal points PIH offers a standard contract, though some deals also involve exceptions for valuation of acquired assets, research, nonclinical activities and ancillary support. To avoid misunderstandings and delays, the group developed a template with specifics including monetary arrangements spelled out and acknowledged by both parties before any contract was signed. Setting start dates We had several practitioners delay their start date or start without credentials or insurance numbers, so they really couldnt do much at first, Stimmler says. To reduce this problem, a standard timeframe

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H u m a n Re s o u r c e M a n a g e m e n t

PRACTICE PROFILE

PIH Health Physicians

of 60 to 90 days was established to carry out all onboarding functions, including credentialing, health plan contracting, operations assessment, office setup, merging staff, and establishing business and clinical operations. Before the start date is set, a project management team representing every department involved in the transition is appointed to assign tasks and timelines. Appointing an onboarding and retention owner Lack of coordination among all the departments involved created a lot of frus-

Our new onboarding process helps new practitioners feel at home. Its really helped build morale and strengthen our culture of working together to put patients first.
tration for doctors. The onboarding owner serves as a central contact for administrators and practitioners to ensure the process goes smoothly. Initially, the consultant assumed the role. PIH later hired a full-time director with experience as a service-line director in the medical group. Her rank and expertise help command respect and cooperation within the organization. Communication A written onboarding plan and regularly scheduled meetings with new practitioners, practice administrators and department heads help keep the project moving and hold people accountable.

Streamlining the process

The team also developed a comprehensive onboarding master project plan and data repository. It started with a review of each departments onboarding processes. Some departments had lists of the tasks they needed to perform; others did not. Department task lists were compiled into a single master list. Each task identifies a responsible department member and accommodates interdependent and sequential processes, such as credentialing and managed-care contracting. The data repository makes information sharing
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among departments possible. For example, essential dates for training, licensing and work history can be accessed by human resources, managed-care contracting and medical affairs. The new process was piloted with the acquisition of a gastroenterology group. All practitioners had provider numbers by their start dates, which was a first for PIH. Physicians were pleased and maintained productivity for the most part. It was the smoothest, most organized onboarding the medical group has ever done, Stimmler recalls. The onboarding director meets regularly with the groups president, chief operating officer and vice president of physician recruitment to discuss potential new hires or acquisitions. Once a provider or medical group is identified, she schedules a weekly meeting of department heads and implements a master plan to ensure the schedule is followed. The process is continually reviewed, revised and enhanced before, during and after each onboarding experience. Physician surveys have been added to the master plan with regularly scheduled follow-up meetings with the onboarding director and newly hired practitioners to ensure smooth transitions. Next steps include integrating physician orientation into the process. Physician mentors will be assigned to new hires, who will attend monthly orientation meetings with the senior medical director during the first year of employment. Our new onboarding process helps new practitioners feel at home, Stimmler says. Its really helped build morale and strengthen our culture of working together to put patients first.

2013 MGMA-ACMPE. All rights reserved.