FREQUENTLY ASKED QUESTIONS ABOUT THE CONE HEALTH MEDICAL GROUP (CHMG)

1.       Q – Will all currently employed physicians (practices) and all future employed physicians (practices) be part of Cone Health Medical Group?

A – Yes. Because patients are touched by all specialties, in different settings (inpatient, outpatient, skilled, etc.), all physician practices need to be part of the system that delivers their care.  For employed physicians, this means participating in the Cone Health Medical Group.

2.       Q – Who is on the Provider Steering Committee (PSC)?  How were they selected or appointed? 

A -The Provider Steering Committee is a group of physician leaders from a variety of specialties and practice settings that were chosen by the Nominating Committee made up of physicians who participated in Joint Physician Advisory Committee or JPAC.

3.       Q – What is the Committee trying to accomplish?  Over what time frame?

A -This Physician Steering Committee’s role is to help Cone leadership design the structure for CHMG that will result in a physician-led organization with physicians “at the table” for decisions on quality and patient safety, strategy, growth, communication, informatics, finance, contracting and professional standards for the group.

4.       Q - Who will be affected by the results of this Committee and project? 

A - All physicians who are employed currently and in the future at Cone Health will be part of the Cone Health Medical Group (CHMG) and will be affected by this change.

5.       Q - How will issues and decisions the Physician Steering Committee address be vetted?  Who will decide on final recommendations? 

A - The Provider Steering Committee (PSC) will seek input from all of the physicians of CHMG through Town Hall (All Physician Meetings), written communications, a website and face-to-face interaction.  The PSC will make their final recommendations after this input to Tim Rice, CEO, for final approval.

6.       Q – How will the Physician Steering Committee decisions affect my employment agreement? 

A - Your employment agreement, or contract, is always the final decision on all matters that it describes regarding your relationship with Cone Health.

7.       Q – How will physicians have input into the final decisions? 

A -The PSC is developing a governance structure in collaboration with Cone Health that will be physician led.  This will include numerous Committees of physicians that will help to shape the growth, strategy, quality initiatives and professional standards for the CHMG physicians.

8.       Q – What expert resources is the PSC using to guide their discussions and decisions? 

A - The Physician Steering Committee has engaged BDC Advisors, a healthcare consulting firm that has significant experience in helping other organizations like Cone Health, to organize their physicians into a high functioning medical group.  BDC Advisors is very familiar with Cone Health – having recently helped the health system form Triad HealthCare Network.

9.       Q – What organizations are you using to model the leadership and governance plan? 

A - We are modeling this after other embedded medical groups that have reached top decile performance in quality, safety and cost efficiency:  High Performing Medical Groups.

10.   Q - How will future compensation for my group be managed? 

A - Because physician compensation is such a delicate subject and is highly regulated in a not-for-profit system, the new CHMG governance structure will not be the forum for physician compensation decisions.  Advice and recommendations will be made by a Compensation Committee that includes several members of senior management who will be reviewing market data and ensuring that all future compensation is market-based and at fair market value.

11.   Q - What are the recommended key governing and management committees?  How will members be appointed? 

A - The primary governing committee will be called the Executive Council and is anticipated to consist of 15 physicians and three Cone executives (in the current draft).  There will be six committees — Quality and Safety, Finance and Contracting, Professional Standards, Informatics, Operations and Communications that will all include numerous physicians.  There will also be guiding committees such as an Administrative Committee (the key physician and administrative leaders) and Recruitment Committee (the leadership and staff accountable for recruiting the physicians).

12.   Q - What opportunities will I have to serve in some role in the new structure?

A - The new Committees will have many opportunities for physicians who have interest or skills in the various areas to participate.

13.   Q - What is the “division structure” of the new CHMG?  What is the purpose of the primary care division?

A - If a specialty has a large number of employed physicians, such as primary care or hospitalists, it is important to organize those physicians in divisions so that they can work together on adopting best practices, reviewing performance to those best practices and sharing the knowledge so that all improve.  It is particularly important for primary care physicians to engage each other in a divisional structure because this specialty moves to a new model of care with the patient-centered medical home.

14.   Q - Will physicians be compensated for serving in an official capacity on any of the CHMG committees? 

A – Yes. Physicians will be recognized for their time with a stipend or RVUs  if they participate on any of the standing CHMG governance committees.

15.   Q - What physician leadership positions are being proposed?  How will physicians be selected to fill these positions? 

A – In the new structure, there are many opportunities for new physician leadership positions. Positions anticipated include an Executive Medical Director for CHMG, Chair of the Executive Council, chairs of each of the committees, Division Medical Directors and physician leaders at each of the practice sites (Lead Physicians).  Most of these positions will be made by appointment; some will require formal posting, interviews and selection while others will be less formal.

16.   Q - How will the CHMG governing structure differ from or integrate with the Triad HealthCare Network structure?  How will their roles be differentiated?

A – The role of THN is to engage the medical community (both independent and those in CHMG) in improving the quality of healthcare for the population of patients served by THN while at the same time improving the efficiency of that care.  The purpose of the CHMG is to create a high performing medical group and at the same time, work in collaboration with THN to align with its metrics and goals around those key quality initiatives.  But just like any independent practice in THN, CHMG also needs to provide an excellent environment for its physicians and staff.  To do that, CHMG needs a governance structure that will assist Cone Health in the strategy and growth of the Cone Health Medical Group as well as determine the goals and standards for CHMG’s clinical performance, service performance and financial performance.  The two           structures are complementary and necessary for Cone Health’s future.

17.   Q - What is Cone senior leadership’s view of this plan?

A – They are very supportive for the CHMG governance and leadership structure to evolve in the next few months.  Cone executives need a CHMG body to participate on a strategic level, and a governance body to provide direction to the management team on the evolution of CHMG.  As the healthcare reform moves from volume-based to value-based payments, having a high performing medical group will be a great asset to Cone Health and Triad HealthCare Network.

18.   Q -What are the key committees recommended in the new plan?  What is their primary purpose?

A –The five committees will be:

• Quality and Safety
• Finance and Contracting
• Professional Standards
• Informatics
• Operations
• Communications 

Quality and Patient Safety Committee

• In collaboration with the Cone Health Quality Committee and TPN, review potential clinical quality metrics from a variety of sources (HEDIS, clinically integrated network scorecard, other pay for performance metrics from payers or compensation plans) and make recommendations to the Executive Council on priority clinical quality metrics and goals for the medical group’s balanced scorecard.
• Review service quality results and make recommendations to the Executive Council on the service metrics and goals for the medical group’s balanced scorecard.
• Review on a regular basis results of all metrics related to clinical and service quality that are applicable to CHMG and develop or review action plans to improve those that are not reaching defined goals.
• Develop and approve clinical pathways or “bundles” to be used by medical group members including a mechanism to review these on a regular basis.
• Set standards and create policies for the use of the clinical pathways by medical group members.
• Make recommendations regarding quality, service, or efficiency incentives included in the CHMG compensation plans.
• Develop a communication and engagement plan for physicians regarding clinical standards, clinical pathways and clinical quality metrics.
• Develop a communication and engagement plan for physicians regarding service standards and service metrics.
• Develop resources for physicians or practice sites that are not performing to the group’s standards in the areas of clinical or service quality.
• Periodically evaluate physician satisfaction regarding his/her ability to provide quality care to patients and develop action plan(s) to improve satisfaction if needed.

Finance and Contracting Committee

• Review annual budget and approve all budget assumptions for the medical group.
• Recommend financial performance metrics for both the CHMG balanced scorecard and also key performance financial metrics for each practice site.
• Recommend financial projects in conjunction with the operations team to improve performance on the metrics, both for the medical group and individual practice sites.
• Develop a user friendly monthly report for each practice for use by the practice manager and the lead physician.
• Develop a user friendly monthly productivity report for each physician detailing wRVU production, trends and targets as well as appropriate benchmarks for the specialty.
• Periodically evaluate physician satisfaction with the wRVU report and make improvements as needed.
• Review proformas for all major projects that have financial implications.
• Develop the process for physician compensation administration to ensure a smooth and error-free process.
• Develop models for expressing the financial benefit of quality improvement activities.

Informatics (IT) Committee

For New Technology:

• Develop a process to evaluate any potential new technology for the medical group in a timely, evidence-based manner and make recommendations to management.
• Recommend IT priorities regarding the medical group to management.

For Current Technology:

• Set standards and create policies for the use of the Electronic Medical Records (EMR) by medical group members.
• Set standards for EMR templates.
• Develop a process to review and approve changes in EMR templates or interfaces.
• Periodically evaluate physician satisfaction with the EMR and other IT products and develop action plan(s) to improve satisfaction if needed.

Professional Standards

• Develop policies that describe the standards for patient care and professional expectations for members of Cone Health Medical Group.
• Coordinate with the Quality Committee on clinical standards and policies related to clinical care.
• Develop a communication and education plan for physicians regarding patient care and professional standards.
• Develop a fair and equitable process to review both patient care and behavioral concerns that are raised by peers, patients, staff or other physician performance monitoring bodies.
• Develop coaching and mentoring resources for physicians or practice sites not performing to the group’s standards.
• Communicate to physicians in a timely manner the results of all performance issues that are reviewed.
• Provide feedback and recommendations to the Executive Medical Director of CHMG regarding suspension or termination of a physician not achieving CHMG performance expectations.
• Work with the legal department to make sure communication about peer review (related to medical group members) from the hospitals is received in a timely manner and that all activity is protected.