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WHAT WE DO
Working primarily with hospitals and integrated delivery systems, Nelson Flores helps clients build successful new hospital medicine programs and enhance the effectiveness and value of existing programs. To that end, we offer the following services for medical and surgical hospitalist programs:
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click on any item below to learn more
New hospital medicine program feasibility assessment
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We work with hospitals and physician groups to assess the desirability and feasibility of developing a hospitalist program. This analysis includes:
- evaluating the current environment
- identifying drivers and barriers (both internal and external) impacting potential program development
- examining internal resources and capabilities necessary to support successful program development
- assessing stakeholder needs and goals
We project hospitalist program volume and workload, staffing requirements and probable program revenues and costs. Based on this assessment, we make recommendations regarding the feasibility and preferred organization of a program. |
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New hospital medicine program design
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We help organizations design their hospitalist programs by creating a comprehensive business and implementation plan, including:
- proposing a workable organizational structure (for example, employment of hospitalists vs. contracting with an independent group or a national hospitalist management company)
- proposing a scope of services and appropriate coverage model
- defining staffing, scheduling and other operational criteria
- projecting program revenues, expenses and financial support requirements in the form of a pro forma budget
- identifying contract negotiation considerations
- suggesting performance standards
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Hospital medicine program implementation assistance
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We provide technical assistance with hospitalist program implementation, including:
- organizing and administering implementation task lists
- drafting policies and procedures, forms, communication tools and other documents
- advising with regard to hospitalist recruitment and compensation
- designing performance-monitoring tools
- other types of implementation assistance, as may be requested
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Physician group formation and design of practice management systems
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When needed, we facilitate the formation of an independent physician professional corporation or other appropriate legal entity to serve as a vehicle for employing the hospitalists and contracting with the sponsoring organization for the provision of services.
This may include coordinating legal requirements, setting up practice management systems, arranging for physician billing/collection and credentialing, and related services. |
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Management of an RFP process for selecting a hospitalist company
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When appropriate, we assist our clients in the selection of a local medical group or national hospitalist management company to provide hospitalist services, including:
- preparing volume, payor mix and other relevant program projections
- drafting a request for proposal document
- identifying potential hospitalist program vendors
- issuing the RFP and managing the proposal submission process
- reviewing and evaluating submitted proposals
- supporting the vendor selection process
- assisting with contract design and negotiation
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Fair market value fairness opinions for IRS and Stark regulation compliance
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| We provide formal assessments of fair market value for hospitalist compensation and a hospital’s overall financial support of a hospitalist program, utilizing national, regional and (where available) local market information. The assessment results in a written fairness opinion that can be relied upon by the hospital’s board for Stark and IRS intermediate sanctions compliance purposes. Prior to submission, each fairness opinion is reviewed by our healthcare legal counsel. |
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Hospital medicine program operational assessment
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| We perform evaluations of existing programs that may be struggling due to political and/or operational challenges, or that simply wish to assess how their performance compares to external benchmarks and current best practices. We find that the primary challenges encountered by hospitalist programs usually related to the rapidly evolving nature of hospital medicine – and of the healthcare system in general – and the resulting changes in organizational expectations and operational complexity. In addition, many programs are still organized in ways that worked well when they were four- or five-physician practices operating in a simpler environment, but are no longer effective for a practice of 15 to 20 or more providers who are not only caring for patients but are also charged with leading organizational change and quality improvement.
We work directly with the hospitalists in these programs, so that we can understand their concerns and help them find ways to maintain a satisfying practice while meeting their stakeholders’ needs. We help them to rationalize the scope of services and prioritize service expansion plans, to develop clear protocols and communication around these issues, and to adjust staffing, scheduling and work allocation to best accommodate clinical workload and achieve organizational goals. We evaluate the financial performance of the practice and the amount of financial support being provided, make recommendations to optimize the program’s finances, and help everyone understand what’s reasonable to expect. We also offer recommendations to enhance other aspects of hospital medicine program operations, from physician recruitment, compensation and other contractual issues to communication (both internal and external to the practice), coding and charge capture. |
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Staffing and scheduling guidance
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| We assist clients in understanding the staffing levels needed for their current and anticipated workload, and in designing staffing models that efficiently address coverage needs. What sometimes appears to be a staffing problem (e.g., not the right number of hospitalists) is often really a scheduling problem. We advise clients with regard to alternative scheduling methodologies, and assist them in developing schedules with attention to continuity of care between hospitalist and patient, physician lifestyle considerations, and distributing manpower effectively to handle variations in workload.
We believe the preference of the doctors themselves is one of the most critical components in determining how to structure a schedule, and want to make sure they understand the pros and cons of their choices so they can decide whether there are better options. |
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Compensation plan design
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| We assist hospital medicine groups in the design and modeling of new hospitalist compensation plans. Our goal is to align incentives so that the compensation plan supports the goals of the practice, and we have worked with many practices to build production, quality and other performance incentives into the compensation model.
Fundamental to our compensation philosophy is the idea that the compensation plan should help connect individual hospitalists both to the work they do and to the well-being of the practice, helping to foster a sense of practice ownership. Our compensation work includes detailed data analysis and modeling to anticipate the likely impact of proposed compensation changes on both individual hospitalist incomes and on the total program budget. We also advise clients on implementation and transition considerations. |
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Facilitation of problem resolution related to disagreements in program goals,
scope and operation
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We are available to attend and facilitate meetings on-site to help address and resolve issues that may arise among the hospitalists or between the hospitalists and other interested parties, ranging from hospital administrators to surgeons or medical sub-specialists. We have helped resolve issues such as:
- the hospitalists’ role in the ICU and their relationship with intensivists
- differing expectations regarding the hospitalists’ role in the emergency department
- coverage of code blues and other emergency situations
- hospitalist involvement in the care of surgical or medical sub-specialty patients
- hospitalist participation in the development and implementation of clinical guidelines and protocols
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Facilitation of hospitalist program strategic planning processes
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We work with both new and mature hospitalist practices to engage them in developing a strategic plan for the evolution and growth of the practice, including:
- facilitating strategic planning retreats
- providing supporting data collection and analysis
- drafting strategic plan documents
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Assistance with financial modeling and negotiation for the contract between the hospital and the medical group
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We assist hospitals and medical groups with the design and negotiation of Professional Services Agreements for hospitalist services, including:
- Projecting the financial support likely to be required for effective operation of the practice
- Recommending appropriate financial support payment methodologies that effectively align interests and protect both parties
- Proposing other contract terms and conditions that will be valuable for successful management of the hospital – group relationship
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Periodic program check-ups, with improvement recommendations
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| We also conduct one-day site visits to successful programs to review the program’s progress, discuss national and regional trends in the practice of hospital medicine, and to offer “tune-up” advice. These services can be provided on a per-visit basis or on a retainer basis. |
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Interpersonal and leadership skills education and coaching
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| We provide training and coaching to hospitalists to help them develop better communication and relationship-building skills, including effective confrontation and conflict resolution techniques. We are particularly passionate about working with hospital medicine practice leaders and medical directors to help them expand their leadership vision and enhance their leadership effectiveness. |
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(AND DON’T DO)
•We don't own hospitalist practices or manage them on a turnkey basis.
•We don’t offer recruiting services or employ your doctors.
•We don't directly provide services such as coding audits, coding education or billing/collections.
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We would be pleased to learn more about your hospital medicine program interests and needs, and to chat with you informally over the phone. If you require more comprehensive assistance, we will be happy to submit a proposal to provide consulting services specifically designed to meet your needs. Please contact us at:
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