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A Guide to Comanagement for Orthopedic Service Line Leaders: Part Two

A Guide To Comanagement For Orthopedic Service Line Leaders Part Two Web

Our previous post outlined several important considerations for developing an orthopedic comanagement arrangement. Now it’s time to consider other factors that may determine whether your program is a success. If this is your first crack at comanagement, it is important to demonstrate to physicians and the rest of the market that you can deliver on your commitments and be a leader in innovation.

1. Develop go-live milestones.

After months of anticipation, your program has likely generated momentum and excitement. To avoid any unnecessary hiccups that can dampen enthusiasm as you go live, identify the desired launch date and then plan backwards from that point. Set up important milestones to reach before the program’s launch. A few important steps to account for include:

  • Collecting relevant volume, financial, operational, access, and quality data.
  • Creating a system for metric tracking.
  • Obtaining a fair market value opinion for the compensation to be paid to the management company and physicians.
  • Reviewing and updating physician contracts as necessary.
  • Building agendas for, and scheduling, the first comanagement company meetings.

Although it is possible to account for these steps after you finish planning the agreement structure, doing so during the planning stages will avoid delay and ensure the program moves forward in a coordinated fashion.

2. Secure internal approvals.

Imagine if, after several months of collaborative planning between administrators and orthopedic surgeons, you realize that you overlooked your organization’s internal approval processes or failed to engage with key stakeholders. Now, instead of building on the momentum and implementing your program, you are in the unenviable position of explaining to your physician partners why the go-live date is being pushed back by weeks, months, or even indefinitely.

Failure to obtain internal system approvals can derail your comanagement program before its even off the ground. Often, comanagement agreements will need to be approved by several committees (finance, physician enterprise, board, etc.). Because many of the individuals on these committees will be unfamiliar with comanagement agreements, you’ll need to educate them prior to bringing the agreement forward for a vote. Soliciting input and seeking approval from key stakeholders up front will help reduce the possibility of delays in implementation

3. Establish your management company board and committees.

It is critical to ensure that the right physicians and service line administrators will serve in the appropriate leadership positions. Ideally, this would be as simple as slotting the most qualified participants into the positions for which they are best suited.

However, there are factors beyond ability and merit to take into account. For better or for worse, political considerations may necessitate broad physician representation (rather than physicians from only one group) on management company boards and committees to promote engagement. After all, this may be the first time these orthopedic surgeons have collaborated with your system and with surgeons from other groups, and it’s important that they all feel like they have a meaningful role in both the comanagement company and service line.

Additionally, if your system comprises multiple hospitals, include representation from each site on the board or in various committees. This can help ensure that orthopedic service line initiatives are created with input and buy-in from each hospital.

4. Identify/designate a program manager.

Planning a comanagement agreement can be difficult; executing one is another challenge entirely. That’s why it’s critical to have a dedicated resource overseeing the program.

At first blush, the notion of a program manager may seem contradictory. Wasn’t the point of implementing a comanagement agreement to have physicians assist in managing the service line? However, having an administrative program manager in place will be critical to developing and executing service line initiatives and projects, especially during the first year.

Ideally, the program manager will be someone who was involved with the planning of the agreement and has earned the trust of both system administrators and physicians. The program manager can:

  • Support all improvement efforts.
  • Assist in tracking progress against incentive measures.
  • Communicate project status, results, and potential issues.

A strong project manager can help ensure your organization understands the purpose of an orthopedic service line initiative and promote it across all departments and locations. Whether the program manager is an internal employee (e.g., a service line leader) or an external resource (e.g., a consultant), it will be critical that they are able to execute on service line initiatives, train and teach the physician members of the comanagement company, and advocate for your program across the system.

5. Communicate regularly.

More than anything, communication is key to setting appropriate expectations, actively managing the program, and keeping things on track. Establish a regular meeting schedule and identify communication channels to share updates and results with stakeholders. To follow through on expectations set during the planning phases, it will be important to communicate effectively with:

  • Senior management in order to ensure continued support.
  • Clinical teams impacted by the change.
  • Physician leaders, to keep them actively involved and engaged.

Comanagement Is Worth the Effort

Comanagement agreements have proved to be successful across the country and are an innovative way to align with physicians and improve your orthopedic service line. Taking the time to carefully plan will help you implement a comanagement program that is robust and sustainable and helps differentiate your organization in the market.

In addition to our blog post about developing comanagement agreements, please see our article Developing a Modern Orthopedic Destination Center, and contact ECG with questions specific to your own organization.

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