Astute, engaged and pro-active leadership has become more important than ever in emergency medicine (EM) as healthcare’s transformation continues to accelerate. Managing successfully in the face of powerful new competition, changing reimbursement models and expanding clinical expectations requires a unique combination of skills and expertise, McKesson experts say.

“In the past, there was a feeling among some emergency physicians that, ‘Hey, we’re the only game in town and nobody is going to take our contract. We just have to come in and cover the shift and do a great job and that’s it,’” said Dave Berry, specialty vice president – emergency medicine for McKesson Business Performance Services (McKesson). “But those days are over. The environment is changing dramatically, and you need to change with it to survive.”

Get your house in order

Berry and John Stimler, DO, a McKesson emergency medicine consultant, recently discussed leadership qualities that are essential for EM leaders in today’s market. First and foremost, they say, group leaders must understand that they’re responsible for a multi-million dollar enterprise and act accordingly.

“As self-evident as this may sound, you would be surprised at how many practices don’t implement basic business practices,” Dr. Stimler said. “What that means is you need to create a formal management structure that includes a board of directors and key leadership functions like CFO, CMO, CIO, as well as others with specific areas of responsibility. At the same time, you should be constantly working to identify, implement and perfect processes that will support the stability and responsiveness of the practice and the services it provides.”

Admittedly, Dr. Stimler said, the complexity of healthcare today means that even the largest organizations don’t always have the range of capabilities necessary to thrive financially and operationally. As a result, groups should consider bringing on outside expertise and resources to improve the practice. Useful external partners can include revenue cycle management companies, risk management groups for malpractice coverage and emergency medicine consultants for help in optimizing operational strategies.

Berry said practices should also look at hiring physician extenders, such as physician assistants, nurse practitioners and scribes. Extenders can boost throughput by taking responsibility for routine cases, and scribes can help physicians by covering ER documentation requirements. Both roles will allow physicians to use their time more effectively by focusing on the most demanding and critical cases.

Open communication channels

Beyond committing to professional management and appropriate support resources, leaders should cultivate the interpersonal skills needed to listen to, and lead, multiple strong personalities. That means being willing to receive suggestions, direction and feedback from practice members and, when appropriate, use the information to formulate effective compromise directions for the group.

In a similar vein, the importance of maintaining positive and engaged relationships with hospital administrators can’t be overstated, Berry said. The emergence of value-based care presents major challenges for emergency practices, from the development of care continuity and clinical collaboration strategies to effective population management and equitable, incentive-based physician reimbursement. Without a formal process that allows for regular give-and-take on strategic issues, groups could find themselves sitting on the sidelines when it comes to major organizational decisions.

“The role of the emergency department is expanding and will increasingly require that groups take on new responsibilities in the areas of population management, cost containment and care continuity,” Berry said. “So the time to get involved in that discussion is now.”

Effective communication is equally important at the operational level, Berry added. Groups should work closely with the appropriate hospital personnel, including IT leadership, to develop the capabilities required to generate and assimilate data on a range of clinical and operational issues. Nursing and physician staff also should be engaged to address day-to-day issues like staffing and turn-around time, as well as the implementation of evidence-based clinical guidelines. And protocols should be established that allow for routine consults with referring physicians and specialists on complex or high-risk cases.

Watch the horizon

As the healthcare regulatory environment becomes more expansive and unforgiving, leaders must be cognizant of issues that can impact the practice. This includes programs like the Physician Quality Reporting System (PQRS), as well as other voluntary and mandated Centers for Medicare & Medicaid Services (CMS) initiatives. Because rules change so frequently, leaders need to develop systems that not only monitor regulatory changes in near-real-time, but can also assist in developing rapid and effective responses.

Finally, Dr. Stimler said, an effective leader must be constantly alert to the changing competitive landscape in emergency medicine. With national chains aggressively courting hospitals with promises of high-quality care, lower costs and better data collection, it is essential that practices enhance their own value proposition to solidify their relationships with hospitals.

“Groups should view their hospitals as partner and clients, and do everything they can to provide the highest quality service in the emergency room,” Dr. Stimler said. “If they can consistently demonstrate that they’re committed to the overall success of the organization, the odds of being replaced will be greatly reduced.”


About the author

McKesson Business Performance Services offers services and consulting to help hospitals, health systems, and physician practices improve business performance, boost margins and transition successfully to value-based care.