PODCAST | Shared Services Performed by Physicians and APPs

Amy Noecker, APP Workforce Practice Leader, and Zach Hartsell, Principal, featured in the Stark Integrity podcast to discuss split/shared billing compliance

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Due to recent changes to the Physician Fee Schedule regarding modifications to billing for split/shared visits, many physicians and advanced practice providers are facing significant workflow changes.

Members of SullivanCotter’s growing APP Workforce Practice recently sat down with Bob Wade, Esq., to discuss the impact of the changes and what health care organizations can do to address them.

This episode provides valuable insight into:

  • The current state of split/shared billing
  • How to evaluate care team composition and responsibilities by provider
  • Whether compensation arrangements should be adjusted to help ensure financial sustainability and regulatory compliance
  • A breakdown of the time-based methodology
  • Other areas of concern that organizations should be aware of regarding split/shared visit attribution

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Revisions to Submitting Split/Shared Visits for Reimbursement


Valuation of Management Services and Management Services Organizations

Considerations for developing effective partnerships in an evolving health care environment

Originally published by the American Association of Provider Compensation Professionals


As health care consumerism takes hold, technology evolves, and the industry continues to prioritize value-based care delivery, the definition of “work” for physicians has changed — and the ways in which physicians are compensated have evolved as well.

There are many forms this can take - such as direct cash compensation, base salary, quality incentives, call pay and more. An often-overlooked form of physician compensation, however, is the benefits received through Management Services Organizations (MSOs) and Management Services Agreements (MSAs).

Learn more about these agreements as your organization explores new partnerships, including information on different financial approaches and service arrangements, a better understanding of the regulatory requirements, and insight into the potential benefits.

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PRESS RELEASE | SullivanCotter Acquires Clinician Nexus

SullivanCotter Announces Formation of New Clinical Workforce Technology Company

Chicago, IL | June 8, 2022

SullivanCotter, the nation’s leading independent consulting firm in the assessment and development of total rewards programs, workforce solutions, and data products for the health care industry and not-for-profit sector, is pleased to announce the acquisition of Clinician Nexus – a clinical experience management technology company located in Minneapolis, MN.

Clinician Nexus is the creator of a powerful and collaborative platform that enables participating hospitals, health systems, and educational institutions to co-manage medical, nursing, and allied health students as they obtain clinical experience. Founded by Katrina Anderson, Bob Bryan, and Tim Schottler in 2016, Clinician Nexus has been successfully connecting health care organizations with students to drive meaningful clinical experiences with the intent to build a well-trained clinical workforce for tomorrow.

The acquisition of Clinician Nexus deepens the firm’s technology talent and enables the creation of two separate entities focused on serving different needs within the health care industry and not-for-profit sector. SullivanCotter will continue to offer market-leading consulting and advisory services while Clinician Nexus will provide workforce and compensation management technology as well as automated workflow solutions designed to support each stage of the clinical workforce lifecycle ꟷ from planning and training to measuring, rewarding, and driving performance. SullivanCotter’s Provider Performance Management Technology™ and Benchmarks360™ Pro and Plus platforms will now be delivered through Clinician Nexus.

“Powered by an industry-leading suite of workforce data, advanced automation capabilities, and a commitment to assisting clients in shaping the future of health care, we are excited to go to market with cutting-edge technology solutions to help them plan, build and enhance their clinical workforce strategies,” said David Schwietz, Chief Information Officer, Clinician Nexus.

With the ultimate goal of supporting the delivery of best-in-class patient care, Clinician Nexus connects organizations with the critical technology, data, tools, and resources required to drive innovative clinical workforce strategies.

“Together with Clinician Nexus, we’ll be able to leverage SullivanCotter’s consulting experience and expertise to develop innovative software solutions, data products, and analytics services for health care organizations nationwide. This will enable us to better support our clients by effectively and efficiently addressing current and future workforce needs as the industry continues to experience dramatic cultural and operational shifts,” said Ted Chien, President and CEO, SullivanCotter.

SullivanCotter will continue to provide advisory services and a comprehensive collection of proprietary benchmarking surveys, administered by Clinician Nexus, to health care and other not-for-profit organizations under its own brand.

For more information on Clinician Nexus and its growing suite of clinical workforce technology products, please visit www.cliniciannexus.com or contact us at 888.739.7039.

About Clinician Nexus

Clinician Nexus enables health care organizations to build thriving clinician teams with industry-leading technology products, workforce and compensation analytics, and automated workflow solutions. Backed by extensive technical expertise and industry-leading data, we deliver innovative approaches to help clients to plan, educate, and engage their clinical workforce at every stage of the lifecycle. We are committed to providing our clients with outstanding guidance and support as they focus on shaping the future of health care.

About SullivanCotter

SullivanCotter partners with health care and other not-for-profit organizations to understand what drives performance and improve outcomes through the development and implementation of integrated workforce strategies. Using our time-tested methodologies and industry-leading research and information, we provide data-driven insights, expertise, and solutions to help organizations align business strategy and performance objectives – enabling our clients to deliver on their mission, vision, and values.


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PRESS RELEASE | Pay Equity Expert Mike O'Malley Joins SullivanCotter

Pay equity is an important prerequisite for fostering a fully engaged workforce

Chicago, IL | May 24, 2022

SullivanCotter, the nation’s leading independent consulting firm in the assessment and development of total rewards programs, workforce solutions, and technology and data products for the health care industry and not-for-profit sector, is pleased to announce the addition of prominent social psychologist and research-driven consultant Mike O’Malley as a Principal in the firm’s Employee Workforce Practice.

As a leader in his field, Mike has spent more than 30 years consulting and educating boards and senior executives on a myriad of human capital matters such as leadership development, compensation, succession planning, change management and more. He is also a widely published author specializing in leadership excellence and organizational design and leverages years of experience in his research-based approach with clients.

In his role at SullivanCotter, Mike partners with health care and other not-for-profit organizations to develop data-driven solutions that enhance performance and help achieve strategic goals. He assists in overseeing the firm’s pay equity analyses and advisory services. With a focus on both performance and equity, he leads critical compensation and benefits redesign initiatives to provide a more holistic and integrated approach to total rewards.

“As a fundamental element of diversity, equity and inclusion initiatives, pay equity is an important prerequisite for fostering a fully engaged workforce. These services are a pivotal component of our commitment to helping clients build stronger organizations that are diverse, inclusive and fair – and Mike’s longstanding expertise in this area will help to support these goals”, said Ted Chien, President and Chief Executive Officer, SullivanCotter.

Previously, Mike held leadership positions in a number of prominent global consulting firms. He currently serves as a Lecturer at the Yale University School of Medicine, where he conducts research and consults on statistics and a broad range of human resources topics.

In addition to having his expertise recognized by major media outlets such as CNBC, CBS and Fox, Mike has also been the keynote speaker at national and international events hosted by the United States Department of the Interior, the Financial Times, the London School of Economics and Political Science, and the Henry Jackson Society.

About SullivanCotter

SullivanCotter partners with health care and other not-for-profit organizations to understand what drives performance and improve outcomes through the development and implementation of integrated workforce strategies. Using our time-tested methodologies and industry-leading research and information, we provide data-driven insights, expertise, data and technology products to help organizations align business strategy and performance objectives – enabling our clients to deliver on their mission, vision and values.


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PODCAST | Submitting Split/Shared Visits for Reimbursement

Zach Hartsell, Principal – APP Workforce Practice – featured in BESLER’s Hospital Finance Podcast to discuss changes to split/shared visit attribution

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Every year, the Centers for Medicare & Medicaid Services incorporate changes in policy, regulations, and requirements for billing under the Medicare Physician Fee Schedule (PFS). These changes are often adopted by commercial payers.

On November 2, 2021, CMS released the final rule for the 2022 PFS. The final rule went into effect on January 1, 2022, and includes some important considerations related to the conditions for submitting split-shared visits for reimbursement.

These changes have the potential to alter the existing workflow of physicians and advanced practice providers related to billing split-shared encounters.

To help explain the impact of these changes, this episode includes:

  • The definition of a split/shared visit
  • Insight into the 2022 changes as well as those coming in 2023
  • Explanation of specific activities that CMS has identified
  • Case-based examples

Looking for additional insight on the changes to the Physician Fee Schedule regarding Split/Shared Visits?

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INFOGRAPHIC | Physician Workforce Trends in Pediatric Hospitals

Pediatric hospitals continue to face physician workforce recruitment and retention challenges

Due to unprecedented labor shortages, pay compression, burnout, retirements and increased competition for physician leadership talent, pediatric organizations are experiencing a number of challenges related to recruiting and retaining the right talent.

As a result, many organizations are using their limited compensation budgets to focus more strategically on hard-to-recruit specialties, high-performing physicians, and areas requiring a greater degree of alignment with organizational imperatives.

These imperatives are influenced by an evolving competitive landscape, changes in reimbursement, new modes of providing patient care in support of greater access, financial pressures and more.

Pediatric hospitals are also focused on addressing specialties impacted most by the pandemic, such as critical care medicine and behavioral health. SullivanCotter expects to see these specialties emerge with greater than average compensation increases in future survey reports.

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PODCAST | Executive Compensation Committee

Priorities and Trends for the Executive Compensation Committee

Episode 1 >

Episode 2 >

In a rapidly evolving health care environment, oversight of executive compensation, recruitment and retention remains a critical responsibility of the board of directors. These decisions are complex, highly regulated and require heightened executive compensation committee engagement and specialized expertise.

In this two-part edition of the Governing Health Podcast Series, SullivanCotter's Tim Cotter, Managing Director, joins McDermott Will & Emery's Michael Peregrine to discuss emerging trends and practices in health care executive compensation.

These episodes include insight into:

  • The current state of salaries, increase budgets, incentive awards and more
  • Emerging compensation practices
  • Effective retention and transition strategies
  • The evolution of annual and long-term incentive plans
  • Executive and director co-investment arrangements
  • For-profit compatibility data

Executive Span of Control | Identifying the Optimal Structure

Executive span of control, which is generally defined as the number of direct reports under a leader, should be periodically reviewed to ensure an effective and efficient management structure.

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In today’s increasingly complex health care environment, executives are responsible for driving performance aligned with a health system’s mission, vision and values. Span of control, which is generally defined as the number of direct reports under a leader, should be periodically reviewed to ensure an effective and efficient management structure. Health systems strive to attain optimal span of control to ensure their front line staff have the appropriate amount of supervision, communication, training and performance management in place, while also seeking to optimize the cost of their operating model.

At the senior leadership level, span of control is vital and serves as an important measure of accountability for an executive. Having too many direct reports or lines of business to oversee can dilute strategic focus if executives become mired in day-to-day operations and compromise a manager’s ability to effectively develop and grow talent. Conversely, having too few direct reports may be an indication of an inefficient management structure with potential duplication of responsibility and approval channels. This can affect the decision-making processes, slow down overall execution, and lead to excess costs.

Note: Span of control is a complex and nuanced management topic. The purpose of this article is to provide a conceptual introduction, share key data and benchmarks from SullivanCotter’s proprietary Workforce Metrics Benchmark database, highlight key strategies and considerations, and summarize the benefits that health systems can achieve from improving span of control. These benchmarks are aggregated across not-for-profit health care organizations with different operating models and strategic imperatives, and therefore should be used as a general point of reference rather than to create specific performance targets.

Finding the optimal mix of management oversight can be challenging.

For this article, SullivanCotter analyzed span of control for more than 4,000 health system executives across different job families and reporting levels in order to identify the typical range of direct reports and help health systems assess their executive span of control structures.

This analysis is based on data from SullivanCotter’s Workforce Metrics Benchmark database and represents nearly 700,000 individuals from 54 not-for-profit health systems (comprising more than 600 individual/subsidiary hospitals and other operating entities) with an average net revenue of over $4.5 billion.

Range of Span of Control by Level

SullivanCotter evaluated span of control across four different executive-level roles consisting of System CEOs and Presidents, Entity CEOs and Presidents, Executive Vice Presidents, Senior Vice Presidents and Vice Presidents. Definitions of each role are included in the Appendix.

Exhibit 1 below shows the range for the number of direct reports per executive. The green shading indicates the 25th to 75th percentiles, while the red shading indicates the 10th and 90th percentiles.

Range of Span of Control - Number of Direct Reports by Level

System CEOs and Presidents generally have 9 to 13 direct reports with a median of 11. As we move further down in the organization, this range tends to decrease for any of the Vice President level positions. Having less than 3 or more than 9 direct reports for this group would suggest it may be appropriate to review the span of control.

While the number of direct reports is a fundamental component of an executive’s scope of responsibility, it is not the only indicator. The combined number of direct and indirect reports can help to demonstrate total accountability and can vary widely depending on number of functions overseen, organization size, and functional area. For this purpose, ‘indirect reports‘ include all of the individuals who report through an executive’s direct reports down the organization hierarchy.

For instance, when evaluating Vice Presidents in Nursing (which may include CNOs of affiliate entities) at smaller organizations (less than 5,000 FTEs), the data show that each VP oversees a median of 268 total direct and indirect reports. At larger organizations (over 25,000 FTEs), each Vice President in Nursing oversees a median of 376 total direct and indirect reports. Across each job family, the number of total reports increases as organization size increases. This highlights the value of scale of an organization in supporting organizational efficiencies. Also, we note that there are more employees within the nursing and operational functions than we typically see in many of the administrative areas (e.g., Marketing, Legal, Human Resources, Finance).

Exhibit 2 below shows the median number of total reports for a Vice President incumbent for select job families by organization size.

Vice Presidents – Median Number of Total (Direct and Indirect) Reports by Job Family and Organization Size

 

 

 

 

 

Range of Span of Control by Job Family

SullivanCotter conducted additional research to analyze span of control by job family and each reporting level within that job family (i.e., Chief Officer of a specific job family at level 1, direct reports at level 2, etc.). This analysis shows how span of control structure can vary across reporting levels for certain job families.

Exhibit 3 below highlights the differences between Clinical and Administrative job families. Explanation of the core functions within each job family is included in the Appendix.

Median Direct Reports - Job Family Reporting Level

Executives overseeing Nursing and Ancillary and Clinical Operations job families have a more consistent span of control with a median of 7 or 8 direct reports regardless of reporting level. Note that with inpatient nursing having a relatively larger number of employees, median direct span of control for level 2 and 3 nursing executives increases to 9. Median span of control in Administrative job families looks different as top executives in Finance, Human Resources and Information Technology functions, for example, have 6 or 7 direct reports and the executives reporting to them have about 5 direct reports.

To assess the limits of span of control, SullivanCotter analyzed executives at levels combined across Clinical and Administrative job families. We consider typical span of control to fall between the 25th and 75th percentiles, with narrow or wide span of control falling outside of that range. Health systems can use these benchmarks to identify individuals that fall below the 25th percentile or above the 75th percentile. Based on these data, executives in Administrative job families who have only 1 or 2 direct reports may have an overly narrow span of control. Conversely, executives in Clinical job families who have 15 or 16 direct reports may have a span of control that is too wide. Again, with inpatient nursing having a relatively larger number of employees, the range of data from the 75th percentile to 90th percentile is 12 to 20 direct reports.

Exhibit 4 below identifies the number of directs reports that fall within these two categories.

Range of Span of Control by Job Family

 

Strategies for Assessing and Redesigning Executive Span of Control

Improving span of control begins with a current state assessment to understand where the health system may deviate from leading practices. These steps include:

  • Identify a relevant peer group. Consider the health system’s size and operating model and utilize specific studies or industry surveys (such as SullivanCotter’s Workforce Metrics Benchmark Survey) that contain benchmarks on span of control and management structures. Management consulting firms may also maintain databases and can develop customized comparative analyses.
  • Complete an overall span of control analysis across the enterprise. Starting with an overall span analysis may help to identify specific functions or entities that may have outlier data points for further review. Be sure to include both direct and indirect reports.
  • Conduct a more detailed span assessment for priority functions such as certain clinical areas or functional support (e.g., revenue cycle, nursing). When conducting detailed analyses for certain clinical or functional support areas (e.g., revenue cycle, nursing), benchmarking against both peer and internal references (e.g., across individual hospitals or entities) is useful in providing additional context. Health systems should also pay attention to individual management incumbents that may be outliers (having many more or less direct reports) compared to benchmarks or to other managers in comparable roles.
  • Identify priority areas for improvement. Data-driven insight can help to identify opportunities for improvement. Unique functional nuances or operating models can have an impact on management scope and health systems should consider specific operational characteristics that may contribute to certain individuals having a higher or lower than expected span of control.

In order to right-size executive span of control, there are several key strategies health systems can consider to help facilitate this process:

  • Consolidate functional areas (such as the development of Shared Services). For health systems that may have a narrow executive span of control, the consolidation of responsibility under fewer executives can help to widen these. It is important to consider the operational and strategic implications of consolidating or redistributing functional areas and to be deliberate about how similar functions should be grouped together under specific executives.
  • Eliminate unnecessary levels. Some health systems may discover that narrow spans of control are the result of too many layers of management. Eliminating a layer can allow for wider span of control while also reducing the number of individuals involved in decision-making and team communication. This, in turn, can help to increase operational efficiency. The optimal number of layers may differ by job family or functional area. Health systems should retain flexibility in their organizational structure to enable customization rather than attempting a ‘one-size-fits-all’ approach.
  • Redistribute functional oversight. Certain sub-functions may be assigned to a different executive who has a more narrow span of control to help balance out the ratio of direct reports. In doing this, it is important to balance the number of direct reports across all executives so as not to simply transfer a wide span of control from one executive to another.
  • Increase the level of intermediate leadership. Executives with an overly wide span of control may need to add leadership layers in order to spread their scope of responsibility. This does not always mean adding headcount and labor cost. They may choose to elevate one or more of their direct reports and have a handful of functional areas within their scope of responsibility report to this individual instead.
  • Re-evaluate total rewards. As individuals are reassigned to different levels, assess their total rewards package to ensure equity across levels. In addition to evaluating market competitive pay based on updated job responsibilities, other total rewards components such as incentive targets, paid time off and benefits eligibility should also be considered.

As health systems select and prioritize these strategies to refine span of control, there are a number of additional considerations to keep in mind:

  • Improving span of control is not just about reducing management headcount. Span of control can also influence and impact other aspects of work such as safety, employee engagement, turnover and talent management/professional development. A wider span of control can be linked to lower employee engagement as oversight gets diluted, leading to reduced talent development and career growth.
  • While a typical span of control metric involves calculating the ratio of managers to direct reports, health systems should not be focused solely on achieving a target metric. Organization structure needs to be considered in the design of a function to help ensure that the right roles at the right levels are put in place to execute on the operating model. Having the right reporting relationships and management layers in place can also aid with career pathways and succession planning.
  • Evolving workforce dynamics also make span of control about much more than the number of managers and staff. Health care span of control ratios have historically been measured on direct in-person supervisory relationships. However, health systems are growing increasingly complex as matrixed reporting and dyad management models become more prevalent. With increased outsourcing, contracted services may not show up under a manager’s official direct reporting. However, these responsibilities still need to be accounted for. The growth of the remote workforce may also impact how we approach people management. While less time may be spent on in-person supervision, health systems are investing in ways to connect more meaningfully and effectively with their employees - which requires sufficient management capacity to execute.

Positive Outcomes

A number of benefits associated with rightsizing span of control have been discussed in this article. The following diagram recaps some of these positive outcomes that health systems have achieved.

Streamlined Decision Making

Health systems with efficient management structures can come to conclusions more quickly and move on to execution and implementation as fewer individuals are involved in the decision-making process.

 

Efficient Communications

Health systems that streamline management layers find that certain types of information, especially when communicated verbally, flows from senior leaders to staff much faster when less interim levels of management need to receive and in turn pass on those communications.

 

Stronger Talent Development

With the appropriate reporting relationships and manager-to-staff ratios customized for each function, employees can build strong coaching and development ties with their managers. These structures also facilitate succession planning as employees are well-positioned to develop into future leaders.

 

Greater Operational Efficiencies

Health systems that streamline through consolidation of functions have realized benefits in operational efficiencies such as shared staffing, common data sources, increased interaction and collaboration that drives towards common results.

Improved Clinical and Staffing Outcomes

Health systems should avoid overly high span of control as that can be linked with lower employee engagement and poor adherence to work standards due to limited managerial investment and day-to-day oversight. In clinical settings, research has shown that a greater span of control can correlate with higher rates of patient infection, employee injuries and staff turnover.1

 

Labor Cost Control

Improvements in span of control are not only about headcount reductions. While some health systems have realized labor cost savings through position eliminations when streamlining their management structure, others have been able to focus on other changes such as shifting positions from VP levels to director levels to prevent a “top heavy” organization structure.

 

1Omery, A., Crawford, C.L., Dechairo-Marino, A., Quaye, B.S., Finkelstein, J. (2019). Reexamining the Nurse Manager Span of Control with a 21st-Century Lens. Nursing Administration Quarterly, 43(12), 230-245. doi:10.1097/NAQ.0000000000000351

Conclusion

The data show that spans of control vary significantly among different operations and functional support areas as well as by executive level. As health systems evaluate their leadership structures, differentiated spans of control should be applied for various cohorts of leaders. Robust benchmark data provide an important reference as health systems determine the optimal spans of control.

Span of control is one aspect to consider when evaluating the ideal management oversight model and should not be reviewed in isolation without other performance metrics. Department leaders must still be accountable for achieving their expected outcomes and quality measures. So while health systems may set targets for executive oversight, they must not become fixated on achieving a specific numerical ratio and lose sight of the overarching goal of balancing the need for senior leaders to focus on strategy and growth while also effectively leading their functions to achieve these goals.


 

Appendix

Executive Job Level Definitions

  • Enterprise CEOs and Presidents: Associates mapped to this level are the enterprise chief executive reporting to the Board of Directors.
  • Entity CEOs and Presidents: Associates mapped to this level typically have overall responsibility for a distinct organizational entity.
  • Executive Vice Presidents: Associates mapped to this level are typically managers of one or more Senior Vice President subordinates. Typically has responsibility for multiple job families and is found at the second reporting level in the organization. Within SullivanCotter’s standard titling structure jobs found at this level are typically referred to as “Executive Vice President” or “Chief Officer”.
  • Senior Vice President:Associates mapped to this level are typically managers of one or more Vice President subordinates. Typically has responsibility for one job family and is found at the second or third reporting level in the organization. Within SullivanCotter’s standard titling structure jobs found at this level are typically referred to as “Senior Vice President” or “Chief Officer”.
  • Vice President: Associates mapped to this level are typically third level managers of one or more Director subordinates. Typically has responsibility for multiple functional areas and is often found at the third, fourth or fifth reporting level in the organization. Within SullivanCotter’s standard titling structure jobs found at this level are typically referred to as “Vice President” or “Associate Vice President”.

 

Select Core Functions within Clinical and Administrative Job Families

Clinical

Ancillary and Clinical Operations includes executives in behavioral and mental health, laboratory, pharmacy and rehabilitation, as well as executives that oversee hospital operations such as the COO and VP of Operations.

Nursing includes executives in care management, inpatient and outpatient nursing, surgical services, transitional care, clinical education, emergency medical services and women's health.

--

Administrative

Financial Services includes executives in functions such as financial administration, tax, audit, planning and analysis, managed care financing, revenue cycle, treasury and investments.

Human Resources includes executives in functions such as diversity and inclusion, employee and labor relations, organizational development, HR operations, leadership and workforce development, talent acquisition and total rewards.

Information Technology (IT) and Health Information includes executives in functions such as IT administration, health information management, IT security, instructional and learning technology, network and infrastructure management, programming and systems development and web services.


 

Note: As the purpose of this article was to evaluate select job families for conceptual illustration, not every job family or function was analyzed. Examples of other job families not included in the analysis are dietary, housekeeping, maintenance, supply chain, service lines and medical group operations (though ambulatory/outpatient nursing executives are included in Nursing).

 


INFOGRAPHIC | Executive Compensation in Pediatric Hospitals

SullivanCotter addresses executive compensation in pediatric hospitals via a recent pulse survey

In the current marketplace for talent, executive compensation in pediatric hospitals is growing increasingly complex as recruitment and retention challenges mount. Organizations remain concerned about burnout among experienced leaders, planned and unanticipated resignations, greater search firm activity, employment opportunities outside the health care industry, and remote work presenting more non-traditional employment opportunities.

SullivanCotter recently conducted a pulse survey to help pediatric hospitals understand how their peers are addressing 2022 executive salary increase budgets and incentive awards for FY2021 performance.

It also highlights other actions these organizations are taking to support executive recruitment and retention.

 

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INFOGRAPHIC | 2022 Executive Compensation Pulse Survey

SullivanCotter’s recent executive compensation pulse survey provides insight into how health care organizations are addressing recruitment and retention challenges in an increasingly dynamic marketplace

Health systems are growing increasingly concerned about burnout among experienced leaders, planned retirements and unanticipated resignations, greater search firm activity and employment opportunities outside the health care industry, as well as remote work presenting more non-traditional employment opportunities.

Considering these concerns, SullivanCotter conducted an executive compensation pulse survey to help participants understand how health systems are addressing FY2022 salary increase budgets and incentive awards for FY2021 performance.

It also highlights other actions systems are taking to support executive recruitment and retention in this dynamic market.

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PRESS RELEASE | Wayne Hartley Joins SullivanCotter to Help Expand Physician Workforce Advisory Services

Longstanding knowledge in health care operations, finance and human resources

Chicago, IL | March 29, 2022

SullivanCotter, the nation's leading independent consulting firm in the assessment and development of total rewards programs, workforce solutions, and technology and data products for the health care industry and not-for-profit sector, is pleased to welcome back Wayne Hartley as a Principal in the firm's Physician Workforce Practice.

Wayne is an accomplished senior consulting leader with a distinguished history of managing high-quality medical operations and utilizes more than 20 years of direct health care industry experience in his work with clients. With longstanding knowledge in health care operations, finance and human resources, Wayne specializes in helping organizations to strengthen physician compensation program strategy, regulatory compliance and value-based outcomes.

"As health care organizations look for innovative ways to stay ahead of the curve in an ever-changing marketplace, our aim is to leverage a diverse and growing panel of expertise from the industry's best and brightest consultants. We're thrilled to welcome Wayne back to SullivanCotter and, with his unique skillset and insight, look forward to learning from his extensive clinical and operational leadership experience, building strategic partnerships with new and existing clients, and expanding the firm's clinical workforce advisory services," said Mark Ryberg, Physician Workforce Practice Leader, SullivanCotter.

In his new role with SullivanCotter, Wayne will work with clients to lead physician compensation design projects and develop models to support organization-wide goals as they relate to patient access, panel size, productivity, quality and more. Additionally, he will advise organizations on the fair market value and commercial reasonableness of physician transactions to enhance compliance and mitigate risk, liaise with boards and physician leaders on high-value business strategies, and introduce new methodologies to assess and improve health system readiness for risk-based reimbursement.

Wayne also serves on the firm's Large Clinic™ Group Growth Team in which he helps to direct strategy and member engagement for the 45-year-old independent affinity group comprised of the largest medical organizations in the U.S.

Prior to joining the firm, Wayne previously served in a variety of leadership positions for a number of nationally-recognized consulting firms. He also has a wealth of clinical and operational experience from his time at two of the largest health systems in Minneapolis.

About SullivanCotter

SullivanCotter partners with health care and other not-for-profit organizations to understand what drives performance and improve outcomes through the development and implementation of integrated workforce strategies. Using our time-tested methodologies and industry-leading research and information, we provide data-driven insights, expertise, data and technology products to help organizations align business strategy and performance objectives – enabling our clients to deliver on their mission, vision and values.


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PRESS RELEASE | Enhancing PPMT™ User Experience for Physicians and APPs

Identifying opportunities to educate and engage the clinical workforce

Chicago, IL | March 23, 2022

SullivanCotter, the nation's leading independent consulting firm in the assessment and development of total rewards programs, workforce solutions, and technology and data products for the health care industry and not-for-profit sector, announces new functionality for its growing Provider Performance Management Technology™ (PPMT™) platform that enhances ease of access and usability for physicians and advanced practice providers (APPs). PPMT™ is an industry-first, cloud-based product that engages the clinical workforce and informs leaders through transparent performance-based compensation administration, contract management, and analytical and reporting capabilities.

New functionality includes valuable upgrades to the PPMT™ portal – allowing physicians and APPs one-click access to view key performance indicators via mobile or desktop. This provides physicians and APPs with a quicker line of sight into current performance and productivity results and enhances their ability to track progress against goals on their personal landing page. PPMT's more robust reporting capabilities are also still available for clinicians who are looking to dive deeper into detailed productivity, performance, and compensation results.

The focus on physician and APP engagement is further enhanced with the addition of self-service utilization reporting for compensation administrators. Enabling administrators to easily see which physicians and APPs have been utilizing PPMT™ and what reports have been accessed helps them to identify opportunities to engage the clinical workforce. "Administrators, leaders and managers are often having conversations with individual clinicians about their compensation and these reports help them to go into these meetings better prepared with opportunities to engage and educate their colleagues," said Shelly Slowiak, Director of Product Support - PPMT™, SullivanCotter.

Designed to address a spectrum of physician, leadership and other key stakeholder needs, PPMT™ combines years of health care compensation insight and expertise with an intuitive and automated technology platform to help drive performance and support the transition from volume- to value-based care.

"The needs of the health care organizations we serve are dynamic and ever-changing – especially in a marketplace that has grown increasingly complex in the past two years. SullivanCotter remains dedicated to continually enhancing our technology products to drive greater value for clients by understanding these needs and evolving alongside them," said David Schwietz, Chief Information Officer, SullivanCotter.

For more information on these enhancements or our entire suite of Provider Performance Management Technology™, visit www.sullivancotter.com/PPMT or contact us at 888.739.7039.

About SullivanCotter

SullivanCotter partners with health care and other not-for-profit organizations to understand what drives performance and improve outcomes through the development and implementation of integrated workforce strategies. Using our time-tested methodologies and industry-leading research and information, we provide data-driven insights, expertise, data and technology products to help organizations align business strategy and performance objectives – enabling our clients to deliver on their mission, vision and values.


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INFOGRAPHIC | Pulse Survey Results: 2021 Physician Fee Schedule Changes

How are health care organizations addressing the 2021 Physician Fee Schedule changes?

Following its annual review of the American Medical Association’s Relative Value System Update Committee’s recommendations, the Centers for Medicare and Medicaid Services (CMS) finalized proposed changes to the 2021 Physician Fee Schedule and has significantly overhauled the Evaluation and Management (E&M) code documentation requirements, time-effort recognition, and wRVU values for new and established patient office visits.  These changes were effective as of January 1, 2021.

As organizations look to understand the impact of these changes on reported physician productivity levels, it is also important to assess the effect it will have on physician compensation arrangements, fair market value and commercial reasonableness considerations, financial sustainability and national survey benchmarks.

SullivanCotter recently conducted a pulse survey for participants in the 2021 Physician Compensation and Productivity Survey to assess how organizations are addressing these changes. View highlights from the results –  including insight into expected adjustments to work RVU productivity thresholds and compensation rates per work RVU.

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Registered Nurses | Strategies to Recruit and Retain

Looking for better strategies to recruit and retain registered nurses?

The talent acquisition process has evolved significantly due to the COVID-19 pandemic. Many hospitals and health systems are finding that the recruitment and retention techniques they previously utilized are no longer enough to satisfy prospective and current employees. Faced with unprecedented staffing concerns regarding registered nurses (RN), organizations are seeking solutions that will help them recruit and retain this workforce.

Based on recent workforce trends, hospitals and health systems should consider the following strategies:

Enhancing Current Compensation Strategies

  • Increase market positioning to the 50th percentile (median) or higher, especially for critical roles
  • Consider introducing specialty pay to recognize specialized skillset requirements
  • Utilize sign-on, referral, retention and other bonuses for hard-to-fill roles
  • Ensure across-the-board or merit increases occur annually (expect 4% in 2022) to avoid market lag
  • Accelerate progression to midpoint for early-in-career RNs
  • Offer short-term, contract-based bonuses for vacant/night/weekend shifts
  • Create or enhance in-house travel nursing programs to provide additional opportunities for current RNs

Creating a Supportive Environment

  • Utilize workforce flexibility such as non-traditional schedules, remote work, weekender programs and other accommodations
  • Employ career ladders to support and illustrate development opportunities and career paths
  • Strengthen safety and quality processes designed to identify and correct the root cause and swiftly address issues
  • Allow nurses to work to the top of their license by providing clinical and/or clerical support where possible
  • Share your mission, values and diversity, equity and inclusion goals

Expanding Benefits Offerings

  • Consider enhanced benefit offerings such as on-site childcare, parking or transportation, home-buying assistance, student loan reimbursement, fertility
    benefits, expanded parental and eldercare leave, additional time off, or sabbaticals
  • Increase retirement contributions for employees who are further in their careers and/or for those who have extended tenure
  • Empower employees with cash and non-cash peer and subordinate recognition programs
  • Clearly and frequently communicate the value of employees’ total rewards packages

Encouraging Feedback and Collaboration

  • Utilize team-based care models
  • Support and encourage open-door policies
  • Encourage RN input and participation in policy-making
  • Provide opportunities to participate in management roundtables and the development of action plans
  • Increase opportunities for workplace committee participation and other developmental experiences
  • Communicate successes and failures


PRESS RELEASE | SullivanCotter Partners with Paradigm for Parity®

Reinforcing SullivanCotter's commitment to championing gender equality in corporate leadership positions

Chicago, IL | March 8, 2022

SullivanCotter, the nation’s leading independent consulting firm in the assessment and development of total rewards programs, workforce solutions, and technology and data products for the health care industry and not-for-profit sector, is pleased to announce its commitment to achieving gender parity within the firm’s executive leadership team by 2030.

“Ensuring an equitable and inclusive workforce has long been a cornerstone of SullivanCotter’s mission, vision and values. As a member of the Paradigm for Parity® movement, we are reinforcing our commitment to actively closing the gender gap by enhancing female representation and ensuring women of all cultures, races and backgrounds are able to thrive and advance within our firm,” said Ted Chien, President and CEO, SullivanCotter.

By implementing the Paradigm for Parity® 5-Point Action Plan, SullivanCotter is part of a coalition of companies dedicated to promoting gender equality through the minimization or elimination of unconscious bias in the workplace. The plan calls for members to accelerate the pace of change by significantly increasing the number of women in senior operating roles to 30% in the near-term, measuring targets and maintaining accountability by providing regular progress reports, basing career progress on business results and performance, and providing sponsors, not just mentors, to help position women leaders for long-term success.

"Paradigm for Parity® is excited to welcome SullivanCotter to our coalition of companies working to close the corporate leadership gender gap for women of all races, cultures and backgrounds," said Sandra Quince, CEO, Paradigm for Parity®. "Using our Paradigm for Parity® Toolkit and 5-Point Action Plan, companies can act on their commitments to gender parity and accelerate the advancement of women into leadership positions. We applaud SullivanCotter’s dedication to diversity, equity and inclusion to achieve gender parity in corporate leadership."

SullivanCotter’s Women’s Council, a group formed to raise awareness of women’s experiences and promote a workplace culture of balance and inclusivity, will help to identify opportunities and recommend initiatives designed to support the Paradigm for Parity® Roadmap as the firm moves forward with its pledge.

About the Paradigm for Parity® Movement

The Paradigm for Parity® coalition is comprised of CEOs, senior executives, founders, board members and business academics who are committed to achieving a new norm in corporate leadership: one in which women and men have equal power, status, and opportunity.

The coalition created the Paradigm for Parity® 5-Point Action Plan for corporations to accelerate the pace of gender equity in senior executive roles. This unique agenda defines bold and specific actions that, taken together and simultaneously implemented as a package, will catalyze change and enable today’s business executives to secure the best leaders of tomorrow. Visit www.paradigm4parity.com or follow us on Twitter using @p4parity to learn more about this exciting initiative.


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INFOGRAPHIC | Split/Shared Visits

Split/Shared Visits: Understanding the impact and opportunity of the 2023 Physician Fee Schedule Changes


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ARTICLE | 2022 Physician Fee Schedule Changes 


On November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) released the final rule for the 2022 Physician Fee Schedule with updates related to split/shared visits that have the potential to alter the existing workflows of physicians and advanced practice providers (APPs) related to billing for these encounters. The changes are effective on January 1, 2022, and January 1, 2023, and are meant to improve patient access, reduce redundancy, and better recognize the roles of advanced practice providers on care delivery teams.

The 2022 modifications allow providers to utilize either time-based accounting or traditional split/shared medical decision-making methodologies. In addition, providers can now use these visits for critical care services and require that a new billing modifier be added for all shared visits.

In 2023, split/shared visits can only be submitted using a time-based accounting methodology – which is described by as the “practitioner who provides the substantive portion of the visit (more than half of the total time spent) would bill or the visit.”

Learn more about the current rules related to split/shared visits.

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INFOGRAPHIC | 2021 Health Care Staff Compensation Survey

Hospitals and health systems continue to experience tension between the need to manage labor costs and health care staff compensation with the reality of employee workforce shortages

In 2020, there was a sense that COVID-19 was a temporary pandemic. Organizations were responding to a developing situation and dealing with staffing shortages in key areas.

Results from SullivanCotter’s 2021 Health Care Staff Compensation Survey help to shed some light on the impact of the pandemic on the industry’s employee workforce. Featuring data from over 1,100 organizations representing nearly 1.2 million individuals, more than 600 positions and 14 pay categories, this dataset provides insight into key specialties and support functions including nursing, clinical, rehab, IT, finance, human resources and more.

With the realization that COVID-19 will be a long-term challenge, organizations have had to shift their strategies to create more permanent solutions in order to recruit and retain staff in an increasingly competitive labor market. We expect to see the impact of these changes reflected in our 2022 survey results.

The 2022 survey is now open! Submit data to gain access to exclusive participant benefits.

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INFOGRAPHIC | Advanced Practice Provider Productivity

How do health care organizations select which APP productivity metrics to measure?

As health care organizations look for ways to better utilize and retain their clinical workforce, effectively measuring and projecting advanced practice provider productivity is imperative.

SullivanCotter’s 2021 Advanced Practice Provider Compensation and Productivity Survey reports productivity data and ratios, collections, and work RVUs from 210 participating organizations – including independent hospitals, health systems, academic medical centers and more. The survey also reports COVID-19-adjusted work RVUs to help organizations better understand the impact of the pandemic.

The 2022 survey is now open! Submit data to gain access to exclusive participant benefits.

Looking to gain additional insight?

Learn more about developing effective productivity measures and rewards to help support your growing APP workforce.

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E-Book | Key Agenda Items for Health Care Board Committees

Supporting health care board committee effectiveness in a changing environment

ACCESS E-BOOK

SullivanCotter has contributed two chapters to the third edition of the comprehensive e-book from McDermott Will & Emery entitled Key Agenda Items for Board Committees: Supporting Committee Effectiveness in a Changing Environment.


> Trends and Priorities for the Human Capital Committee
Authors: Tim Cotter, Managing Director - Kathy Hastings, Executive Workforce Practice Leader - Cathy Loose, Employee Workforce Practice Leader

Is your organization equipped to address ongoing industry challenges in 2022 and beyond? COVID-19 has not only accelerated dramatic shifts within health care, it also has become a catalyst for change in workforce strategies. Identifying emerging trends and practices and understanding their impact is important for the human capital committee to consider as it plans for the upcoming year.


> 10 Questions for the Compensation Committee
Authors: Tim Cotter, Managing Director - Bruce Greenblatt, Managing Principal

What important items should the Compensation Committee be considering as it plans for 2022 and beyond? SullivanCotter addresses important committee priorities, compensation-related matters such as executive salary adjustments and incentive programs, critical diversity, equity and inclusion initiatives, and more.


INFOGRAPHIC | 2021 Advanced Practice Provider Compensation and Productivity Survey

Market-leading survey data to help manage the growing APP workforce

As health care organizations nationwide continue to increase the size of their advanced practice provider workforce, the market’s interest in data-driven intelligence to help recruit, retain, and engage this critical provider group is growing.

View highlights from SullivanCotter’s 2021 APP Compensation and Productivity Survey – featuring data on more than 92,000 thousand individual APPs (nurse practitioners, physician assistants, certified registered nurse anesthetists, certified anesthesiologist assistants and certified nurse midwives) and nearly 2,200 APP leaders.

The survey collects and reports important advanced practice provider benchmarking information as it relates to utilization, productivity, compensation, pay practices as well as addressing important issues such as APP turnover and vacancy rates. Additionally, this year’s results contain the first set of benchmark data following the onset of COVID-19 and represent an important resource for organizations needing pre and post-pandemic reference points.

The 2022 survey is now open! Submit data to gain access to exclusive participant benefits.

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