HSG’s focus on physician network management has given us real insights into the operational and management challenges faced by hospitals. Those challenges vary, depending on which Growth Phase your network is in.

Many of our clients are in Growth or Operational Chaos modes, when common performance issues and their causes include:


Performance Issue
Physicians Don’t Understand Role Lack of Strategic Direction
Silos vs. Multi-Specialty Lack of Culture & Physician Leadership
Variability in Clinical Best Practices Quality Reporting & EMR Usage
Confusion Regarding Brand Identity Inconsistent Use of Brand
Timely Communication of Results Ineffective Infrastructure & Reporting
Escalating Losses Revenue Cycle, Charge Capture, Scheduling, Contracting, Generous Compensation
Multiple Physician Contracts & Compensation Plans Reactive vs. Planned Growth
Physicians Not Engaged Lack of Group Culture & Defined Performance Expectations
Loss of Referrals within the Network Lack of Group Vision and Culture
Hospital Perception of Value is Low Lack of Integrated Strategy & Culture


Developing the 100-Day Turnaround Plan

HSG’s approach to physician network turnaround is to design and implement a 100-day plan that:

  • Identifies the most pressing issues;
  • Devises strategies and tactics to stabilize the operations;
  • Energizes the network’s operations; and
  • Sets the tone for sustainable performance improvement.

We base our turnaround plans on the premise that all practices should, at a minimum, perform at the 60th percentile of MGMA benchmarks with the ultimate goal of performing at the 75th. If median performance isn’t acceptable for independent physician practices, why should it be acceptable for hospital-employed physicians? The answer is it shouldn’t, and that expectation needs to be part of the network’s culture. Our goal is to create a group that is proud to be part of your organization and consistently performs at a high level while providing quality patient care.

12 Key Work Plan Elements

  1. Review your organization’s strategic plan to determine if the network’s strategic initiatives support those of goals and objectives for the overall organization.

Is accountability for goal achievement driven down into the group’s management team?  Are there adequate resources allocated to ensure success? Has a financial impact analysis been completed to validate the plan?

  1. Identify barriers to network success.

Be ruthless in identifying people and organizational barriers that prevent the group from operating more effectively. Garner top management support to eliminate these barriers.

  1. Benchmark network performance to industry standards.

You can’t manage what you don’t measure. Benchmark each practice’s performance to appropriate industry standards.  Then develop monthly dashboard reports, set performance expectations for the practices, and share the operating results with the physicians and managers. Be clear about your expectations for performance and change!

  1. Assess the group’s culture and provider engagement level and formulate action plans to energize physician collaboration.

Don’t allow the physicians to abdicate their role in managing and operating the practices. They are crucial to your success. Form a Physician Advisory Council and use it to change negative behavior and build a positive group culture.

  1. Evaluate the complement of network physicians.

Do you have the right number and mix of specialties to meet the network’s goals and objectives? Do you have the right primary care-to-specialist ratio? Should practices be consolidated into larger sites or better distributed throughout the market? How do advanced practitioners fit into the equation?  Beyond the right number and mix, you need physicians who embrace the common vision, expectations and demands required to be part of the group.

  1. Review the physician compensation plan. It’s unreasonable to develop a new compensation plan in a 100-day plan. What you can do is assess whether the current plan supports the network’s overall goals. If not, address it once other performance issues are resolved. The Physician Advisory Council should have a significant role in this area.
  1. Evaluate the effectiveness of the management team and the infrastructure.

Do you have the right people in the right jobs? Does the current management team have the physician support needed to make necessary operational changes? Are there structured reporting mechanisms to ensure pertinent information is shared with the providers?

  1. Revenue cycle must be a focus.

The mandate here is to pay attention to details and focus on fundamentals.  Set performance standards and measure against them. Incentivize and reward both the front desk and business office staffs for achieving established performance benchmarks. Set the standards at the 75th percentile, not the median. Median performers go broke.

  1. Optimize the practice management and EMR systems.

Most practices don’t take full advantage of their system’s capabilities. Invest appropriately in training and develop superusers for the system. It will pay dividends.

  1. Implement Periodic Review.

Establish periodic review sessions to gauge your progress. Focus on hitting your goals; hold your team accountable and stay the course.

  1. Engage key physician leaders and managers in the process.

You will need both physician leader and management team support to get this done. Everyone involved must understand their role and what is expected of them. They need to be involved in the process and should be expected to help formulate the goals and tactics.

Be sure to communicate why this is being done and explain the long-term goals.

Five Benefits of a 100-Day Turnaround Plan

The five benefits of implementing a 100-Day Turnaround Plan include:

  • Reenergizing the physician and management team to focus on achieving goals and objectives;
  • Establishing key performance measurement metrics;
  • Setting the expectation the network will become a high-performing group;
  • Holding people accountable for results; and
  • Developing a plan that becomes the foundation for an on-going performance improvement process.

Neal D. Barker

Partner and Managing Director, Compensation and Compliance