To join conference call
Dial-in: 1-866-809-9263
Participant code:
The ED Call Pay Crisis:
Strategies for Fair, Equitable, and
Sustainable Solutions
Presented by:
Martin B. Buser, MPH, FACHE
Roger A. Heroux, Ph.D.
Michael E. Hogue, M.D.
June 4, 2009
610-285-8791
To join conference call
Dial-in: 1-866-809-9263
Participant code: 610-285-8791
HMR, LLC
ED Call Panel Solutions
Martin B. Buser, MPH, FACHE
Roger A. Heroux, Ph.D.
1
Overview of Today’s Objectives
 Define
the problem with ED call panels
 Understand
the process to approach the issues with ED call
panel solutions
 Findings
from interviews
 Findings
from research
 Feasibility
analysis and business plan
 Possible
recommendations for a fair and
equitable solution
 Call
 The
Pay Security Solution
To join conference call
future
Dial-in: 1-866-809-9263
Participant code: 610-285-8791
2
Stipend impact for on your bottom line

Year One:
Three panels (GS, Ortho and NS) at $500/day
$547,500

Year Two:
Six panels at $500/day
$1,095,000

Year Three: Fourteen panels at $500/day
$2,555,000

Year Four:
Year
One
Specialties Separate
Year
Tw o
Year
Three
Year
Four
General Surgery, Orthopedics and Neurosurgery at $1,500
Cardiology, Urology, Pulm, Vascular Surgery, OB, G-I,
IM/FP, ENT, Plastics at $800
Peds, Ophthalmology, Neurology and Cardiac Surgery at $500
$5,000,500
To join conference call
Dial-in: 1-866-809-9263
And escalating!!
Participant code: 610-285-8791
3
The Driving Forces Behind
the On-Call Crisis
4
Emergency Department (ED) Requirements
 Ethically
 Full
and by law...
panel of specialty physicians
 Distinct
from the emergency physicians who provide the first level
of care in ED’s
5
Definition: Unassigned patients
 “Patients
who require on-site consultation or admission to the
hospital and do not have a a prior relationship with a physician on
the Medical Staff to assume their care”
 Independent
of patient funding
 Cannot
make payments to physicians to care for their own
patients
6
Background
Past:
 Voluntary
 Cost
shifting possible
 Referrals
 How
community service
built practices
fast can I get on the panel?
7
Scope of the Problem
 National
 You’re
issue
not alone!
 Problem
growing daily
 Specialty-driven
 Increased
adversarial relationships between medical staff and
hospital
 No
easy solution
 Expensive
to solve
8
Definition: ED On-Call Panel for Unassigned Patients
Significant volume
 For
a 40,000 visit ED, it will represent over 2,000 inpatients per
year
Unassigned population:
 35-50%
of the ED hospital admissions
 12-20%
of the total hospital admissions are ED unassigned
admissions
If a trauma hospital- adds more volume and dynamics
9
Designing for the Future
 The
best solutions allow for better clinical integration and
partnerships between the hospital and medical staff
term – learning how to work together with common goals
and aligned incentives within a shared budget
 Long
 Must
be more efficient and effective
10
Multi-Step Process
 Learn
what the issues are
 Learn
what the burden is
 Learn
what the market is
 Develop
a forum for discussion
 Develop
an acceptable solution that is fair, equitable and
financially sustainable
 Manage
the implementation well
11
The Needs of the
Medical Staff
12
ED Call Panel/Medical Staff Analysis: Interviews
 What
have we learned?
13
Interviewing
 What
are the issues and dynamics?
 How
deep do they go?
 Who
is leading the cause?
 What
are their real issues?
 Income?
 Competency?
 Manpower?
 Greed?
 Irritations with the hospital systems?
 What
 How
can you do something about and what is impossible?
urgent is it?
14
What we find from the Interviews
 Special
 No
Rules to Get Off Call
Longer Able to Cost Shift for Unfunded Patients
 Desire
to be Paid for Availability
 Lifestyle
 ED
Issues
Call Affecting Recruitment and Retention Potential
15
Research:
 What
do we learn?
 Data
is objective and revealing!
16
The Research Process: Opens the “Black Box”
 Each
study period unassigned chart audited for CPTs and ICD-9
professional codes
 Code
all care provided throughout the hospitalization
 Unassigned
 Expected
volumes and payer mix identified by specialty
rate of reimbursement by specialty
 Service
line analysis (average length of stay (ALOS) by
diagnostic related group (DRG), $/DRG/Specialty, etc.)
 Financial
scenarios
17
Get the Right Data – Find Out What’s
Happening at your Hospital
Sample Hospital
Reports
18
Analyze:
Number of Panels
Staffing by Panel
Required Panels
ED Call Burden By Specialty
Quantify the volume by specialty
RVUs by Specialty
Current Payment System
Expected Payment to Specialties
19
Hospital Statistics Overview (FY2008)
Hospital Admissions
16,972
ED Visits (Inpatient and
Outpatient)
73,552
ED Admissions
8,226
Total ALOS
3.79
Total Hospital Case Mix
1.5356
20
ED Unassigned Annualized Patient Categorization
Breakdown
Admits
ED Only
Consults
Total Patients
4,992
696
5,688
Note: Patients may be seen in multiple locations, however this report shows the primary location
of service for each specific patient. The ED unassigned admission volume is estimated
based on an annualization of patients identified by hospital staff.
21
ED Unassigned Overall Averages
Months
Studied
RVUs per
Patient
Ave
Specialties per
Patient
Ave Inpatient
LOS
0.5
22.97
1.75
3.93
Note: The ED unassigned admission volume is estimated based on an annualization
of patients identified by hospital staff.
22
ED Unassigned Financial Class Group - Mix of Patients
ED Patients from the Primary Service Area Only
ED Referrals from Outlying Communities
7%
20%
1%
18%
13%
2%
Blue Cross/Blue Shield (312)
19%
Champus (48)
13%
Commercial (792)
Medicaid (744)
Medicare (1464)
11%
Self Pay (840)
35%
18%
43%
23
Estimated Current ED Unassigned Annualized
Professional Fee Practice Value for All Specialties
Estimated Current
Practice Value
$3,856,211
Note: The estimated collection rate and current estimated practice value is calculated on
estimates made by financial class based on historical trends. Actual results may vary
depending on actual billing experience.
24
Monthly Average ED Unassigned Specialty Cases and
RVUs Delivered
Specialty
Hospitalist/Internal Medicine
FP Resident
Cardiology
Surgery
Gastroenterology
Family Practice
Critical Care/Pulmonology
Infectious Disease
Nephrology
Urology
Pediatrics
Internal Medicine
Hospitalist/Family Medicine
Orthopedics
Neurology
Cardiovascular Surgery
Pulmonary
Neurosurgery
OB/Gyn
Otolaryngology
Podiatry
Psychiatry
Oncology
Anesthesia
Electrophysiology
Endocrinology
Ophthalmology
Distinct MDs Coded
(Study Period)
7
10
10
9
6
11
2
2
5
5
8
4
1
7
2
3
2
3
5
3
2
3
4
1
1
1
1
Monthly Average
Specialty Case
Count
138
96
90
72
48
44
36
32
32
32
30
28
26
24
20
16
12
10
10
8
6
6
4
2
2
2
2
25
Monthly Average
RVUs Delivered
1,396.64
860.80
1,566.78
1,414.46
601.72
354.78
325.61
361.90
383.82
369.58
201.86
312.98
205.84
656.84
178.58
1,069.40
64.30
153.54
196.42
65.84
56.66
23.08
46.88
2.04
9.00
4.18
2.64
RVUs per Specialty
Case
10.12
8.97
17.41
19.65
12.54
8.06
9.04
11.31
11.99
11.55
6.73
11.18
7.92
27.37
8.93
66.84
5.36
15.35
19.64
8.23
9.44
3.85
11.72
1.02
4.50
2.09
1.32
Monthly Average ED Unassigned Specialty Cases
Specialty
Hospitalist/Internal Medicine
FP Resident
Cardiology
Surgery
Gastroenterology
Family Practice
Critical Care/Pulmonology
Infectious Disease
Nephrology
Urology
Pediatrics
Internal Medicine
Hospitalist/Family Medicine
Orthopedics
Neurology
Cardiovascular Surgery
Pulmonary
Neurosurgery
OB/Gyn
Otolaryngology
Podiatry
Psychiatry
Oncology
Ophthalmology
Electrophysiology
Endocrinology
Anesthesia
Summary
IP Admit
Specialty Cases
102
76
42
24
6
34
0
0
14
2
28
26
10
24
8
0
0
10
6
2
0
0
2
0
0
0
0
416
IP Consult
Specialty Cases
34
20
44
32
38
10
36
32
18
6
0
2
16
0
6
16
12
0
2
2
6
6
2
2
2
2
2
348
26
ED Only All
Specialty Cases
2
0
4
16
4
0
0
0
0
24
2
0
0
0
6
0
0
0
2
4
0
0
0
0
0
0
0
64
Total Specialty
Cases
138
96
90
72
48
44
36
32
32
32
30
28
26
24
20
16
12
10
10
8
6
6
4
2
2
2
2
828
Solution Strategies and
Model Programs
27
Should Physicians Be Paid for ED Call?
 Yes
 Should
be Fair, Equitable for the Medical Staff Panel Members
 Should
be Financially Sustainable for the Hospital
28
Sample Hospital Report – Develop a Business Plan
 Get
the facts!
 Build
a business plan for expected shortfall if payment
guarantees are provided
 Understand
economic value of ED call to each specialty
29
ED On-Call Panel Options:
 Remove
 Close
irritants of call
the ED
 Develop
an IM hospitalist program
 Develop
Surgical Specialty hospitalist programs
 Maintain
bylaws mandatory on-call w/o pay
 Regionalize
 Require
care by specialty among local hospitals
a minimum number of call days before payment
30
ED On-Call Panel Options (cont’d):
 Recruit
more specialists
 Pay
stipends
 Pay
base stipend plus activation fee
 Hire
physician assistant first responders
 Guarantee
pay for work performed
 All patients
 Uninsured patients only
 Uninsured patients outside of the immediate service area
 Develop
Co Management Agreements
 Compensate
 Hybrid
for selected OP Follow Up items
compensation model
 Compensate
with Tax Advantaged dollars
31
Options: Remove Irritants of Call
 Make
ED more efficient
 Track
throughput
 Reduce
constant ED calls
 Open
surgery for ED follow-up cases
 Assist
with $ for selected ED referrals
 Cover
unfunded patients
 Allow
easy re-admission of difficult patients
 Manage
discharge planning effectively
32
Options: Hospitalists
 Dedicated
 Internal
inpatient physicians
medicine/family practice
 55%-60%
of ED unassigned admissions are medicine-related
 Control
utilization
 Control
referrals
 Allows
 Must
time to explore options
be properly staffed and designed to be extremely effective
33
HOSPITALIST DIRECTED PATIENT CARE
Acute Patient Care
Hospitalist Physician
On-site Hospitalist Support Team
(Case Manager, Care Coordinator/Clerical)
On-site Medical Director
Supportive
Infrastructure
Benchmarking for Best Practices
34
Options: Specialty Hospitalist Programs
 Growing
quickly as an option
 If
paying stipends, it may be more economical to hire full time
surgical specialists and achieve dedicated service
 Must
develop a business plan to understand the costs and risks
35
Hospitalist Services Go Beyond IM!
1. Internal Medicine/FP
2. IM/Peds
3. Peds
4. OB
5. Ortho/Traumatology
6. General Surgeons
7. Intensivists for the Critical Care Patients
36
Options: Pay Stipends
 Fixed
costs
 Difficult
to determine proper payment
 Stipends
 Never
 What
tend to go to the most vocal
stops escalating
is the relative value of on-call time?
37
Options: Pay Stipends
 Should
there be tiers?
 Everyone on call panel should receive the same base rate
 Vary the activation fee based upon frequency, severity and FMV
analysis
 How
do you determine the amounts?
 With facts
38
One Sample Hospital Report
Option: Base Fee Plus Activation Fee
 Ortho,
Neuro, OB and General Surgery
$200 Base Fee + $XXX Activation Fee
 Pulmonology,
Vascular, Cardiology, Neurology and
Plastic Surgery
$200 Base Fee + $YYY Activation Fee
 G-I,
Opth, Peds, Psych, Urology, and ENT
$200 Base Fee + $ZZZ Activation Fee
39
Option: NP/PA First Responder
 First
Line of Response
 Covers
ED Consults for Trauma, Neurosurgery, Cardiovascular
and Orthopedic Surgery
 Coordinates
all care with the on-call specialist
 Responsible
from admission to discharge
 Assign
 Net
4 Surgical NP FTE’s to cover 24/7
Cost is Staffing Costs less Professional Fees collected.
40
Option: Pay for Productivity
 Emergency
A
on-call medical group
separate professional corporation
 Contracts
with existing medical staff members
41
Contractual Relationships
Billing Service
Hospital
Steering & Coding
Committee
Medical
Corporation
Contracting
MD
Contracting
MD
Contracting
MD
Indicates contracts
42
Contracting
MD
Sample Hospital Report
Pro Forma Summary - Yearly Cost Estimates With
Various Scenarios
Program
Cost Paying
100% of
Medicare
Cost Paying
110% of
Medicare
Cost Paying
120% of
Medicare
Cost Paying
130% of
Medicare
Cost Paying
140% of
Medicare
Cost Paying
150% of
Medicare
All Specialties and
All Payors
$895,111
$1,423,982
$1,952,853
$2,481,723
$3,010,594
$3,539,464
All Specialties and
Unfunded Payors Only
$603,406
$663,746
$724,087
$784,428
$844,768
$905,109
Non-Selected Specialties
and
All Payors
$504,294
$773,687
$1,043,080
$1,312,473
$1,581,866
$1,851,259
Non-Selected Specialties
and
Unfunded Payors Only
$338,344
$372,178
$406,013
$439,847
$473,681
$507,516
Note: Excludes those specialties with existing coverage agreements or exclusive
franchises
43
Option: Compensate with Tax Advantaged Dollars
Integrated Healthcare Strategies
Michael E. Hogue, M.D.
Call Pay Security Solution
44
Call Pay Program
Integrated Healthcare Strategies developed a call pay program
designed to meet the following goals:
 Transition
from a cash payment philosophy to the development
and implementation of a retirement program opportunity
 Generate
 Control
future escalation in call pay amount
 Flexibility
 Provide
immediate and long term savings
in implementation
a competitive differentiation
 Encourage
long-term retention
45
Call Pay Dilemma – Systems
 Cost
of call is becoming a significant burden on hospital operating
margins
 Current
structure unsustainable as costs are escalating yearly at
unacceptable rates
 Hospital
systems face increasing call pay requests—slowly
becoming the industry standard
 Increasing
strain on emergency departments—increasing number
of uninsured patients
46
Call Dilemma – Physicians
 Perception
that “On-Call” problem for physicians is unreimbursed
care
 In
reality, “On-Call” is a time issue
 Historical
attempts have been to solve this with monetary
payment
 Payment
is made/taxed/spent—money is gone and the time issue
is unchanged
 Current
call pay structure will never be enough to reimburse for
excess time away from family
47
Additional Physician Issues
 Call
time adds increasing burden to physician work schedules
 Call
time limits physicians’ opportunity to maximize income
 Reduces clinic time
 Reduces elective cases
 Increases exposure to uninsured patients and corresponding legal
risk
 Private
practice physicians have difficult time sheltering money
for retirement
 Qualified
plans inadequate to meet the needs of highly
compensated physicians – increased exposure to market risk
48
Solution
IHStrategies’ approach to solving the call pay issue is focused
on answering three key questions:
 How
do we generate immediate savings for systems?
 Can
we offset physician time issues by addressing another
critical issue?
 How
do we design a plan to more adequately reward physicians
for time commitment?
49
Solution
Physician Issues
Hospital Issue
Need physicians’
time
to cover call
Time away from clinic
Time out of OR
Time away from family
Increased malpractice exposure
Negative impact on practice
COST OF RETIREMENT SAVING
50
The Call Pay Security Solution
Is a personal retirement program that combines a
specially-designed indexed universal life insurance
contract with a unique tax replacement strategy to
provide a global solution to the challenges of
developing long-term retirement income.
51
The Call Pay Security Solution
Designed to function like a Roth IRA with a twist
The Basics
 Contributions made after tax
 Account grows tax deferred
 Distributions are tax free
The Twist
 No income limits for participation
 No limit on contributions
 Replaces income earning potential on lost taxes with a tax
replacement loan
“Dollar for Dollar, A Roth IRA may just be the best savings plan in America.”
- Money Magazine, October 2008
52
The Call Pay Security Solution
 Provided
on an after-tax basis
 Outside of IRS deferred compensation scrutiny
 Immediately vested - fully portable
 Provides a tax replacement loan to participant
 Participant grossed-up annually for taxes by outside lender
 Gross-up funded by a third party
 Gross-up not reportable on 990
 Organization pays annual financing cost on the tax gross-up
 Utilizes
a highly tax-efficient indexed universal life insurance
product
 Only vehicle that offers tax deferred earnings and tax-free
distributions
 Guaranteed issue ($1million - $2million)
 Minimum
annual guaranteed return
 Tax free distributions reduces exposure to increasing tax rates
 Assets protected from malpractice claims (in most states)
53
Call Pay Comparison
CURRENT
PROPOSED
System
$25,000
+
Interest
$35,000
Physician



Outside
Lender
System
$6,000
Physician





1099 of $35,000
Taxes @ 40% 14,000
Net of $21,000
54
1099 of $25,000
Taxes @ 40% $10,000
Net Contribution $15,000
Gross Up Loan $6,000
Net Investment $21,000
The Call Pay Security Solution
How It Works
(2) Tax cost replenishment loan
(3) Earnings
(1) Participants’ after-tax contribution
Expenses
(1) Cost of insurance
(2) Administrative fees
INDEXED
CONTRACT
At Retirement
(1) Tax-free retirement income
(2) Ultimately – tax-free insurance death benefit
55
Cost Comparison of Call Pay Options
Current annual call pay obligation of $35,000,
reduced to $25,000 in CPSS program
Impact
Centura ifif Call
Call Pay
Impact
totoSystem
Payis is
paid in cash annually
paid in cash annually
Impactto
to System
Centura using
CPSS
scenario
Impact
using
CPSS
scenario
Year
Proposed Call
Pay
(1)
Match /
Loan
(2)
Annual Interest
on Loan
(3)
Total
Cost
Total Annual
Annual Cost
to
to Centura
System
(1) + (3)
Year
Call Pay
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
25,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
6,000
575
1,150
1,725
2,300
2,875
3,450
4,025
4,600
5,175
5,750
6,325
6,900
7,475
8,050
8,625
9,200
9,775
10,350
10,925
11,500
25,575
26,150
26,725
27,300
27,875
28,450
29,025
29,600
30,175
30,750
31,325
31,900
32,475
33,050
33,625
34,200
34,775
35,350
35,925
36,500
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
35,000
36,050
37,132
38,245
39,393
40,575
41,792
43,046
44,337
45,667
47,037
48,448
49,902
51,399
52,941
54,529
56,165
57,850
59,585
61,373
500,000
286,748
120,000
68,820
120,750
56,753
620,750
343,501
Totals
NPV at 6%
Totals
NPV at 6%
940,463
509,654
Total estimated savings of 32.6% over the 20-year period
ASSUMPTIONS:
• Annual increase in call pay (if paid in cash): 3.0%
• Tax rate: 40%
56
• Loan interest rate: 5.75%
• Carrier: Penn Mutual
The Call Pay Security Solution
Retirement Funding Comparison – 45 Years Old
Call Pay
The Call Pay
Paid in Cash
Security Solution
(25-Year Stream)
(Income Stream to Age 121)
$35,000
$25,000
($14,000)
(10,000)
$0
$6,000
$21,000
$21,000
ANNUAL AFTER-TAX RETIREMENT INCOME
$63,156
$87,500
TOTAL AFTER-TAX RETIREMENT INCOME
$1,578,900
$4,375,000
FREE OF FORFEITURE RISK
YES
YES
FREE OF CORPORATE INSOLVENCY RISK
YES
YES
PROTECTION FROM INCREASING TAX RATES
NO
YES
TAX-FREE LIFE INSURANCE DEATH BENEFIT
NO
YES
CALL PAY AMOUNT
INCOME TAX PAID
CONTRIBUTION GROSS UP LOAN
AMOUNT TO DEFER OR INVEST ANNUALLY
The Call Pay Security Solution delivers a 38% increase in annual after-tax
retirement income versus cash in a 25-year income stream
ASSUMPTIONS
• Tax rate of 40.0%
• Investment yield of 7% gross during accumulation phase for cash option
• Investment yield of 5.5% gross during distribution phase for cash option
• Investment yield of 7% for CPSS
• Annual call pay increase of 3%
• Income stream begins at age 71
57
S&P 500 Index versus Indexed Universal Life (IUL)
S&P 34 year annualized return 6.59%
IUL 34 Year annualized return
58
8.60%
The Call Pay Security Solution – Contract Details
The probability of earning different index return levels during the
last 20 years of monthly S&P 500 price returns assuming the
14% annual cap and 2% floor (12/07)
Earning a Return
Greater Than
Annual
Returns
3-yr
Returns
5-yr
Returns
10-yr
Returns
20-yr
Returns
5.0%
70.2%
92.7%
98.1%
100.0%
100.0%
6.0%
68.2%
84.4%
90.4%
100.0%
100.0%
6.5%
66.0%
82.4%
87.8%
100.0%
100.0%
7.0%
63.0%
78.0%
83.8%
100.0%
99.3%
7.5%
61.0%
73.3%
77.7%
100.0%
95.9%
8.0%
58.7%
68.1%
72.4%
97.3%
85.8%
8.5%
57.7%
61.6%
65.2%
89.6%
71.0%
9.0%
55.4%
55.1%
56.8%
72.0%
48.6%
10.0%
51.5%
28.9%
34.1%
25.1%
8.7%
59
Summary Of System Benefit
The Call Pay Security Solution provides systems with the
following benefits:
 Provides
immediate savings of approximately 26%
 Provides
long term reduction in cost of approximately 33%
 Individualizes
 Eliminates
call pay negotiations by specialty/section/facility
the need for continuing negotiations for call pay
 Provides
a highly flexible plan that can be customized to the
organization’s needs
60
Summary Of Physician Benefit
The Call Pay Security Solution provides physicians with the
following benefits:
 Tax-leveraged
 Immediately
 Not
wealth accumulation program
vested and portable
subject to corporate insolvency or risks of forfeiture
 Secure
investment vehicle
 Asset protection
 Minimum guaranteed return
 Index based, no asset management
61
Negotiating with the
Medical Staff
62
The Forum for Negotiations
“The power is in the process”
 Interview
to learn perceptions of the medical staff
 Research
 Engage
the ED unassigned data
the leadership of the medical staff
 Establish
a small steering committee
 Solutions
only for the entire medical staff
 Get
sign-off from the medical executive committee
 Implement
 Keep
with precision
steering committee involved
 Measure,
monitor and manage
63
Common Solutions
 ED
Unassigned and Unfunded Only
 ED
Unassigned Patients
 Base
 IM
Stipend plus FFS Guarantee
Specialty Hospitalist Program
 Additional
Specialty Hospitalist Programs
 Activation
Fee
 Tiered
Stipends
 Coverage
 Fracture
Agreements
Clinic for Orthopedic follow up
 Compensation
with Tax Advantaged Dollars
64
The Future?
 More
specialties will be hospital-based
 Estimate
that 75% of hospital census will be managed by some
form of hospitalists including:
 Internal medicine hospitalists
 Intensivists
 OB
 Pediatrics
 Orthopaedic surgeons
 General trauma surgeons
65
About Integrated Healthcare Strategies
A
Human Resources consulting firm exclusively serving
healthcare organizations
 Organizations
we work with:
 Secular, religious, government-based and not-for-profit
organizations
 Clients
include hundreds of:
 Hospitals
 Academic medical centers
 Health networks
 Nursing homes
66
About Integrated Healthcare Strategies, cont.
5
integrated specialty practices:
 Executive Total Compensation
 MSA Executive Search
 Physician Services
 MSA HR Capital
 Governance and Leadership Services
 From
these 5 practices, we’re able to assist clients in the areas of
 Physician strategy and compensation, employee compensation,
executive compensation, human capital solutions, labor relations,
leadership transition planning, executive search, employee surveys,
performance management and board governance solutions.
 Founded
 Offices:
 Website:
in 1958
Minneapolis, MN and Kansas City, MO
www.IHStrategies.com
67
About Hospitalist Management Resources, LLC
 Independent
consulting company
 We consult with Hospitalist Programs, Intensivist Programs and ED
Call Panel Solutions
 We do not staff or operate programs
 More
than 350 consultations in 11 years
 Develop
new programs and enhance existing programs into
Fourth Generation Programs
 Business plans, ROI strategies and clinical and financial
benchmarks to validate Programs
 Help
hospitals evaluate and create ED Call Panel Solutions
68
About Hospitalist Management Resources, LLC, cont.
 Founded
April 1999
 Founders:
 Each
Martin Buser and Roger Heroux, Ph.D.
bring 25+ years Healthcare experience
 Offices:
San Diego, CA and Colorado Springs, CO
 Website:
www.HMRLLC.com
 RHeroux@hmrllc.com
 MBuser@hmrllc.com
Colorado Springs (719) 331-7119
San Diego (858) 344-1060
69
Questions?
70
Contact Us
Michael E. Hogue, M.D.
Mike.Hogue@IHStrategies.com
1-800-327-9335
Martin B. Buser, MPH, FACHE
MBuser@hmrllc.com
1-858-344-1060
Roger A. Heroux, Ph.D.
RHeroux@hmrllc.com
1-719-331-7119
71