3 tips to keep patients happy during physician transitions

As healthcare continues its gradual shift from fee-for-service to value-based reimbursement, a practice's success increasingly will depend on how well it satisfies its patients. The business driver behind patient satisfaction is simple: Patients who aren't happy won't stay with a practice over the long-term.

Consequently, many practices are concentrating on efforts such as reducing patient wait times and enabling online appointment scheduling. Typically overlooked, however, are strategies to keep patients happy when physicians retire or leave for another practice. 

One of the biggest mistakes practices make is to underestimate the relationship between a departing physician and his or her patients. The bond is often especially strong when a well-established physician retires; many patients are genuinely discouraged to learn that they will need to cultivate an entirely new relationship with an unfamiliar physician.

To retain those patients, practices must quickly establish continuity of care so that patients don't feel abandoned. The key is to maintain a consistent level of patient interaction, and to help them understand why the transition is happening and how this will impact their care.

Best practices
A collaborative approach can go a long way toward ensuring that both patients and staff emerge from a physician transition feeling content. Take, for example, the process used at the Robert Wood Johnson (RWJ) Physician Enterprise when one long-time provider decided to retire.

Under the guidance of the administrative team, the retiring physician actively helped recruit his replacement, meeting with several candidates and approving the final selection of a young, local doctor with community ties. He encouraged the new recruit to shadow him, and personally introduced patients to the new provider. Because he was a clear advocate for the new doctor, both his long-time staff and his patients more readily accepted the change.

This example illustrates three best practices that organizations can employ to bolster satisfaction whenever physician staffing adjustments occur:

1) Transparency. Transparency is important not just between practice and patient, but also among all the physicians and staff involved. In the RWJ scenario, providers and staff were aware of the retirement well in advance of its effective date. Patients were notified at the point in time where it would best satisfy their need to know with the providers' ability to prepare the practice for the transition. In addition, the new physician knew the retirement timeline and game plan from the day he accepted the job offer, and no alterations were made to the timeline unless they were first cleared by both physicians.

2) Communication. Although it's common for practices to make staffing "announcements," a top-down approach to staffing decisions often leads to resentment. So rather than "dictate" a staffing move, practices should instead generate buy-in through clear communication that starts with the physicians involved. In the RWJ example, practice administrators worked with the retiring and new physician--as well as practice staff--to control when and how they wanted to share the message with patients.

Keep in mind that staff satisfaction is an important factor too; they should have input into decisions that affect the well-being of the practice. Thus, RWJ staff members were involved in the physician interview process and were asked to help plan the transition. When patients saw that practice staff embraced the change, they were satisfied as well. 

3) Fairness. Productivity-based compensation can be a sticking point as new physicians ramp up their caseloads and departing doctors wind them down. So in the spirit of fairness, practices should ensure that departing physicians are not penalized for their gradual productivity decrease, and that new physicians are not expected to assume full risk immediately.

When possible, the luxury of time can help ease the productivity challenge. Although he waited several months to inform his patients, the retiring RWJ physician discussed his departure with practice administration over a year in advance. They negotiated a compensation plan that allowed six months at 100 percent of prior base, three months at 60 percent of base, and three months at 30 percent of base. At the same time, the new provider's compensation package was crafted to provide protection from risk during the transition, but also to reward for successful productivity retention and practice growth.

Satisfaction in the face of change
Through the combination of transparency, communication and fairness, RWJ Physician Enterprise not only kept patients happy in a time of changeover, it actually improved patient satisfaction and productivity. The practice's annual work Relative Value Units (wRVUs) jumped by five percent, and overall patient satisfaction rose from 98 percent to 99 percent. The percentage of patients who indicated they would recommend the practice also increased from 89 percent to 93 percent.

Not every transition fits the RWJ scenario, of course. In cases where physicians leave involuntarily because of non-performance, for instance, the process may have to be much faster. Nevertheless, patients should be given as much notice of the change as possible, and the rest of the physicians in the practice should be involved in planning the future.

The departure of a physician can be an unsettling time for a practice, but it doesn't have to mean decreased patient satisfaction or retention. By giving patients -- and staff -- full insight into an equitable and collaborative transition plan, practices can keep patients happy even when well-respected physicians depart.  

Donald Callahan is the director of operations at the Robert Wood Johnson Physician Enterprise; Randall Shulkin is an Executive Consultant with Culbert Healthcare Solutions.