I need two copies. One for my and one for my friend. Total 6 pages. It’s 3 Pages each. I attached the articles. You can choose any of the articles but choose separate articles. Read the Instruction what you required to do. 

Due in 12 hour.

HCA 502 ARTICLE APPLICATION PROJECT – SPRING 2020 (online)

As you know the articles for this course are broken down into 6 parts (topical areas). The main purpose of this assignment is to have you use some of these articles for various HR initiatives that are relevant to your current or former workplace. To accomplish this goal you need to do the following:

1) For each of the 6 parts identify ONE article that you believe is relevant to an organization that you work (or have worked) for. Please note you
must select one article per part
. You cannot skip one part and do two articles from another part. By the end of this course you will have selected a total of SIX articles for this assignment.

2) For each selected article your first paragraph or two will be a summary (about 5 or 6 sentences) of that article. Label this section:
PART 1

: SUMMARY
. Make sure you put the title of the article above this section.

3)

The next section will be a brief description of a company you work at (or have worked at) and a problem that this company has (or had) that relates to the article you selected above. For example, your company may have had a problem with: high turnover in a given job, poor employee morale in a certain department, weak customer satisfaction, sexual harassment claims, etc. This section should also be a paragraph or two. Label this section:
PART 2: PROBLEM
.

4) The third section will be a description of a HR initiative (e.g., new policy, revised procedure, additional benefit regarding…) that is relevant to the selected article and the situation you described above in part two. In this paragraph please indicate why this initiative will address the problem/issue you described in part 2. Label this section:
PART 3: HR INITIATIVE
.

5) In the fourth section identify the main implementation challenge you anticipate to your HR initiative. For example will your initiative cost the company a significant amount money? Do you expect resistance to your initiative from any particular individual or group? If yes, why? How much time might it take to get people on board with your idea or to get your idea up and running? Will there be any structural changes needed to the company (e.g., division of labor, supervisory changes, revisions to labor agreements)? Label this section:
PART 4: IMPLEMENTATION CHALLENGE
.

6) The final section should describe how you would evaluate your initiative. What criteria will be looked at to see if your initiative was effective? How much time after implementation should this data be collected? Who should do this assessment? Label this section:
PART 5: EVALUATION
.

In summary, you are writing five sections on each of the 6 articles you select. Each article analysis should not exceed three-spaced pages. Each article analysis will be scored based on the scoring system below:

Scoring Guide (20% for each section)

Part 1: Article Summary

In 3 or 4 sentences the student correctly and clearly summarizes the key points in the chosen article. Make sure the exact title of the article and the author(s) is identified in the first sentence or in the heading above this section.

Part 2: Problem section

In a paragraph or two the student briefly describes their current or former company. Then the student describes a problem or issue this company is having that relates to the article in part 1. The student’s writing is clear, complete, and professional.

Part 3: HR initiative section

The student comes up with a HR initiative that addresses the problem described in part 2. The student’s writing is clear, complete, and professional.

Part 4: Implementation challenge section

The student identifies a major implementation challenge associated with his/her initiative described in part 3. The student’s writing is clear, complete, and professional.

Part 5: Evaluation section

The student describes how he/she would evaluate the success of his/her initiative. The criteria that will be used and when the data will be collected is also described in this section. The student’s writing is clear, complete, and professional.

Please make sure you
use these headings in your paper
so it’s clear to me when one section ends and the next one begins.

https://moodle.kings.edu/pluginfile.php/393888/mod_resource/content/3/hiring%20a%20coder

https://moodle.kings.edu/pluginfile.php/393889/mod_resource/content/3/hiring%20and%20orientation

https://moodle.kings.edu/pluginfile.php/393890/mod_resource/content/3/hiring%20a%20CMO

https://moodle.kings.edu/pluginfile.php/393892/mod_resource/content/4/locum%20tenens

https://www.eeoc.gov/eeoc/newsroom/release/10-2-18c.cfm

https://www.eeoc.gov/eeoc/newsroom/release/10-22-19.cfm

https://www.eeoc.gov/eeoc/newsroom/release/11-19-18.cfm

week 2

OCTOBER 2018 ∣ Urology Times ∣ 39

CODING / Business

KIMBERLY CLARK

Ms. Clark is associate editor for Urology Times sister brands

Medical Economics and Physicians Practice. This article was

originally published by Physicians Practice.

I
naccurate coding remains a main cause of
lost revenue for a medical practice, high-
lighting the value of an on-staff profession-
al coder.

Skilled coders are in high demand, so recruit-
ing and retaining the right candidate presents a
challenge. The unemployment rate for coders
saw a slight decrease from 6.6% in 2016 to 5.9%
in 2017, according to the 2017 Salary Survey of
nearly 13,000 respondents conducted by AAPC
(formerly known as the American Academy of
Professional Coders). However, the average salary
for all employed respondents grew 6% to $52,648,
meaning employers will likely need to pay more
to keep or attract coding talent.

“With the unemployment rate [for coders] so
low, the job market for employers is more com-
petitive,” said Raemarie Jimenez, CPC, vice pres-
ident of membership and certification solutions
at AAPC in Salt Lake City. “You are competing
with other practices and other opportunities
where [coders] have more options.”

Your current staff often can be the best source
for new coding talent. “One thing you should look
at is helping an internal person who you want to
retain get those [coding] skills. Invest in [his or
her] training,” said Laurie Morgan, MBA, part-
ner and senior consultant at Capko & Morgan, a
medical practice management consulting group
based in California. “It’s not always that easy to
find ways to give people career paths inside of a
practice. This is one area where you really have
an opportunity to do that.”

But if you lack that opportunity, you will need
to look externally and not only attract the most
qualified candidates but also provide a competi-
tive employment offer. Here are some tips to help
ensure that you choose the right coder for your
practice, and that the coder chooses you back.

Determine your coding needs

Because a coder can contribute at multiple stages
during the revenue cycle, defining the coder’s role
and responsibilities is the first step of the hiring
process, Morgan says.

Morgan recommends practice leaders—which
can include the practice manager or administra-
tor, the practice owners, and the manager of the
billing team—meet to align on what the coding
job will entail and develop a comprehensive job
description.

“[They must decide] if this person is working
only on coding or on billing as well,” she said.

A coder by trade, Astara Crews, CHC, CPC,
director of regulatory affairs at ENT & Allergy
Associates LLP, a group practice with offices in
New Jersey and New York, says that the coder’s
role often depends on a practice’s size and revenue
because smaller practices tend to not have the
business need and/or resources to support distinct
coding and billing roles.

But having a joint biller and coder role can be
valuable to a practice.

“Having [a biller] who is aware of the cod-
ing rules adds that extra layer of assurance that
[claims] are not going out fraudulently,” Crews
said.

Describe your ideal candidate

In order to screen the best candidates, identify the
qualifications and experience a coder must have
to be successful in the coding position in addition
to the soft skills needed to work effectively with
other staff members.

Jimenez recommends limiting your scope to
candidates with professional certification.

“[Practices] are not giving enough weight to

certifications. They will hire someone just to
sit in that seat, thinking that [coding] is an easy
job, and they don’t get well-trained individuals.
If they’re certified, you know they’ve passed an
exam showing competency.”

Keep in mind that individuals could have a
compelling case for why they would excel in the
position, even if their backgrounds do not exactly
match the job requirements, Morgan says.

For example, do not discount candidates sim-
ply because their certifications are not specific to
your practice’s setting or specialty.

“If the candidate learned how to do coding suc-
cessfully for several different specialties in the
past, then that may be an indication that they will
be very adept at learning a new specialty,” she said.

Furthermore, coders who are new to the indus-
try can become valuable assets if training and
supervision are available.

“I used to work with coding externs who
were completing a course and getting certified,”
Jimenez said. “For me, it was beneficial [to host
them] because they came with no bad habits, so I
was able to teach them the way I wanted it done
in our particular circumstance.”

Create a compelling job ad

Pique applicants’ interest by posting a job ad that
not only includes key information about the job
but also demonstrates why applicants should want
to work at your practice.

Posting the job description alone will not
be alluring to applicants because it will be too
bureaucratic, Morgan says.

“You need to convey your practice’s personali-
ty, history, and mission. Why is your practice an
exciting place to work? Is your practice a dynamic
place to work? A compassionate place to work?”

Also consider how digestible your job ad will
be for a reader, Morgan says. For example, avoid
large blocks of text and the use of obscure or
vague terms to describe the job duties. Use bul-
let points, shorter phrases, and clear language.

Recruit from the right places

Engage in both active and passive recruitment to
generate a strong candidate pool.

To reach candidates actively searching for a

Hiring a coder: How to recruit
and retain the right candidate
Follow these tips in order to land the ideal hire for your practice

“[Practices] are not
giving enough weight to
certifications… If they’re
certified, you know they’ve
passed an exam showing
competency.”

RAEMARIE JIMENEZ, CPC

VICE PRESIDENT OF MEMBERSHIP AND CERTIFICATION

SOLUTIONS, AAPC

Please see CODER, page 40

40 ∣ Urology Times ∣ OCTOBER 2018

Business / MALPRACTICE

job, post your job ad on general job sites, your
practice’s website, and social media accounts as
well as job boards specific to coders, such as the
AAPC health care job database, Morgan says.
The American Health Information Manage-
ment Association (AHIMA) also offers a service
called AHIMA’s Career Assist that can connect
employers with coders.

Social media provides an opportunity to con-
nect with individuals who may not be looking for
a job but have the skill set you need. On LinkedIn,
individuals often list credentials after their name,
so you can identify certified coders and reach out
to them, Morgan says.

Your current employees are an additional source
for new referrals. However, smaller practices may
need to be more cautious. While you should let
your staff members know the position is open and
invite them to nominate candidates, “you want to
have some boundaries,” said Morgan, who thinks
paid referral programs are especially risky for small
practices. “You don’t necessarily want relatives
working with one another. If you have a very small
team, having people who know each other too well
from outside of work can introduce drama.”

Ask the right questions

Use interviews to ascertain if candidates possess
the necessary coding acumen as well as the soft
skills to be successful in the coding position.

Brief phone interviews may prove useful if

the size of the candidate pool is substantial.
Conduct these calls with applicants to learn
more about them, their background, and level
of interest in the position, Morgan says, noting
that open-ended questions that allow applicants
to talk about their skills and interests are best
(Why are you looking for a job? What attract-
ed you to apply to this position? Why is this
position a good fit for you?). If an applicant still
seems like a good match after the phone inter-
view, then bring him or her in to interview with
the manager and other relevant staff members,
she adds.

Jimenez suggests asking candidates about previ-
ous coding jobs they’ve had and what roles they’ve
performed, their productivity and accuracy rates
when selecting codes, and the results of any audits.
She also recommends requiring an initial assess-
ment to test candidates’ ability to complete the
type of coding expected by the position.

It’s also important to pose behavioral or situa-
tional questions to determine how well a candidate
is able to work with others. While some coders
may spend the majority of their time poring over
charts in the back office, a practice really should
look for a coder who can communicate reasoning
behind a code selection, navigate through dis-
agreements with a physician or other staff mem-
bers, or simply share new findings, Crews says.

“As a coder, the primary function is not only
to code a service but also to interact with [the
team] as part of education,” Crews said, noting
that a coder needs have interpersonal skills and
be adaptable to change.

As a competitive salary typically is the main

draw to an open position, consider setting the
salary for your coding position in line with what
other practices provide.

The AAPC salary survey calculator is a useful
resource for practices that want to judge if their
compensation offerings are competitive, Jimenez
says (bit.ly/AAPCsalarycalculator). The calculator
allows employers to search the average state salary
by certification, education level, and health care
work experience.

But if your practice cannot afford to match
what other practices pay, additional benefits such
as a 401(k), vacation days, and sick leave can make
your position more attractive. Coding also lends
itself to remote work, which Jimenez says “can
be a significant financial saver for the individual
and employer” as well as offer the individual more
flexibility and work-life balance.

Crews suggests providing career growth
opportunities and support to attract candidates.
Think about covering the cost of the coder’s
continuing education units that are required
to maintain certifications, membership dues to
professional organizations, or providing finan-
cial support and time off to attend professional
conferences, she says.

“To be competitive, I think a practice should
look at the individual as not just a body to fill a
seat or a body to fill a coding position… but look
at the individual as a whole and try to recruit indi-
viduals based on what they have to offer,” Crews
said, stressing that “not-so-great salary” can be
offset with opportunities for professional growth
and development to successfully attract coding
talent. UT

Malpractice insurance: Considerations
when buying a policy
Hiring a carrier based on price alone can have consequences, expert warns

JAMES F. SWEENEY

Mr. Sweeney is a contributor to Urology Times sister brand

Medical Economics, where this article was originally published.

M
edical malpractice insurance is
one of the greatest expenses phy-
sicians face during their careers.
But knowing what to look for in

a policy is a mystery for many physicians, as well
as a time-consuming chore that rarely gets the
attention it deserves. And buying the wrong type

or incorrect amount of insurance—or buying it
from the wrong carrier—can be extremely costly.

Physicians who take the time to understand
how to buy malpractice insurance will not only
save money, but ensure that they’ve got the right
type and amount of liability coverage.

Types of insurance

Policies typically cover expenses incurred while
defending and settling malpractice suits. These
can include attorney fees, medical damages, arbi-

tration and settlement costs, court costs, and
punitive and compensatory damages. Liabilities
incurred from criminal acts or sexual misconduct
usually are not covered.

There are two basic types of malpractice insur-
ance: claims-made and occurrence. A claims-
made policy provides coverage only if the policy
is in effect both when the incident took place and
when a lawsuit is filed. Occurrence policies cover
any claim for an event that took place during the

C O D E R
continued from page 39

Please see INSURANCE, page 41

https://bit.ly/AAPCsalarycalculator

Copyright of Urology Times is the property of Advanstar Communications Inc. and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder’s express written permission. However, users may print, download, or email
articles for individual use.

42 / Journal of AHIMA September 19

T
practice guidelines for managing health information

PRACTICE BRIEF

THE GOAL OF a strong clinical documentation improvement
(CDI) program is to validate that the documentation supports the
highest level of specificity based on the clinical evidence provided.
An effective CDI program begins with proper recruitment, careful
selection, and adequate orientation of CDI professionals, whose
purpose is to initiate concurrent and/or retrospective reviews of
the health record for clear, consistent, complete, precise, reliable,
legible, and timely documentation. CDI reviews can occur in both
inpatient and outpatient settings and should include the level of
documentation necessary to accurately assign the appropriate
International Classification of Diseases, tenth edition, Clinical
Modification and Procedural Coding System (ICD-10-CM/PCS)
and Current Procedural Terminology (CPT) codes.

These efforts result in greater integrity of the documentation,
which supports appropriate reimbursement and accurate quality
scores. Defining the goals of the CDI program, as well as the pur-
pose of the CDI professional’s role within the organization, will
assist providers in developing a process that results in the con-
sistent hiring of quality staff.

Individuals qualified to serve as a CDI professional include,
but are not limited to:

� Health information management (HIM) professionals
� Coding professionals
� Physicians
� Nurses
� Other professionals with a clinical and/or coding background

In this diverse population of possible candidates, having an
appropriate knowledge base is one piece of the overall process
and does not guarantee success. This Practice Brief will provide
guidelines for the ideal successful recruitment, selection, and
orientation processes for CDI professionals in the development
of a sustainable and high-quality CDI program.

Recruitment Best Practices
Researchers agree that the best way to recruit top talent is to cre-
ate a culture that promotes a positive work environment,1 which
leads to greater job satisfaction and employee retention.2 Creating
a culture in which staff members are treated with respect and
consideration while compensated with a competitive salary
and benefits package will help your organization stand out as a
place where people want to work. 3 A positive setting, salaries, and
benefits are significant components of a job search for new hires so

it’s important to create a workplace where top talent would want
to work.4

Managers can seek opportunities to involve CDI profession-
als in committees and/or meetings that promote CDI activi-
ties and physician education. Another opportunity would be
to leverage CDI professionals as contributing writers for the CDI
newsletter. Newsletters can be created specifically for CDI topics
and dispersed throughout the organization. This helps promote the
benefits of having a CDI program and identify the current docu-
mentation topics impacting the organization.5 Developing increas-
ingly influential roles for existing staff may assist in recruiting for
the organization as current staff communicate the value of their
own roles within the organization and demonstrate the rewarding
nature of the program. Opportunities to learn and grow profession-
ally will cascade from current employees to peers who may be
seeking to make a job change. These individuals can also add
value to the interview process, allowing them to more easily
identify applicants who fit the team and who will enhance the
selection process.

Finding the right individuals does not end with acknowledging
experience. Successful CDI programs also consider cultural com-
patibility, leadership skills, effective communication, and intel-
lectual ability to excel in a complex healthcare environment. The
recruitment process can take several months and should not be
rushed or neglected.

Recruitment often goes beyond traditional candidate search-
es, job hiring sites, and word-of-mouth recommendations. Fur-
thermore, many organizations lack the infrastructure and process-
es for recruiting CDI professionals because of a focus on internal
talent development. Internal talent development is always a
preferred method for growth and development, but it is not the
only recruitment option available.

Recruiting Internally
There are advantages to recruiting internally—hiring from within
the organization. These candidates are already ingrained in the or-
ganizational culture and are knowledgeable of the organizational
goals and needs as well as the focus of the CDI program. Internal
candidates often approach the new positions with positive out-
looks and knowledge of how they can make a difference.

When recruiting internally for CDI positions, there are many po-
tential candidate streams. Internal candidates can be located with-
in the HIM, coding, quality, nursing, or case management de-

Recruitment, Selection, and Orientation for
CDI Professionals

Editor’s Note: This Practice Brief supersedes the July 2013 Practice Brief titled “Recruitment, Selection, and Orientation for CDI Specialists.”

Journal of AHIMA September 19 / 43

Practice Brief

partments. These candidates often require an additional skill or
knowledge development if the CDI position is outside their current
scope. For example, if a unit coordinator has completed their asso-
ciate-level degree, is credentialed as a registered health informa-
tion technician (RHIT), and demonstrates the skills to advance
into a CDI position, they still may need additional training on
the specifics of CDI.

There are also potential disadvantages to recruiting internal can-
didates, including the promotion of organizational cultural com-
placency, restricting the candidate pool, perpetuating poor per-
formers, and constraining creative ideas.

Recruiting Externally
Many organizations utilize external recruitment as a balance
to internal recruitment activities. Recruiting external candidates
facilitates new ideas and brings fresh candidates into the organiza-
tion. It allows the organization to choose from a larger pool of
applicants. It also can lead to a more experienced and diverse
workforce, and can decrease training costs because the candi-
date comes into the organization with the skills and knowledge
required for the job with little or no development needed.

For example, if an external candidate holding the registered
health information administrator (RHIA), certified coding spe-
cialist (CCS), and certified documentation improvement prac-
titioner (CDIP) credentials applies for a position in the CDI
department, they will come into the organization with specific,
required knowledge. For example, a candidate who is a registered
nurse (RN) may already hold a CCS credential and have case
management experience.

Organizations should also consider the disadvantages of hiring
externally, as it is much more of an unknown for the organization.
Even with a solid recruitment effort, selection pool, and orienta-
tion process, new candidates are still relatively unknown. It can be
difficult to identify how they will fit with other staff members and
react in certain situations. External candidates—for example, an
experienced CDI professional—may find it difficult to adapt to a
new process. Adding in questions during the recruitment phase
regarding their comfort level with changes can help identify
those individuals who may struggle with the program’s struc-
ture. Candidate misplacements can cost the organization time
and financial resources.

Selecting the Right Employee
Prior to selecting employees for new positions, the organization
must decide if it is open to recruiting entry-level professionals
without CDI experience or if it prefers professionals with little-
to-extensive CDI experience. It is also essential to define the for-
mat of the program—for example, in-house/onsite reviews vs.
offsite/remote reviews. There has been an upward trend in hy-
brid programs which are attractive to many candidates and al-
low for flexibility, increase employee satisfaction, and increase
productivity. Defining these parameters helps filter the candi-
date pool and streamlines the hiring process.

CDI is quickly expanding beyond the adult inpatient scope
to include outpatient, psychiatry, pediatrics, rehab, and same-
day surgeries/ambulatory care. This expansion is leading to the

need for specialized reviews and a mix of CDI staff who can ca-
ter to this growing need.

Recruiters often run into issues like information falsification
on resumes. When this occurs, the candidate may appear quali-
fied on paper but in reality, isn’t able to offer the expertise re-
quired to be successful in the CDI role. Recruiting and selecting
the right fit for any CDI program requires a careful and thought-
ful analysis of each prospective candidate to ensure the candi-
date can perform at the level required for the position.

Generally, to be successful in a CDI role, candidates must have
the clinical knowledge required to review a health record, the
ability to recognize deficiencies or gaps in documentation, and
strong critical/analytical thinking skills. Effective communica-
tion skills are of the utmost importance as well, because the
person in this role needs to be able to confidently converse with
providers and other team members. A candidate that possesses
these qualities would be ideal for a CDI program.

Optimal candidate selection has the potential to decrease em-
ployee turnover. Ultimately, a strong CDI professional can provide
a positive influence on the organization’s culture and pro

gram

effectiveness. In addition, successful selection will save the or-
ganization time and money during the orientation and training
process.

Throughout the process of hiring a new employee, remember to
carefully assess the applicant’s fit with both the team and physi-
cians. Utilizing experience and intellectual capabilities alone will not
guarantee an appropriate hire. The ability to seamlessly interact with
the team and communicate effectively with physicians is a strong in-
dication of how well the CDI professional will integrate into the or-
ganization. To that end, it is important to ensure that final hiring
decisions remain under the hiring manager’s authority.

Candidates that are a good organizational fit may be extremely
difficult to find so staying flexible is important when making hir-
ing decisions. Still, creating the right culture, maximizing the best
workers, and staying involved during the hiring process may not
fill every open position. In some instances, the right choice may
not be the person with long-term experience, but the person that
fits best with the team and culture of the organization. This may
mean hiring someone with less experience and committing to pro-
viding the necessary training and education to develop the skill set.

Preliminary Selection
Selection begins with a preliminary application review and screen-
ing interview, which is usually conducted over the phone. This pro-
cess eliminates candidates who do not meet the minimum eligibil-
ity criteria established by the organization. This process should
include a thorough review of the candidate’s application or re-
sume, skill set, academic background, certifications, and work
history.

Depending on the goals of the CDI program—whether looking to
hire trainees or experienced professionals—evaluation of a poten-
tial candidate may include identifying healthcare experience, pri-
or experience in coding or other related work, and possession of
the CDIP/CCDS credential. Establishing these criteria will help
narrow down the pool of candidates.

The next step in the selection process may include specific

44 / Journal of AHIMA September 19

Practice Brief

questions that further narrow down the pool of candidates. This
may be completed by either human resources staff or the hiring
manager. These questions may focus on items such as:

� Gaps in the application: “Can you tell me why the educa-
tion section is blank?”

� Additional qualifications: “Do you have any additional certi-
fications or qualifications you would like me to know about?”

� Questions about experience: “Your application indicates two
years of healthcare experience; can you explain other expe-
rience that may be relevant?”

� Adaptability: “How comfortable are you with change? Can
you give me an example of a time when you had to learn
a new process and how well you adapted to this change?”

Interview
Interviews are conducted after candidates have been chosen through
the preliminary selection process. Interviews can take place on site
or via Skype or other video conference options for candidates who
cannot come to the physical location, allowing for flexibility to en-
courage prospective hires. The interview format can be a one-on-one
discussion with the hiring manager, a team interview, or a combi-
nation of the two. The interview process should be defined in a
procedure indicating who will be included and which standard
questions will be asked. While the interview format and poten-
tial questions should provide a foundation to gain information
from each candidate, the format should also be flexible, allowing
members of the interview team to introduce new questions based
on the interviewee’s responses. To create a flexible interview at-
mosphere that is most conducive to candidates, it is important
to include key stakeholders in the interview process, including:

� Hiring manager
� CDI director/manager
� Members of the CDI team
� Coding professionals
� Nursing specialists
� Physician advisor

The interview process can be intimidating for candidates so
it is important to make an effort to reduce their anxiety. Allow
space for the candidate to talk about their personal experienc-
es, which can help the hiring manager gauge the candidate in
an informal manner. It can also help the interviewer generate
questions based on the information offered by the candidate.

It is very important for interviewers to avoid distractions like
checking notes to read questions. This approach takes the sponta-
neity out of the interview and may create a restrictive atmosphere
that doesn’t allow candidates to better express themselves.

Questions can be asked about candidates’ previous CDI expe-
rience, with the potential to identify and articulate connections
between their experience and the processes in place at the in-
terviewer’s organization.

Plan an Organizational Orientation
Organizational Orientation
To ensure success and sustainability, a successful CDI program
requires structure. Organizations should address staffing and

management of the CDI program within the current human re-
source dynamics of the organization. A comprehensive depart-
ment-specific training program with clear objectives should be
incorporated into an overall training program for the CDI pro-
fessional. In addition to organizational training, the CDI profes-
sional should have a plan for training specifically geared toward
educating the CDI professional.

CDI Program Orientation
It is important for organizations to ensure CDI staff are “thor-
oughly trained in the principles of high-quality clinical docu-
mentation as well as the review of patient records to identify
possible deficiencies in documentation.”6 A collaborative train-
ing session where nurses, doctors, allied health professionals,
and seasoned CDI professionals are present is highly recom-
mended in order to give the new CDI professional a well-round-
ed view of the program.

Training for CDI staff should include three parts:7
� Training in the theory of high-quality clinical documen-

tation
� Training in the physician query process
� Training on how to collect and analyze data for the pro-

gram

Training in the theory of high-quality clinical documentation
Training in the theory of high-quality clinical documentation
should include the fundamentals of coding and reimburse-
ment, and should cover how high-quality clinical documen-
tation affects the reimbursement process. CDI staff should be
knowledgeable of current coding guidelines in order to deter-
mine if documentation provided in the health record is suf-
ficient to appropriately identify the severity of illness and risk
of mortality of the patient being treated. The CDI professional
should also be trained on the basics of quality indicators and
how inadequate documentation can affect the organization’s
quality scores.

Diagnosis Related Group (DRG) Training
An important aspect of CDI training and education is un-
derstanding the impact of severity diagnoses and its relation
to Diagnosis Related Groups. Some organizations provide
a specific list of diagnoses to be queried by the CDI profes-
sional as ongoing initiatives. This list is usually comprised
of commonly occurring severity diagnoses—comorbid con-
ditions or major comorbid conditions—while other organi-
zations educate their associates on query opportunities per
major diagnostic categories. The final group of CDI programs
educate CDI professionals on DRGs and coding concepts.
For further guidance on educating CDI professionals on
understanding DRGs and coding guidelines and practices,
please refer to Appendix A, included in the online version of
this Practice Brief.

Training in the Physician Query Process
Training in the physician query process is a critical component
of the clinical documentation improvement process. CDI pro-

Journal of AHIMA September 19 / 45

Practice Brief

fessionals should be trained on appropriate ways to review a
health record to identify documentation deficiencies, when a
physician query may be needed, and the parameters for con-
structing a compliant query. According to Hess, “The record re-
view process should include addressing all components of the
patient record as possible sources for query opportunities.”8

In general, physician queries should be constructed to clarify
conflicting, ambiguous, or incomplete information, obtain clin-
ically relevant information not previously addressed within the
current documentation, and clarify present-on-admission indi-
cator assignments.9

For more information on constructing a compliant query,
reference AHIMA’s 2019 Practice Brief titled “Guidelines for
Achieving a Compliant Query Practice” and the AHIMA Inpa-
tient Query Toolkit. Both are available online in AHIMA’s HIM
Body of Knowledge.

Training On Data Collection and Analysis
CDI professionals should be trained on how to collect data, how
to analyze the data collected, how to enter information into the
program database, and how to formulate and organize the data
for a physician query.

The collection of program data should include the identifica-
tion of:10

� All cases reviewed
� The number of cases with queries
� The nature of the query
� The physician’s response to the query

Post-Training Evaluation
After initial training of CDI staff, a post-training evaluation
should be conducted to ensure the appropriate transfer of
knowledge has occurred and the CDI professional has a strong
grasp on key concepts. Post-training evaluation can also include
a “shadowing” program in which more experienced CDI profes-
sionals within the organization shadow newer staff in order to
ensure an effective training process.

Ongoing Education for CDI staff
Ongoing education for CDI staff is crucial to the ultimate suc-
cess of the CDI program. Ongoing education can include ad-
ditional coursework to obtain credentials such as the Certified
Documentation Improvement Practitioner (CDIP). Ongoing
training can also include choosing specific cases for review
within the CDI group as a learning opportunity to help all staff
continue to develop skills.

For more on current and future trends in CDI, please see the
extended online-only version of this Practice Brief, available in
AHIMA’s HIM Body of Knowledge. ¢

Notes
1. Seppälä, Emma and Kim Cameron. “Proof That Positive

Work Cultures Are More Productive.” Harvard Business Re-
view. December 1, 2015. https://hbr.org/2015/12/proof-
that-positive-work-cultures-are-more-productive.

2. Ibid.

3. Adler, Howard and Richard Ghiselli. “The Importance of
Compensation and Benefits on University Students’ Per-
ception of Organization As Potential Employers.” Journal of
Management and Strategy 6 (1): 2015. http://www.sciedu.
ca/journal/index.php/jms/article/viewFile/6200/3713.

4. Ibid.
5. AHIMA. Clinical Documentation Improvement Toolkit.

Chicago, IL: AHIMA Press, 2016. http://bok.ahima.org/
PdfView?oid=301829.

6. Hess, Pamela Carroll. Clinical Documentation Improve-
ment: Principles and Practices. Chicago, IL: AHIMA Press,
2015. p. 157.

7. Ibid.
8. Ibid, p. 162.
9. AHIMA. “Guidelines for Achieving a Compliant Query

Practice (2019 Update).” Journal of AHIMA 90, no. 4 (April
2019): 36-41.http://bok.ahima.org/doc?oid=302674.

10. Hess, Pamela Carroll. Clinical Documentation Improve-
ment: Principles and Practices.

Prepared By
Tammy Combs, RN, MSN, CDIP, CCS, CCDS
Jennifer Daly, RN, MSN, CDIP, CCDS
Okemena Ewoterai, CDIP, CCS, CCDS
Chinedum Mogbo, MBBS, MsHIM, RHIA, CCDS, CDIP, CCS
Daphne I. Willis, MSA, RHIA, CPHQ, CDIP

Prepared By (2013)
Gloryanne Bryant, RHIA, CCS, CDIP, CCDS
Sheila Burgess, RHIA, CDIP, RN, HIT PRO-CP
Martin Conroy, RHIA
Nancy Lero, RN, BSN, CCDS, CDIP, CBCS
Ranae Race, RHIT
Carla Serrano, RHIT, CDIP, CCS, CCDS, CPC
Sheryl Theno, RHIT, CDIP
Lou Ann Wiedemann, MS, RHIA, CDIP, CPEHR, FAHIMA

Acknowledgements
Katherine Kozlowski, RHIA, CCS, CDIP, RMCC
Patty Buttner, MBA/HCM, RHIA, CDIP, CHDA, CPHI, CCS,

CICA
Donna Rugg, RHIT, CDIP, CCS-P, CICA, CCS
Newelle Horn
Robyn Stambaugh, MS, RHIA
Sandy Bundenthal, RHIA, CCS

Read More
Appendices Available Online
http://bok.ahima.org
There are four appendices available in the online version of

this Practice Brief, available in AHIMA’s HIM Body of Knowledge:
• Appendix A: Key Points in Developing a CDI Program
• Appendix B: Orientation for New CDI Professionals
• Appendix C: Ongoing Education Plan
• Appendix D: Qualitative Productivity Tool Example

Copyright of Journal of AHIMA is the property of American Health Information Management
Association and its content may not be copied or emailed to multiple sites or posted to a
listserv without the copyright holder’s express written permission. However, users may print,
download, or email articles for individual use.

www.podiatrym.com JUNE/JULY 2018 | PODIATRY MANAGEMENT

125

caused by physician turnover and to
reduce stress on physicians during
peak usage times, which also can lead
to turnover.
In addition, vacation time of three
to four weeks annually is a standard
benefit in the employed physician
model, a departure from the tradi-
tional independent model, in which
physician practice owners were less
willing or able to take vacations. This
has further contributed to the rising
use of locum tenens physicians, who
provide coverage for physicians who
are on vacation or who are absent
due to continuing medical education

(CME) requirements or illness.
Although physicians still can con-
tract directly to arrange locum tenens
assignments, most locum tenens po-
sitions today are filled through tempo-
rary staffing companies. These com-
panies identify candidates, pay them
a daily rate, arrange and pay for their
travel to and from assignments, and
pay for their malpractice insurance. In
return, physician practices and other
providers pay the agency a daily rate
that fluctuates based on the specialty
of the locum tenens physician. Rates
run from approximately $1,000 for
a primary care physician to approxi-
mately $3,500 for a sub specialist such
as a pediatric surgeon.

Reprinted with Permission from
The Journal of Medical Practice Man-
agement, May/Jun 2017, pgs 407-410,
copyright 2017 Greenbranch Pub-
lishing, LLC, (800) 933-3711, www.
greenbranch.com

T
he practice of one physi-
cian filling in for another
who is temporarily absent
from his or her practice
is time-honored in the

medical profession. Known as locum
tenens (Latin for “to take the place
of”), temporary physicians, as a pro-
fessional courtesy, have traditionally
filled in for colleagues who are ill,
traveling, or otherwise away from
their practices.
It was not until the 1970s that the
use of locum tenens physicians ex-
panded from limited, ad hoc assign-
ments arranged by physicians them-
selves to a more broad-based and
systematic component of healthcare
staffing. Government grants allotted
to make physicians available in med-
ically underserved areas ushered in
the modern era of locum tenens staff-
ing, which now is a multibillion-dol-
lar industry.
Today, physician practices, hos-
pitals, and many other healthcare
providers use locum tenens physi-
cians for a variety of reasons, while
at the same time a growing number
of physicians are choosing to work
on a locum tenens basis. Staff Care’s
2017 Survey of Temporary Physician
Staffing Trends indicates that 94% of
hospitals, medical groups, and other
providers used locum tenens phy-
sicians at least once in the last 12
months. The survey estimates that

about 48,000 physicians worked on a
locum tenens basis in 2016, up from
about 26,000 in 2002.
According to the survey, the fol-
lowing are the primary reasons why
healthcare facilities use locum tenens
physicians:
• To fill an empty position until a
permanent physician is found;
• To fill in for staff who have left
(i.e., turnover);
• To fill in for vacationing, ill, or
otherwise temporarily absent physicians;
• To fill in during peak usage
times; and
• To meet rising patient demand.

In an era of physician shortages,
many physician practices and other
healthcare providers find it difficult to
fill permanent positions quickly. They
use locum tenens physicians to main-
tain services and revenue until a per-
manent staff member is recruited. The
rise of the employed physician model
also has contributed to the growing
use of locum tenens physicians. Em-
ployed physicians often do not have
the same financial or emotional stake
in their practices that practice owners
do, and therefore can more readily
move from one practice to another.
This has led to an annual physician
turnover rate of 13%, according to the
data firm SK&A. Locum tenens phy-
sicians can be used both to fill gaps

Here are rules on hiring temporary associates.

Locum Tenens Staffing and
Billing Considerations

By Aimee N. Cutter ANd PhilliP miller

STAFFING iSSueS

Today, physician practices, hospitals,
and many other healthcare providers use locum tenens

physicians for a variety of reasons.

Continued on page 126

www.podiatrym.comJUNE/JULY 2018 | PODIATRY MANAGEMENT

126

STAFFING iSSueS

cedure code. The regular physician,
not the substitute physician, receives
any Medicare payment for the service.
Additional information about the
Q6 modifier can be found at the web-
sites for the Railroad Medicare Hub5
and CMS.6

Billing for Long-Term Absences
Vacancies caused by turnover,
the need to fill in while the practice
seeks a permanent physician, long-

term illnesses, and other events often
are longer term and may last for over
60 days. In the case of long-term ab-
sences, billing for locum tenens phy-
sicians also entails using the Q6 mod-
ifier and is subject to the same four
requirements listed earlier.
However, when using locum
tenens physicians for periods longer
than 60 days, it is advisable to incor-
porate the additional steps, require-
ments, and time frames discussed in
the next section.

Find the Right Candidate
Work with your staffing agency to
identify the best candidate(s) for your
locum tenens position. It is imperative
to understand your payer population
and state-specific or payer-specific re-
strictions when sourcing locum tenens
physicians and to communicate your
needs clearly. For example:
• Does your state’s Medicaid pro-
gram require that physicians be ac-
tively enrolled to allow patients to fill
prescriptions under their DEA?
• Do any payers require that the
physicians be Board Certified, either
generally or for a specific specialty?
• Do any payers require that the
physicians be actively registered with
the Council for Affordable Quality
Healthcare?
• Do you have a significant mili-
tary population requiring credential-
ing with Tricare?
Establishing expectations upfront

Cost Comparison
Per diem rates can represent a
considerable investment. Physician
practices should schedule the use of
locum tenens physicians well in ad-
vance of when they will be needed,
to ensure the most favorable rates.
Locum tenens costs also should be
planned for within the overall con-
text of staffing costs at the practice.
A comparison of the daily cost of em-
ploying a family medicine physician
on a permanent basis and the cost of
a using a locum tenens family physi-
cian is instructive.
Assume that for a full-time family
physician, the mean salary is $225,000
per year.1 Add a benefits package worth
$45,6132 and malpractice insurance of
$14,821.3 If you assume a work year of
250 days, the permanent employee’s
daily rate works out to $1,140.4 The
average daily rate of a family physician
locum tenens is $1,350.
This comparison suggests that the
daily cost of employing a permanent
physician and using a locum tenens
physician are relatively similar. How-
ever, permanent physicians represent
more than a cost. They generate rev-
enue for the practice, which locum
tenens physicians do not, unless the
practice is able to bill for their services,
in which case the use of locum tenens
physicians becomes more cost-effec-
tive. The process of locum tenens bill-
ing is outlined in the following section.

Billing for Short-Term Absences
Locum tenens physicians may
be used to fill in for either planned
or unplanned absences. A planned
absence often entails a short-term
staffing gap when a physician is ab-
sent due to vacation, CME, or other
planned event. When locum tenens
physicians are filling in for short-term
absences, practices generally bill for
their services through what is known
as the Healthcare Common Procedure
Coding System (HCPCS) Q6 modifier.
Using the Q6 modifier, a patient’s
regular physician may submit the
claim, and (if assignment is accept-
ed) receive the Part B payment for
covered visit services, including emer-
gency visits and related services, of a
locum tenens physician who is not an

employee of the regular physician and
whose services for patients of the reg-
ular physician are not restricted to the
regular physician’s offices.
Services provided by non-physician
practitioners (e.g., certified registered
nurse anesthetists, nurse practitioners,
physician assistants) may not be billed
under the locum tenens billing reas-
signment exceptions. These provisions
apply only to physicians. Additionally,
the Q6 modifier is not applicable in the

event of a physician’s death or when
a departing physician has terminated
benefits with the group.

Requirements
Services may be submitted under
a locum tenens arrangement if all of
the following criteria are met:
• The regular physician is un-
available to provide the visit services;
• The Medicare beneficiary has
arranged or seeks to receive the visit
services from the regular physician;
• The regular physician pays the
locum tenens for his or her services
on a per diem or similar fee-for-time
basis; or
• The locum tenens physician
does not provide visit services to
Medicare patients over a continuous
period of longer than 60 days (excep-
tions made for military deployment).

Although the Q6 modifier is
specific to Medicare billing, private
payers often have their own similar
arrangements. Medicaid generally fol-
lows the Medicare model of locum
tenens billing; however, policies can
vary, so it is important to understand
the policy in your state.

How to Bill
The regular physician (physician
A) identifies the services as substitute
physician services meeting the require-
ments of this section by entering the
Q6 modifier (service furnished by a
locum tenens physician) after the pro-

Locum tenens costs should be planned
for within the overall context of staffing costs

at the practice.

Locum Tenens (from page 125)

Continued on page 130

www.podiatrym.comJUNE/JULY 2018 | PODIATRY MANAGEMENT

130

STAFFING iSSueS

sider that the steps outlined above
are general guidelines and that nu-
ances may arise depending on prac-
tice location and other factors.

Conclusion
A variety of trends, including a
pervasive physician shortage and
the employed physician model, have
driven the growing use of locum
tenens physicians in medical prac-
tices and other provider settings.
Those practices that plan for their
locum tenens staffing requirements
in advance and are able to bill for
the services of locum tenens physi-
cians will receive the most benefit at
the least cost. PM

References
1 Merritt Hawkins. 2016 Review of
Physician and Advanced Practitioner Re-
cruiting Incentives. June 2016. https://
www.merritthawkins.com/uploadedFiles/
MerrittHawkins/Surveys/MH_Recruiting_
Incentives_2016 .
2 American Medical Group Associa-
tion. 2013 Group Compensation and Fi-
nancial Survey. January 2013.
3 AON Corporation. Hospital and Phy-
sician Professional Liability Benchmark
Report. November 2013.
4 Staff Care. 2016 Survey of Temporary
Physician Staffing Trends. February 2016.
5 Palmetto GBA. Railroad Medicare
Hub. www.palmettogba.com/palmetto/
providers.nsf/DocsCat/Railroad-Medi-
care~8EELHJ3576.
6 Physician Payment Under Locum
Tenens Arrangements—Claims Submit-
ted to Carriers. CMS. https://www.cms.
gov/Regulations-and-Guidance/Guidance/
Manuals/downloads/clm104c01 .

will allow the staffing agency to pro-
vide you with appropriate choices for
coverage and avoid potential denials
when submitting claims.

Understand the Complexities of
The Payer Credentialing Process
Credentialing physicians with
payers often can be an arduous pro-

cess that puts additional strain on
your back-office resources. Lean on
your agency to assist you with facil-
itating the completion of payer ap-
plications to reduce these burdens.
Make it a habit to include the follow-
ing requirements with your facility’s
onboarding packet:
• Provide your agency with cop-
ies of the signature pages for each
payer for the physician to complete,
advising that they will need to be ex-
ecuted in “wet ink.” It is recommend-
ed that you obtain duplicate copies of
each signature page in the event they
are needed down the line.
• Request that your agency pro-
vide copies of the following support
documents required by most payers:
• State medical license (not verifi-
cation);
• DEA number, which must be
registered in the state in which your
facility resides;
• Social Security card. If the card
states “For Work Authorization Only”,
one of the following will be required:
passport; Permanent Resident card; or
work authorization statement.
• Active Government-issued ID;
• Board Certification; and
• Any active provider identifiers
for your state and local payers for
purposes of re-assignment or linkage.

Once these items are collected you
can submit the applications following
the same process you would with any
of your permanent physicians.

Enrollment Timelines
The following list presents a gen-

eral enrollment timeline; this could
vary based on your state’s managing
entities:

Medicare
• New enrollments: up to 90
days; and
• Re-assignments: up to 45 days.
• In most cases Medicare will grant
an effective date up to 30 days prior to
receipt of the enrollment application.

Medicaid
• The enrollment timeframe is
state-specific and could be anywhere
from one week to six months.
• Most states will not allow you
to submit a Medicaid application
until the Medicare enrollment pro-
cess is complete. Additionally, Med-
icaid HMO applications cannot be
submitted until traditional Medicaid
enrollment is complete.
• In most cases Medicaid will
grant the same effective date award-
ed by Medicare. If you receive a later
effective date, it is recommended
that you appeal the decision with the
managing entity.

Commercial
• All requirements are deter-
mined by the contract between your
group and the payer.
• Enrollment timeframes can be
anywhere from 90 to 180 days.
• Commercial payers rarely, if ever,
provide a retroactive effective date.

Billing Claims For Locum Tenens
The process of billing a claim for
a locum tenens who is enrolled in
your group is the same as doing so
for a permanent physician. In the
event that you have an immediate
need for coverage and the locum ten-
ens needs to provide services to pa-
tients during the enrollment process,
it is recommended that you hold all
claims until you have received the
provider identifiers. As long as the
encounters coincide with the effec-
tive date granted by the payer, you
will be reimbursed. In addition, con-

Locum Tenens (from page 126)

Aimee Cutter is
Program Manager,
Locums Revenue Cycle
Management, AMN
Healthcare, Dallas, TX
75019; e-mail: aimee.
cutter@amnhealthcare.
com; website: www.
amnhealthcare.com

Phillip miller is Vice
President, Communi-
cations, Merritt Haw-
kins and Staff Care,
companies of AMN
Healthcare. website:
ww.amnhealthcare.
com.

Locum tenens physicians may be used to fill in for
either planned or unplanned absences.

Copyright of Podiatry Management is the property of Kane Communications Incorporated
and its content may not be copied or emailed to multiple sites or posted to a listserv without
the copyright holder’s express written permission. However, users may print, download, or
email articles for individual use.

P H Y S I C I A N L E A D E R S H I P

How to Find the Ideal
Chief Medical Officer

John Byrnes, MD, president and CEO, Byrnes Group LLC, Ada, Michigan

H ave you ever hired the wrong physician executive—a physician who was well respected and a superb clinician, but for some reason failed as a leader? We have
probably all been there. Unfortunately, this problem is all too common.

The fallout from bad hiring decisions can be costly. A failed hire costs hospitals
and healthcare systems not only the fee paid to the executive recruiter but also
severance pay (in many cases) and the expense of hiring a replacement. The total cost
can be well over $500,000 for a typical chief medical officer (CMO). Healthcare
leaders need to do everything possible to avoid these mistakes.

So how do we select highly effective physician executives who will be successful
leaders in our organizations?

M Y F O R M U L A F O R S U C C E S S
I have been a system CMO twice. In one of these positions, I was responsible for
hiring CMOs for three hospitals across the healthcare system. Each hospital was
unique, not only in culture but also in size and geographic location. A CMO who
would be perfect for one hospital might not be successful in another. Hiring three
CMOs with distinctive skill sets that matched the organizations’ needs was no
small feat.

If you are in a similar position, I recommend three steps: (1) partner with
leadership to appoint a selection committee, (2) have the selection committee read
relevant literature, and (3) retain an experienced executive recruiter.

P a r t n e r W i t h L e a d e r s h i p t o A p p o i n t a S e l e c t i o n C o m m i t t e e
As a system CMO seeking to hire three hospital CMOs, I first partnered with the CEO
and other members of the C-suite at each hospital to appoint a selection committee
at the local site. Each committee was made up of C-suite executives and physician
leaders from throughout the hospital. Everyone on the committee had input during
the selection process, but the hospital CEO had the final word.

H a v e t h e S e l e c t i o n C o m m i t t e e R e a d R e l e v a n t L i t e r a t u r e
Selection committee members should read books and articles about physician
leadership. Everyone on my health system’s selection committees read two books.
Developing Physician Leaders for Successful Clinical Integration (Dye & Sokolov, 2013)
contains valuable advice on selecting, developing, and mentoring physician leaders.

311

Journal of H ealthcare M anagement 6 1 :5 S eptember/ O ctober 2 0 1 6

It was perfect for our situation. The second book, Exceptional Leadership: 16 Critical
Competencies for Healthcare Executives (Dye & Garman, 2015), is a review of the
essential leadership competencies for healthcare executives. Dye and Garman (2015,
xiii) define competencies as “a set of professional and personal skills, knowledge,
values, and traits that guide a leaders performance.” The selection committees found
both books to be good refreshers for executives with considerable hiring experience
and useful introductions for those hiring their first CMO.

The selection committees focused on four groups of sought-after leadership
competencies (Dye & Garman, 2015):

• Well-cultivated self-awareness (leading with conviction, using emotional
intelligence)

• Compelling vision (developing vision, communicating vision, earning trust
and loyalty)

• A real way with people (e.g., listening like you mean it, giving great feedback,
mentoring, developing high-performing teams)

• Masterful execution (e.g., building true consensus, driving results, stimulating
creativity, cultivating adaptability)

The selection committees then combined these competencies with a key lesson
described in Developing Physician Leaders for Successful Clinical Integration (Dye &
Sokolov, 2013). As noted earlier, CMO roles can differ greatly in terms of the skills
and competencies needed for success. These three scenarios illustrate the competen­
cies needed for various CMO roles:

• A medium-sized hospital in a noncompetitive market is organized in a fairly
traditional manner. The CMO serves as a liaison with the hospital’s mostly
independent medical staff. The leadership competencies likely to receive
greater emphasis are listening like you mean it, earning loyalty and tmst, and
building consensus; of less significance are being visionary, communicating
vision, and driving results.

• A health system comprising six hospitals in two highly competitive markets
with several hundred employed physicians and immediate plans for significant
clinical integration likely would place greater emphasis on being visionary,
communicating vision, cultivating adaptability, and building consensus.

• A small rural hospital that serves as the only acute care facility in a 50-mile
radius, with employed physicians mostly younger than 45, would likely place
greater emphasis on the leadership competencies of listening like you mean it,
giving feedback, mentoring others, developing teams, energizing staff, generat­
ing informal power, and building consensus.

The selection committees with which I worked used this insight to identify key
competencies needed for each of the three hospitals in the system. We also learned to
avoid one of the most common hiring mistakes—placing undue emphasis on

3 1 2

P hysician Leadership

chemistry and presentation when, according to Dye and Sokolov (2013), culture/fit
and leadership should be the focus of attention.

R e t a i n a n E x p e r i e n c e d E x e c u t i v e R e c r u i t e r
The third step in finding the right CMO is retaining a highly respected and successful
executive recruiter with extensive experience recruiting physician executives. CMO
searches can be particularly difficult because the pool of available and qualified
candidates is limited and a high percentage of first-time physician executives fail. The
recruiter should have exceptional insight in how to hire physician executives who
will succeed—as well as a huge file of potential candidates.

F I N A L T H O U G H T S
Hiring a CMO who will succeed in an organization with a unique culture is not an
easy task. Many of us default to internal candidates because they already know the
culture. Sometimes this is the right way to go. At other times, bringing in someone
from the outside is best: an individual with a variety of experiences in different
organizations and a successful track record in similar positions. I have hired CMOs
both internally and externally, and succeeded and failed with both approaches.
However, the last time I batted 1.000 was when I used the three steps described here.

R E F E R E N C E S
Dye, C. F„ & Garman, A. N. (2015). Exceptional leadership: 16 critical competencies fo r healthcare

executives.

Chicago, IL: Health Administration Press.

Dye, C. F., & Sokolov, J. J. (2013). Developing physician leaders fo r successful clinical integration.

Chicago, IL: Health Administration Press.

For more information about the concepts in this column, contact Dr. Byrnes at
john@johnbyrnesmd.org.

313

mailto:john@johnbyrnesmd.org

Copyright of Journal of Healthcare Management is the property of American College of
Healthcare Executives and its content may not be copied or emailed to multiple sites or posted
to a listserv without the copyright holder’s express written permission. However, users may
print, download, or email articles for individual use.

P H Y S I C I A N L E A D E R S H I P

How to Find the Ideal
Chief Medical Officer

John Byrnes, MD, president and CEO, Byrnes Group LLC, Ada, Michigan

H ave you ever hired the wrong physician executive—a physician who was well respected and a superb clinician, but for some reason failed as a leader? We have
probably all been there. Unfortunately, this problem is all too common.

The fallout from bad hiring decisions can be costly. A failed hire costs hospitals
and healthcare systems not only the fee paid to the executive recruiter but also
severance pay (in many cases) and the expense of hiring a replacement. The total cost
can be well over $500,000 for a typical chief medical officer (CMO). Healthcare
leaders need to do everything possible to avoid these mistakes.

So how do we select highly effective physician executives who will be successful
leaders in our organizations?

M Y F O R M U L A F O R S U C C E S S
I have been a system CMO twice. In one of these positions, I was responsible for
hiring CMOs for three hospitals across the healthcare system. Each hospital was
unique, not only in culture but also in size and geographic location. A CMO who
would be perfect for one hospital might not be successful in another. Hiring three
CMOs with distinctive skill sets that matched the organizations’ needs was no
small feat.

If you are in a similar position, I recommend three steps: (1) partner with
leadership to appoint a selection committee, (2) have the selection committee read
relevant literature, and (3) retain an experienced executive recruiter.

P a r t n e r W i t h L e a d e r s h i p t o A p p o i n t a S e l e c t i o n C o m m i t t e e
As a system CMO seeking to hire three hospital CMOs, I first partnered with the CEO
and other members of the C-suite at each hospital to appoint a selection committee
at the local site. Each committee was made up of C-suite executives and physician
leaders from throughout the hospital. Everyone on the committee had input during
the selection process, but the hospital CEO had the final word.

H a v e t h e S e l e c t i o n C o m m i t t e e R e a d R e l e v a n t L i t e r a t u r e
Selection committee members should read books and articles about physician
leadership. Everyone on my health system’s selection committees read two books.
Developing Physician Leaders for Successful Clinical Integration (Dye & Sokolov, 2013)
contains valuable advice on selecting, developing, and mentoring physician leaders.

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It was perfect for our situation. The second book, Exceptional Leadership: 16 Critical
Competencies for Healthcare Executives (Dye & Garman, 2015), is a review of the
essential leadership competencies for healthcare executives. Dye and Garman (2015,
xiii) define competencies as “a set of professional and personal skills, knowledge,
values, and traits that guide a leaders performance.” The selection committees found
both books to be good refreshers for executives with considerable hiring experience
and useful introductions for those hiring their first CMO.

The selection committees focused on four groups of sought-after leadership
competencies (Dye & Garman, 2015):

• Well-cultivated self-awareness (leading with conviction, using emotional
intelligence)

• Compelling vision (developing vision, communicating vision, earning trust
and loyalty)

• A real way with people (e.g., listening like you mean it, giving great feedback,
mentoring, developing high-performing teams)

• Masterful execution (e.g., building true consensus, driving results, stimulating
creativity, cultivating adaptability)

The selection committees then combined these competencies with a key lesson
described in Developing Physician Leaders for Successful Clinical Integration (Dye &
Sokolov, 2013). As noted earlier, CMO roles can differ greatly in terms of the skills
and competencies needed for success. These three scenarios illustrate the competen­
cies needed for various CMO roles:

• A medium-sized hospital in a noncompetitive market is organized in a fairly
traditional manner. The CMO serves as a liaison with the hospital’s mostly
independent medical staff. The leadership competencies likely to receive
greater emphasis are listening like you mean it, earning loyalty and tmst, and
building consensus; of less significance are being visionary, communicating
vision, and driving results.

• A health system comprising six hospitals in two highly competitive markets
with several hundred employed physicians and immediate plans for significant
clinical integration likely would place greater emphasis on being visionary,
communicating vision, cultivating adaptability, and building consensus.

• A small rural hospital that serves as the only acute care facility in a 50-mile
radius, with employed physicians mostly younger than 45, would likely place
greater emphasis on the leadership competencies of listening like you mean it,
giving feedback, mentoring others, developing teams, energizing staff, generat­
ing informal power, and building consensus.

The selection committees with which I worked used this insight to identify key
competencies needed for each of the three hospitals in the system. We also learned to
avoid one of the most common hiring mistakes—placing undue emphasis on

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P hysician Leadership

chemistry and presentation when, according to Dye and Sokolov (2013), culture/fit
and leadership should be the focus of attention.

R e t a i n a n E x p e r i e n c e d E x e c u t i v e R e c r u i t e r
The third step in finding the right CMO is retaining a highly respected and successful
executive recruiter with extensive experience recruiting physician executives. CMO
searches can be particularly difficult because the pool of available and qualified
candidates is limited and a high percentage of first-time physician executives fail. The
recruiter should have exceptional insight in how to hire physician executives who
will succeed—as well as a huge file of potential candidates.

F I N A L T H O U G H T S
Hiring a CMO who will succeed in an organization with a unique culture is not an
easy task. Many of us default to internal candidates because they already know the
culture. Sometimes this is the right way to go. At other times, bringing in someone
from the outside is best: an individual with a variety of experiences in different
organizations and a successful track record in similar positions. I have hired CMOs
both internally and externally, and succeeded and failed with both approaches.
However, the last time I batted 1.000 was when I used the three steps described here.

R E F E R E N C E S
Dye, C. F„ & Garman, A. N. (2015). Exceptional leadership: 16 critical competencies fo r healthcare

executives.

Chicago, IL: Health Administration Press.

Dye, C. F., & Sokolov, J. J. (2013). Developing physician leaders fo r successful clinical integration.

Chicago, IL: Health Administration Press.

For more information about the concepts in this column, contact Dr. Byrnes at
john@johnbyrnesmd.org.

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mailto:john@johnbyrnesmd.org

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