Julie Rosen, chief of government recruiting agency WittKieffer’s Not-for-Revenue Observe, not too long ago authored a report about constructing sustainable management in Federally Certified Well being Facilities. She not too long ago spoke with Healthcare Innovation about a number of the report’s findings and her expertise recruiting FQHC leaders.
Earlier than working at WittKieffer, Rosen served as government director of the Schwartz Heart for Compassionate Healthcare in Boston, a nationwide not-for-profit group advocating for enhancing the patient-clinician relationship. Previous to the Schwartz Heart, she was assistant vice chairman for public and group affairs at Tufts Well being Plan and government director of the Convention of Boston Instructing Hospitals. She additionally served in management roles with the Massachusetts Hospital Affiliation, Massachusetts Medical Society, and American Dental Hygienists’ Affiliation.
Along with surveying FQHC leaders for this report, WittKiefer additionally carried out proprietary analysis on the profession paths of greater than 350 FQHC CEOs throughout the nation.
Healthcare Innovation: I feel most of our readers are conscious of what FQHCs do, however what are some key challenges of being within the CEO place of an FQHC?
Rosen: It’s attention-grabbing that you simply say that most individuals know what FQHC businesses are. I do know lots of people in healthcare which have by no means heard of an FQ, which I discover astounding, as a result of so many individuals get their healthcare there now — almost 10 p.c of People.
There are extra challenges round social determinants of well being. A number of FQHC sufferers are in danger, underserved, they usually have wants together with transportation, financial safety, meals and safety from environmental hazards like lead paint. So along with healthcare, many FQHCs present entry to social helps reminiscent of meals and transportation.
The opposite factor that makes it totally different is that 51% of the board members of FQs must be sufferers.
After I do my searches, I insist that there are affected person representatives, as a result of that is nearly all of the board. Board training is admittedly essential — ensuring that everyone is on the identical web page, ensuring that the board has sufficient data, and ensuring that the board is consultant.
HCI: In your analysis, did you discover some widespread themes in regards to the CEO demographics and tutorial backgrounds?
Rosen: It is attention-grabbing. A number of the FQHC founders who’re retiring are social staff who grew small group clinics. They began including totally different doctor practices, after which swiftly they’d a $100 million operation. They picked up the enterprise expertise, and now the group’s prepared for one thing totally different. A number of the FQHCs did very well in the course of the pandemic, as a result of there was lots of PPE and different cash, however these funds have dried up. So that they’re struggling and in want of sturdy management.
We place some CEOs who’ve by no means labored in an FQ surroundings. In California, we simply positioned a lady who was a Kaiser government from a really giant outpatient observe and who needed to present again. We’re seeing lots of our older folks with conventional healthcare careers who now wish to give again.
HCI: Do you see lots of physicians moving into that CEO position?
Rosen: Sure. The primary two FQ searches we did have been in Massachusetts, they usually have been each MDs. On the FQHCs, there are sometimes main clinician productiveness points. They be part of FQHCs as a result of they wish to do good work. They want extra time with every affected person as a result of their sufferers are extra sophisticated. And due to the fee incentive system, they have to be extra environment friendly, so there are points about productiveness and scheduling.
HCI: Your report discovered that there is been a 20% CEO turnover charge prior to now two years. Are there some the reason why we’re seeing this excessive turnover charge now?
Rosen: There are some causes which can be associated to FQs, and there are different causes which can be extra associated to demographics. Folks retire, saying they’ve had sufficient. These searches are gratifying however actually exhausting. Getting all people on the identical web page is tough, as a result of what the FQs need is an excellent, strategic one who’s a visionary, who’s nice at operations and nice on the scientific stuff, and nice at finance, and might be an emissary for the group. And, oh, by the way in which, raises cash and has a ton of emotional intelligence. And but they don’t have the sources to compensate CEOs the way in which hospitals and different healthcare organizations can.
HCI: The report additionally will get into whether or not they have succession planning in place and are beginning to put together folks internally to maneuver up into that CEO place. And it sounds just like the report mentioned that is not taking place fairly often.
Rosen: That is proper. The Nationwide Affiliation of Neighborhood Well being Facilities (NACHC) does have some mentorship applications the place older, retiring FQ CEOs mentor youthful ones.
I come from the hospital business initially, and there’s a lot extra success there by way of succession planning. A number of these FQHC organizations are operating by the seat of their pants, so they do not actually have the sources to consider that. I feel out of the 30 positions we’ve been concerned with, perhaps six or seven have been crammed by individuals who have been developing by the ranks.
HCI: Are we seeing extra FQHCs getting concerned in value-based care applications? And does that require an extra ability set on the a part of the CEO?
Rosen: Each FQ desires the CEOs to know what value-based care is. I feel it relies on the state and what number of FQs there are and the way refined the state is by way of its fee. We’ve carried out a ton of labor in California and Massachusetts, and people are the extra refined states. However should you go to another states, they’re simply not fairly as refined. They’re simply moving into value-based care now.
HCI: Your report, says that workforce challenges embody expertise, attraction, retention and burnout. Are there some methods you’ve got seen profitable FQHC leaders take care of these points?
Rosen: Often by versatile scheduling. However coming again to what I mentioned earlier than about productiveness, it is an enormous challenge. It is an actual balancing act. There’s additionally been actual pressure within the organizations between the executive workers, particularly in the course of the pandemic, and the scientific workers, as a result of the executive workers did not have to come back in. They may earn a living from home. That is form of outdated information, however there’s nonetheless a lingering pressure in a number of the FQs between those that are on the entrance traces and people who are doing the billing and coding.
HCI: Is there the rest you wish to point out?
Rosen: Simply that the FQs are nice organizations. There are some actually proficient leaders on the market. There are lots of FQs which can be moving into joint ventures with hospitals and partnerships round housing. I’ve carried out searches for homeless shelters which have FQs connected to them. So there are only a lot of various ways in which FQs are bobbing up, and I feel it is actually the wave of the long run.