Julie Rosen, chief of govt 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 govt director of the Schwartz Middle for Compassionate Healthcare in Boston, a nationwide not-for-profit group advocating for enhancing the patient-clinician relationship. Previous to the Schwartz Middle, she was assistant vice chairman for public and group affairs at Tufts Well being Plan and govt director of the Convention of Boston Educating 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 fascinating that you just say that most individuals know what FQHC companies 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 — practically 10 % of Individuals.
There are extra challenges round social determinants of well being. Loads of FQHC sufferers are in danger, underserved, and so they 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 the vast majority of the board. Board training is de facto necessary — 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 concerning the CEO demographics and tutorial backgrounds?
Rosen: It is fascinating. Loads of the FQHC founders who’re retiring are social employees who grew small group clinics. They began including totally different doctor practices, after which hastily they’d a $100 million operation. They picked up the enterprise expertise, and now the group’s prepared for one thing totally different. Loads of the FQHCs did rather well in the course of the pandemic, as a result of there was a variety of PPE and different cash, however these funds have dried up. So that they’re struggling and in want of robust management.
We place some CEOs who’ve by no means labored in an FQ atmosphere. In California, we simply positioned a lady who was a Kaiser govt from a really massive outpatient observe and who wished to present again. We’re seeing a variety of our older individuals with conventional healthcare careers who now need to give again.
HCI: Do you see a variety of physicians moving into that CEO function?
Rosen: Sure. The primary two FQ searches we did had been in Massachusetts, and so they had been each MDs. On the FQHCs, there are sometimes main clinician productiveness points. They be part of FQHCs as a result of they need to do good work. They want extra time with every affected person as a result of their sufferers are extra difficult. 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 fee previously two years. Are there some the reason why we’re seeing this excessive turnover fee now?
Rosen: There are some causes which are associated to FQs, and there are different causes which are extra associated to demographics. Folks retire, saying they’ve had sufficient. These searches are gratifying however actually onerous. Getting all people on the identical web page is difficult, as a result of what the FQs need is an impressive, 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 best way, raises cash and has a ton of emotional intelligence. And but they don’t have the sources to compensate CEOs the best way 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 individuals internally to maneuver up into that CEO place. And it sounds just like the report stated that is not occurring fairly often.
Rosen: That is proper. The Nationwide Affiliation of Neighborhood Well being Facilities (NACHC) does have some mentorship packages 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. Loads 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, possibly six or seven had been crammed by individuals who had been arising via the ranks.
HCI: Are we seeing extra FQHCs getting concerned in value-based care packages? And does that require an extra talent set on the a part of the CEO?
Rosen: Each FQ desires the CEOs to grasp what value-based care is. I feel it will depend on the state and what number of FQs there are and the way subtle the state is by way of its fee. We’ve performed a ton of labor in California and Massachusetts, and people are the extra subtle states. However for those who go to another states, they’re simply not fairly as subtle. They’re simply stepping into value-based care now.
HCI: Your report, says that workforce challenges embrace 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 stated earlier than about productiveness, it is an enormous situation. It is an actual balancing act. There’s additionally been actual pressure within the organizations between the executive employees, particularly in the course of the pandemic, and the scientific employees, as a result of the executive employees did not have to come back in. They may do business from home. That is type of outdated information, however there’s nonetheless a lingering pressure in a number of the FQs between those that are on the entrance strains and those that are doing the billing and coding.
HCI: Is there the rest you need to point out?
Rosen: Simply that the FQs are nice organizations. There are some actually gifted leaders on the market. There are a variety of FQs which are stepping into joint ventures with hospitals and partnerships round housing. I’ve performed searches for homeless shelters which have FQs connected to them. So there are only a lot of various ways in which FQs are arising, and I feel it is actually the wave of the longer term.
