Well, hi, everyone. I'm Daniel Williams, senior editor at MGMA, host of the MGMA Podcast Network. Welcome back to another MGMA business solutions podcast. We're gonna be talking today to Annie Otto and Kyle Hadley. They are both with locumtenens.com, who is a valued partner of MGMA.

Today, they're gonna be talking about how transition management supports continuity of care during staffing changes. Amy, Kyle, welcome to the show.

Thank you. Thanks for having us. We're excited about this. So I'm Amy Otto. I'm a director of business development on our enterprise solutions team.

And in my role, I help hospitals kind of navigate the clinician staffing and workforce solutions. And part of that now is a discussion on transition management. So I'm looking forward to this today.

Great. Thank you so much. And, Kyle, share a little bit about yourself as well.

Yeah. Thank you for having us, Daniel. I'm Kyle Hadley. I'm the senior vice president of anesthesia here at locumtenens.com. One of my key responsibilities is overseeing the strategy here at locumtenens.com.

And as things change, subsidies are going up, hospitals and groups are expanding. One of the big things that we're focused on is supporting them in these transitions, and that's where I play a role.

Alright. Well, it is great having you all here and looking forward to this discussion. Because transitions, change management, all of that is just it's seismic right now in the workforce. We have experienced that both internally at MGMA and seeing it in lots of practices out there too. So love getting to discuss this with y'all.

So Amy, let's start with you. From your experience, what types of organizational changes or staffing moments most often prompt health care leaders to explore a transition management approach? What's really spurring that?

Well, so typically, these conversations happen for me when I'm doing either a quarterly business review or an annual business review with our clients. And what we like to do is listen to their pain points, and it seems like a lot of them lately have been surfacing around rising costs. Perhaps they may have particular service line that they outsource, and they're losing control, or they feel like they're being held over a barrel because they don't have a lot of say in decisions. And and a lot of times, these particular service lines, like anesthesia or radiology, like, they're critical to the livelihood of the hospital system. So I listen for things like their outsourcing.

I ask about renewals. Do they have anything coming up that they wanna talk about possibly bringing in house? Because oftentimes, they feel trapped by the practice management groups. And in many cases, like with anesthesiology, they can't do other service lines without anesthesiology. So they might be thinking about a long lasting sustainable staffing model.

So those conversations come out typically in in a discussion about their needs and just really listening to what are their pain points and what are they seeing? What are they hearing among their staff? How how much control are they currently having and how much visibility and transparency are they seeing in anything that they're outsourcing.

Okay. We're we'll come back to that a little bit more. I just I wanna turn to Kyle here and just talk about something that Amy was mentioning about these critical moments here. So why are transitions at such an inflection point, such a critical moment for healthcare organizations, And what are some of those factors right now that are taking place that are making organizations like lt.com, really direct their attention towards it as well?

Yeah. So transitions are are occurring all across health care right now. So all all that a transition is is changing from one state to another. The management piece, though, is critical because at the intersection of this, Daniel, you have patient care, workforce stability, and you really need financial performance. So whether it's a staffing change, whether it's a group that's exiting due to subsidies being increased or service lines needing to be realigned, even leadership shifts, there's very little margin for error in health care right now.

Patient volumes, they don't pause. Regulatory requirements, they don't relax. And staff fatigue tends to increase during these uncertainties. So locumtenens.com, we take a, one size fits all approach by customizing our solution to the needs of of those health systems.

Okay. I wanna follow-up with you, Kyle. What happens then if it's not proactively managed? If it's not addressed at the front end, what are some of those friction points, challenges that may occur?

Yeah. So if it's not proactively addressed and it's addressed reactively, what you typically see are reactive responses. And so that typically means higher costs, more turnover, less productivity, and less efficiencies because you're trying to learn your new processes. You're trying to get ahold of your contracts. You're trying to get ahold of staffing challenges all while things are changing.

So you have to get ahead of it and understand your goals and understand the processes in which you're gonna face and also kind of think through the challenges. And that's where we come in, to to help those customers.

Okay. Thank you for that. Amy, let's talk about effective transition management. Again, we have been, working with practices at MGMA. We've gone through some different organizational transitions ourselves and just seeing what those friction points can look like.

Let's look at it from a health care perspective and really with the continuity of care. What does effective transition management look like? And if you want to give us an example, I'd love to hear it even in a crisis setting what that would look like because that's just we can't put that on the back burner. Right? It has to be addressed right now.

So help us understand that.

100. 100%. So in crisis settings, I mean, health care systems are often they're forced to work fast or at a fast speed. And working fast without structure really does present risk. So transition management, like, the right partner and organization, we're we're giving our clients a playbook.

We have best practices to share, and Kyle made a really good point too. We customize based on their need and based on the service line and their pain points and really looking at what is their long term goal. So this process is based on their specific needs. So it's important to align leadership. You have to align the clinicians, the operations.

So there's lots of decisions to be made. And oftentimes, these are made very quickly, but they can't be made in silos. So it's constant communication as part of this transition management and really having a playbook that we share with our clients and having a a very methodical, well laid out plan. You can work quickly, but again, working fast can create risk if you don't have that that customized plan. So we have a lot of support in supporting crisis teams.

I mean, that's what we do. Right? Locumtenens.com. We react quickly. Someone has a need.

We need to fill it quickly. And so sometimes under stress, we really try to take that methodical approach. We create trust with our clients by doing so. And really just having internal teams that expedite things like credentialing.

Mhmm.

That's a huge lift. It's a huge part of all of this. And if you don't have a team in place that does just that, you're gonna have trouble. So also ensuring that the clinicians are payer credentialed is important. You wanna maximize that reimbursement.

And also just the scheduling. There's so many moving parts. And at locumtenens.com, I mean, Kyle and I are supported by amazing teams. A customer care team, a credentialing team, a technology team, a scheduling team. So we we have all of these parts that are working together for a smooth transition and a smooth timeline Because really finding that trusted partner is probably the key to transition management.

So you wanna emerge stronger on the other side and the continuity of care. It doesn't happen by accident. It happens by design. So good transition management really should turn disruption into stability.

Okay. I love that. Alright. Well, Kyle, let's look at transition management. I was hearing everything that Amy was talking about, but you've got to do first things first.

Right? So when you're engaging in transition management, what does that initial phase look like? What's that discovery phase look like? What's going on behind the scenes so that, as Amy was saying, you have everything working the right way. You have those best practices, but where do you start?

Probably the most important piece to get this whole thing right. And a lot of a lot of our customers aren't even calling it transition management

Okay.

By the time they're they're talking about the initial phases. They're starting to look at what kind of decisions do we have to make and who's involved. So we always say that the upfront evaluation is very critical, and it helps a client move from reaction to intention. And for us, that's super important because they have to have a defined goal, and they have to understand what clarity looks like in their situation. So what we recommend is them reviewing their current current staffing models, what their requirements are gonna look like as far as coverage goes.

Credentialing is a large piece. Everything must work. And the the clinicians must be enrolled with payers so that you're financially able to create revenue, but then also have privileges within the system. They need to evaluate all their outstanding contracts. So you've got to bring in the contracting team as well.

A lot of people forget to do that. Scheduling is a key component, understanding how you're gonna plug these people in as you shift during a transition. And then what we see a lot a lot of times is key stakeholders start to get pulled in at the umpteenth hour. And so it's very important to ask those questions who all might be impacted during this and then start to slowly decline the number of people enjoying the meetings and rather than starting to add a lot of people at the last minute. So that's that's probably where the most risk lies.

But but I mean, we have a checklist and we've performed this many times to understand who will likely be impacted.

Okay. That gets me thinking to the next question then. Amy, I'm going to direct that to you. It's speaking to just what Kyle was talking about. So you want to roll these things out, but at the same time, you don't want to disrupt care, and you don't want to disrupt those care teams.

How do you do that? What do you establish where you can be making change but also making sure all the trains are running on time, everything else is working seamlessly or as seamlessly as possible behind the scenes?

Yeah. That's a great question. Because once transmit transition management is actually underway, the goal kinda shifts really from a planning more of a stabilization. And so that transition management is almost like we provide guardrails, Kyle. Like, if you think about it, it's like we really do kind of provide this methodical way of moving forward as change is happening, as the delivery of care is happening, because it's not just about the coverage.

Something I wanna point out is it it's it's not just about putting the position in place there and filling up the schedule. It's about how you support the integration. So true transition management when done effectively, you're thinking about putting the right physician in the right place at the right time. But most importantly, that there's consistent and clear expectations too. So really having, like I was talking about, the support teams that help with the onboarding and making sure that the physicians are integrating with their culture.

We listen. We try to make things as easy as possible so that the staff who's on-site and already pretty stressed out about the change and the emotional weight of it, that they can kinda sit back and do their job and knowing that we have the scheduling, we have the onboarding. We're gonna make sure that those clinicians show up at the right time at the right place. We're getting them to the parking garage, getting them through their orientation. There's so many moving parts.

So you talk about once it's underway, there's a lot of things moving simultaneously. Like Kyla was saying, you know, oftentimes the contracting is working as same time as the credentialing and and the licensing. There's lots of things happening at the same time. So, again, once it's underway, the transition really needs to be more intentional and not chaotic because our job is to really bring these on-site teams so that we're focused on the care and let the staff that's on-site trust us with the care and the schedule. And so they don't feel like they're putting out fires and they can actually provide the excellent patient care that that they love to to work.

You know? They love to do their jobs. Let them do their jobs while we put out the fires and while we're we're handling the transition.

Yeah. Amy, you said the right word, chaotic. Because, you know, every time I talk to somebody who's in a practice, they're talking about all the chaos, all the things going on, all the complexities, the challenges. I have to pause and just take a deep breath just to relax, even thinking about it makes me feel stressed for all those people in the practices. That's amazing that behind the scenes y'all are helping put out all the fires behind things so then they can streamline all the care.

So when we talk about streamlining all those elements, Kyle, I want to ask you this. You've got all these different elements. Y'all have been talking about scheduling, credentialing, onboarding, all the across the board communication. So if you're effectively bringing in this transition, how do you do it? How do you make things streamlined so that chaos gets kind of pushed back into the background so everybody can do their jobs on the front line there?

Yeah. That's a good question, Daniel. So our experience is that an effective transition management and I wanna and the word effective is really important there because a lot of people manage transitions, whether it be in health care or in life in general with the current climate. But it introduces structure and and coordination at a time when that complexity is increasing. So what we we aim to do is centralized oversight for scheduling, credentialing, onboarding, and all communication so that it's not handled in silos.

So we are responsible and accountable for all of the oversight. And we provide timelines that are aligned with the responsibilities that are clearly defined. So while things are are are going all over the place and, you know, you're juggling a million things, lt.com, when we engage in a transition management, those are the things that we're focused on. We're responsible for holding, you know, consistent meetings with minutes and giving consistent updates so that everyone knows where things stand. And the goal of that is just to result in fewer delays, less confusion, smoother experiences for the clinicians and the administrators.

And at the end of it, when you get through, you can look back and see that the waters were calm rather than maybe the way they looked as you entered them.

Yeah. We've been talking so far about implementing all these different elements to the transition team. Let's talk about measuring it. Amy, I'll direct this question to you. Let's talk about the analytics, the reporting, the performance, all those things.

What's what role do they play, and how do they get implemented again where it's as seamless as possible, where people can just go, alright. I can see the progress that's being made.

Gosh. Data, I mean, it's everywhere. It's so much. It's like data coming in all the time where it's a little overwhelming, to be quite honest. But data does one thing, and it builds trust.

Solid data builds trust. So when teams are seeing that the coverage is stable, that the schedule is filled, that the patients are being seen, and that the outcomes aren't slipping, that anxiety really does decrease. And we see that, and it's a great feeling. No. We know we're doing our job when we see that anxiety decrease.

So really transparency through reporting, it reassures everyone that the transition is being handled intentionally. And this data, it can really turn the chaos into clarity because data is what it is. Right? It's fact. So when we look at data, we look at things like coverage and fill rates.

We try things like patient access and continuity indicators. Patients are happy. They're being seen in a timely manner. They're not waiting longer for their appointments. And there's also some quality and safety markers that you can look at as well, provider engagement.

You look at your on-site staff. If the provider burnout is lower by bringing in this group of physicians that is helping with this transition and and filling the gaps and filling the schedule, you should really see a decrease in burnout with your on-site staff. So how can you measure that data? I'm not sure. But, again, it's something that's a reporting tool that we look at.

We look at morale, operation efficient efficiency, reimbursement. We can look at some cost trends, just to name a few. I mean, really does it it it's specific to the client as to what data is important to them and why they made the change to begin with. So we wanna look at the data that's meaningful for them, and we also want to be able to track what's necessary. But just to name a few.

I mean, those are some of the KPIs that we do look at that are pretty standard.

Okay. Kyle, I'm gonna direct the next question to you. Amy said something really interesting. A certain word got a lightbulb moment for me. She talked about stability.

And so let's talk about this. So if you're out of practice, you've had this transition, you've implemented things, you've got your dashboards, you're studying it. So once that stability is in place, you're feeling good about it, what does success look like? We can say we're stable or things are stable now, but what does that success look like?

From a from a health care facility's perspective, success is continuity without disruption. Yes. What that means is maintain patient care. At this point, they have reliable staffing. They're not operating through daily firefighting in crisis mode.

Financial performance is stabilized. You're no longer reacting with spending. And and most importantly is, like, the staff confidence is restored. Your clinicians feel supported. Communication has improved.

Trust and leadership rises. When we when we engage in a transition initially, that's not the case. There's a lot of people with a lot of questions. It's hard to get out in front of some of those doubts, and relationships are impacted. But by the time you have a successful transition, the goal for us is to leave you with permanent staff.

No organization is set up to utilize locums for the rest of their existence. So our goal is to get you up to speed, support you through that change, and then leave. And then if you need us to support you with with per diem coverage, we can do that. But ultimately, we want the hospitals and health systems to be stronger operationally than before.

Amy, success is measured in a lot of ways, but one of those ways to do it is through a feedback loop. So when you've got that team working together, they're making that transition, what does that feedback loop look like? How are they communicating with each other? How are they reporting up, reporting down, and to their peers? What does that look like?

Communication is is so important. And I think, like Kyle was mentioning, how do we know a a program is successful? So to be honest, this isn't rocket science. We're putting this term transition management into something that it it it's really quite simple, but it needs to be done right and intentionally. So it's really about listening, and it's about the people that are living in the transition, which is, I think, sometimes it gets, you know, put by the wayside and not thought of.

But, like, some of the comments that we do hear from clients is, wow. You know, we finally have visibility and what's happening on a day to day basis. Or, you know, I didn't know what to expect as part of the transition, but these clinicians came in and and they were so prepared. They felt like a part of our team. Or, you know, these decisions are have been looming in many cases.

And, you know, people realize, oh, at some point, we're gonna have to part ways with this group, this regional group or practice management group, and and it can be emotional. So we're trying to lower the stress and really just put our clients at ease, show that we're listening. And really these turning times of of transition, we try to turn them into opportunities for stronger relationships with our clients. Because not only is there cost savings, there's more control, there's more retention. And really right now, more than ever, I think health systems are looking for long lasting partnerships to assist with what are deliberate and operational changes and bridges to the future.

You know, they wanna plan for what's coming ahead. So I really think it's almost like thinking about spend optimization and coverage maximization. It's like, how can we make the best with what we've got? And at the end of the day, how can we make it cost effective? But truly, and Kyle will speak to this, like, at the heart of everything we do is the patient.

And so really for us, success is when the patients haven't noticed that there's any type of change or any type of transition. So it's a great feeling when we do it right. The hug around the neck, the thank you. I'm glad we trusted you. I mean, those are all the the things that make us feel so good about what we do every day.

That that is awesome. I am going to ask two more questions, and I'm going to shift it just a little bit, Amy. That was beautiful, the way you described that. But Kyle, sometimes there are organizations, they've got the transition coming, they know it's looming in front of them, and they haven't had that hug around the neck yet, so they may be a little hesitant. They may go, Oh my gosh, I don't know if we should make this change.

What kind of advice do you give them upfront early to try and lessen some of that anxiety or just uncertainty of what may be coming out in front of them?

So I mean, we believe that the biggest mistake you can make is waiting until it becomes urgent to act. I'll give you an example. So we engaged with a hospital in the Midwest, and they waited until the last minute to tell us that their subsidy was going up a 130% year over year. And they wanted to know their options. They had seven weeks to make that decision.

So we we collaborated with all their decision makers. We looked at the evaluation of the cost, and ultimately, they didn't need to commit to the transition management process. What they did was they signed to renew their group through that increased subsidy. Having said that, two years later, they reached out to us and said, next year, our subsidy goes up again, and this year, we have twelve months to come up with a plan. So we worked with them, and they no longer work with this private group that they were working through before.

They used our transition management program, and now they are fully staffed with 34 anesthesiologists, and they're saving roughly $26,000,000 through the four year period that they were gonna lock in with this anesthesia group. So that should tell you everything. Acting early isn't a sign of weakness. It's a sign of responsible governing. And so we may not be the right option.

And transitioning may not be the right option. But you don't understand your options at their full impact unless you act early.

Wow. That is so powerful. Amy, were you gonna share something with that as well?

I was. You know, that's a great example, Kyle. And Kyle has numerous examples he can share. He's he's far more apt at this than I am. But on a radiology side, we also had a a client in Colorado that they found out that they were parting ways with their radiology group, and it wasn't by choice.

And suddenly they have, you know, ninety days, hundred and twenty days to find radiologists to fill this need. And when we started working with them, I think that it was a surprise to them how, like, seamless our process was and how we really did we presented clinicians, like, the next day, and I think that that gave them some comfort. But we have such a large candidate pool, and we're so used to reacting quickly that, you know, Kyle's mentioned of of the cost savings, I mean, that's huge. And I think that when you part ways, we talk about the subsidies and there's so many moving parts and it's it truly is a cost savings, but it it's so proactive. It's you know, they might not have done not have done it at the time, but now that you have twelve months to plan, I mean, those are the types types of conversations we wanna be having proactively so that we can put these strategies in place.

But, yeah, that's a huge savings, Kyle. That's better than a hug around the neck.

It's just a different kind of good. I mean, they're both awesome. But I have this leads to the last question I have for y'all. It really does speak to the workforce challenges that healthcare organizations, big and small, are dealing with right now. So when we think about transition management, how do you see it evolving, y'all, in building out a strategy so teams can really approach those staffing challenges and address operational stability?

I'm going to put this out here. Which one of y'all wants to answer this last one?

I could take this one, Daniel. So I'm certain that you and your role are familiar with the ongoing workforce shortages, clinician mobility, the evolving care team models that are changing. So what we're finding is that change is no longer the exception. This is the new norm. And I don't think it's gonna change in health care.

I don't think it's gonna change in our personal lives. So organizations must begin recognizing that there's value in a repeatable, scalable transition process. And so long term, they it's less about crisis management and more about planning, being agile, and having risk mitigation. So I believe that organizations will begin to embrace this. This this is not just for for staffing.

You have to also use transition management if you're changing scheduling platforms or if you're changing someone who who handles your linens. Like, there's a whole process for that. So I think organizations are gonna embrace having repeatable, scalable processes as it relates to transition. And if they're not, then they're always gonna be reacting to change whenever other competitors are being proactive.

Alright. Well, Kyle Hadley, Amy Otto from locumtenens.com. I wanna thank y'all so much. I love the partnership we have with LT here at MGMA, and I appreciate y'all stopping in on the MGMA podcast today.

Thank you. Thank you so much for having us.

Yeah. Thank you, Daniel.

Alright. Appreciate it. You got it. Well, that is gonna do it for this episode of MGMA Insights, everyone. Please be sure to look in the MGMA podcast show notes, also on mgma.com where we're gonna share an article that shares additional resources and other tips and tools related to transition management.

So until then, thank you so much for being MGMA podcast listeners.