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Why You Shouldn’t Let History And Momentum Dictate Your Medical Business Structure
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| Physicians bemoan the commoditization of healthcare and, especially, their role in it.
But often this thinking is akin to seeing their practice and, especially, their specialty as if it were a
train on a track. They see themselves headed down that track and, parallel to it and only feet away, as if within a large freight yard in a metropolitan city, are their colleagues and competitors, all headed in the same direction.
The only solution they see, if they see a solution at all, is to improve their existing business
structure and existing business relationships. While many simply bemoan the fact that the train is
not running properly, others take significant action to get the train moving faster or to improve the
experience offered on that train.
There’s nothing inherently wrong with that; in fact, I’ve been preaching the notion of creating an
experience monopoly for over a decade.
But that’s no longer enough.
As medicine becomes more and more commoditized, forward thinking medical group leaders must understand that there’s nothing but the existing weight and momentum of their group and its past holding them to that track.
What if that train could be placed on an entirely different track running in a different direction, or
what if, instead of the track, the train could run on roads, making right turns and left turns at will?
As you are certainly well aware, together with increasing commoditization we have increasing
regulatory constraints, from national prohibitions such as Stark and the federal antikickback statute to state prohibitions on fee splitting. But, to strategic thinkers, those are simply inconveniences that must be taken into account or avoided completely.
Toss all of the metaphorical trains off the track. Uproot all of the metaphorical rails. Put the pieces back together some other way or add new parts or leave some out – see what new structures can be built.
So for example, what new business arrangements could be created between, say, a multispecialty medical group that includes surgeons practicing at multiple hospitals, and an enterprising anesthesia group with tremendous, if until now underutilized institutional knowledge about where best to schedule cases, about how to wring more efficiency out of surgical scheduling, and the like?
Or, what types of structures could a pain medicine group create that would include chiropractors?
Or, what if an orthopedic group purchased a small, out of business hospital and just skipped
treating any Medicare patients at the facility?
It might be hard to believe, but, as an entrepreneurial attorney, my suggestion is that you forget all the rules. Well, at least to begin with. Forget that you’re a “suchandsuchologist” or a “thisnotthatedist” and then, without preconception, imagine what structures can be built. It’s no longer
painting by numbers or writing within the bounds of the lines, it’s finger painting like you’re once
again 5 years old and anything is possible.
Only after that do we even begin to adjust for compliance constraints.
The structures of the past aren’t serving you well. The government and those running larger entities are attempting to impose their own new structures on you.
So why keep heading down the wrong track?
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| | | Wisdom. Applied. - 184: Satisficing Your Way To Success
To succeed in business, you have to focus on sufficiently satisfying, that is, satisficing, the needs and expectations of your customers and on reminding them of that fact.
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| | All Things Personal
No matter your politics, take a look at N.Y. Exec. Law § 63, the statute underlying the zillion dollar penalty against former President Trump.
As opposed to requiring a finding of actual fraud, a tort developed over hundreds of years of British and American jurisprudence and which includes, among its elements, the necessity of actual damages, it permits the government to bring suit, and obtain apparently mind-boggling fines upon a determination of “persistent fraud” which requires no actual fraud and therefore, which requires no actual damages.
Among the statute’s definition of this sort of “fraud” [which we might refer to as “faux-raud”], are, and stay with me here anyone who enters into contracts between physician groups and hospitals, or who opines on fair market value, “deception”, “misrepresentation”, and “unconscionable contract provisions”.
Think about it.
Is it “deception” when a hospital relies on a valuation firm that’s produced over 100 valuations for it based on survey data that lags the market by two years? Is it “unconscionable” to require a contract provision that requires physicians to give up, or give up the right to exercise, their medical staff privileges when the group that they work for loses its exclusive contract? Is it “misrepresentation” and “deception” for valuation firms to base their “opinions” on reported data which everyone knows bears no relationship to the current market?
Anyone who thinks about the power given to the state, any state, under a law like this should question doing business there. Or at least, not smirk when that law acts as the bell that tolls for someone you dislike. After all, it can just as easily toll for you.
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What tailored content would you most like to see during this time? How can we focus on solutions to your most pressing
strategic concerns?
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| | Podcast Compilation Greatest Hits - Manage Your Practice Edition
We've curated our most popular podcasts on managing your practice into our second compilation album.
Sit back, enjoy, and think about your future.
Listen here. |
| | | | | | We all hear, and most of us say, that the pace of change in healthcare is quickening. That means that the pace of required decision-making is increasing, too. Unless, that is, you want to take the “default” route. That’s the one is which you let someone else make the decisions that impact you; you’re just along for the ride. Of course, playing a bit part in scripting your own future isn’t the smart route to stardom. But despite your own best intentions, perhaps it’s your medical group’s governance structure that’s holding you back. In fact, it’s very likely that the problem is systemic. The Medical Group Governance Matrix introduces a simple four-quadrant diagnostic tool to help you find out. It then shows you how to use that tool to build your better, more profitable future. Get your free copy here.
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| | | Whenever you're ready, here are 4 ways I can help you and your business:
1. Download a copy of The Success Prescription. My book, The Success Prescription provides you with a framework for thinking about your success. Download a copy of The Success Prescription here.
2. Be a guest on “Wisdom. Applied. Podcast.” Although most of my podcasts involve me addressing an important point for your success, I’m always looking for guests who’d like to be interviewed about their personal and professional achievements and the lessons learned. Email me if you’re interested in participating.
3. Book me to speak to your group or organization. I’ve spoken at dozens of medical group, healthcare organization, university-sponsored, and private events on many topics such as The Impending Death of Hospitals, the strategic use of OIG Advisory Opinions, medical group governance, and succeeding at negotiations. For more information about a custom presentation for you, drop us a line.
4. If You’re Not Yet a Client, Engage Me to Represent You. If you’re interested in increasing your profit and managing your risk of loss, email me to connect directly. |
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