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| Dear Friend,
Quick! What do the following questions have in common?
A. What would you pay for a sculpture?
B. How much does the carrot on the plate in front of me as I write this weigh?
C. Is an MSO a good idea for your practice?
Each of them is a nonsensical question, impossible to answer without much more information.
However, the first two are rather harmless. In the absence of knowing what sculpture (e.g., a lump of clay shaped by yours truly or an authentic Botero), or what carrot (the universe of carrots ranges from a micro veggie to nearly as large as a tree’s taproot), there's no way you could answer the question.
The third, “is an MSO a good idea for your practice?”, can be quite dangerous.
In a recent article in a national healthcare publication, multiple interviewed orthopedic surgeons gave all sorts of opinions on why MSOs are the future of orthopedic practice. Yet, if you paid close attention while reading, it quickly became apparent that they weren't even talking about the same thing.
At its essence, an MSO is a “management services organization”, a supplier of a menu of management services to, in the case of the mentioned article, medical practices. Often the MSO is structured to provide the complete range of administrative services, from space to front office to back office, to billing and collection, and so on, a sort of turnkey, “just show up and practice medicine” structure. But it need not be that.
As was evident from the comments of the interviewed doctors, some spoke of a very different model, the sale of their practice in toto, or perhaps (they weren’t very clear) just of all of their non-practice assets (i.e., soup to nuts business assets and functions) to a “private equity” group, as if “private equity” is the universe of entities in the MSO business.
The same idea holds true with many healthcare structures, whether it’s an MSO, an IPA (an independent practice association), an RBMG (a sort-of cousin to an IPA), a CIN (a clinically integrated network), and so on.
In our metaphor, none of them are the painting on the wall. In fact, they’re not even the hole. What they are is the drill. They’re tools that describe a method of getting you to the business entity or outcome that you seek to create or achieve. They’re not ends in and of themselves.
What’s most important for you is to first decide what it is, on a business level, that you’re trying to achieve.
Forget for the moment (but only for the moment!) about legal structure and compliance and the fact that it’s a “fill in the blank” such as an MSO.
Instead, simply concentrate on what it is, bottom line, that you want to achieve.
Then, and only then, should we ask the question of what tool or tools--the specific structure or structures--can be applied to get you there. |
| | | Business Life in the Time of Coronavirus Mini-Series
The coronavirus crisis caused a short term economic crisis for many medical groups. Our mini-series shows you the way out. Plus, many of the concepts discussed are applicable during both good times and bad.
[If you haven't already seen them, follow this link to watch our entire series.] |
| | Watch Tuesday's video here, or just keep reading below for a revised, more polished version:
Let's talk about thinking, in particular, about systems thinking as opposed to thinking about one issue only, one problem only, it could even be one entire contract only.
Let’s back into the topic by exploring how this relates to another concept that I’ve talked about a lot, certainly on the blog and on other videos--that’s the concept of the OODA loop.
The OODA loop concept was developed by Col. John Boyd, considered by some, even many, to be the second-greatest military strategist, Sun Tsu being the first, to have ever lived.
OODA is the acronym for Observe, Orient, Decide, Act – a simple loop, although in its full version there are many elements that provide feedback at interim points, other sorts of feedback loops within the main OODA loop.
Boyd came up with this concept as a result of his experience as a Korean War era fighter pilot and later a trainer of fighter pilots. He realized that the ability to engage with your enemy in an aerial dogfight, and win, depends in very large part on the ability of the pilot to quickly cycle through OODA: Observe where the enemy is and where you are. Orient things to one another. Make a decision as to your next action. Take the next action. Then iterate, and iterate.
What his concept describes is the fact that the combatant who could cycle through that loop faster, by more quickly observing, orienting, deciding and acting, had the advantage.
Note that that’s far different than simply saying, fly the plane fast, or something entirely rote, such as when engaging the enemy, slow down and turn to the right. OODA is different than a discrete thinking exercise; it’s thinking within the context of a system.
The same thing holds true, on a different level, with your medical group.
For example, let’s say you’re considering entering into a contract with the Jones ASC. You shouldn’t simply focus on the terms of the proposed Jones contract; there are likely many other issues at play. Here are just a few:
How would a deal with the Jones ASC fit in with the larger strategy of your business operation and with the future of your medical group?
Does it make sense to enter into a contract with Jones ASC at all, even on good terms? Why?
Why shouldn't you enter into the contract?
What are the reasons for the contract, other than the obvious answers such as it being profitable?
What if it’s not profitable? Might there still be a reason to enter into the contract?
How does entering into the agreement with the Jones ASC impact staffing? How does it impact the number of job offers that you have out?
How does it impact compensation? What if reimbursement from work at Jones ASC is far lower than other facilities? How does that impact recruiting? Does it impact your relationship with the some other facility?
The takeaway here is to think strategy and to implement strategy, the business strategy and the related legal strategy of on what terms and with whom to contract, based on the entire picture, including from feedback loops.
Think in ways that involve systems, not just discrete facts.
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| | How to Deploy the Secret Sauce of Opportunistic Strategy
Webinar On Demand
They say that COVID-19 has changed the world, creating the "new normal." Many of your colleagues and many hospital administrators are running scared.
Others, leaders like you, know that crisis means opportunity.
Let me provide you with the strategic tools and insights that you need in order to seize opportunities, whether they’re in the context of your current business relationships, the expansion of your business activities, or the creation of new ventures.
You will learn:
•Defense as a defective default: It’s necessary, but not sufficient.
•Exploiting weakness: Drop the guilt and identify opportunity.
•Flat line negotiation is fatal: Understand its myths and limitations.
•Negotiation reality: Learn to identify and deploy on multiple planes to affect the outcome.
•Maneuver: Harness the power of maneuver, both in overall strategy and in specific negotiation strategy.
Others see a crisis and freeze in fear. Learn how to see the opportunities and obtain the tools to increase your odds of obtaining them.
The price to attend is $479. The cost of not attending is astronomical. |
| | | Wednesday - Mistakes Happen - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
Mistakes happen.
There's a divergence of opinion on the question of whether or not to apologize or express sorrow over a healthcare error.
Will it lead to increased chances of malpractice litigation and be construed as an admission of liability? Thirty-six states, including California and Texas, have enacted laws protecting certain expressions of sorry and remorse from being admissible in court.
Recently, I was on an American Airlines flight. A flight attendant carrying a tray with a filled red wine glass lost her balance and dumped the wine on my shoulder, down my back and onto, well, my, err, seat. She immediately and profusely apologized and said that she'd get me a cleaning voucher. I smiled and told her that it was OK. She told me that most passengers would have screamed at her or threatened to get her fired.
Mistakes happen, and it's often how the mistake maker, not the "victim," reacts that makes the difference in the outcome.
If your state immunizes apologies, does your group have a policy on when, how and what to say? Let's talk about it. |
| | | Listen to the podcast here, or just keep reading for the transcript.
You can’t believe your luck!
You're in the back of an ambulance, its siren streaming as it pulls into the emergency entrance of Big Medical Center of Somewhere, America. You’re quickly rolled inside, in tremendous pain but still conscious. Up walks a physician in impeccable C-suite attire with a stethoscope draped over his neck.
God must be smiling on you, for you're being taken care of by the highest-paid physician on the hospital's payroll, yes, the top clinical integration/transformation executive!
What, you're not lucky?
Hospitals are focusing their hard and few-earned dollars exactly where it counts, spending big bucks on the physician executives who will surely rescue them from nosocomial existential syndrome: chief officers of this or that trendy trend.
According to a recent report, here are the top earning lifesaving physician executives: - Dr. Top Clinical Integration-Transformation Officer pulls in close to $600,000.
- Dr. Top Quality Executive earns a bit more than $460,000.
- Dr. Top Medical Informatics executive earns close to $380,000.
But don’t feel sorry for them having to spend so much time in meetings, drinking coffee, and having executive lunches. Those dollar figures are just the cash portion of their compensation.
Hey, I’d expect a lot of transformation for $600,000. Change is good, right? Just ask the physician I met from Venezuela. Oops.
Hundreds of hospitals are closing. Others left standing bemoan the fact that they’re broke and often blame it on their greedy contracted physician groups. “You want a stipend so that half your group doesn’t leave? What, are you crazy? We lost $4 million last year and now we have to hire a chief transformation officer and a few MDs who gave up medicine for informatics.”
Does anyone else find this funny? Does anyone else see this as not only rearranging the deck chairs on the post-iceberg Titanic, but spending to parachute in some extra caviar and champagne?
Still conscious as you’re rolled into the operating room and the team gathers around you (yes, you're still awake . . . couldn't afford those damn anesthesiologists) you’re baffled as the room gets dark, not light. And then you understand why: Dr. Top This-or-That wants to make sure that everyone can see her PowerPoint presentation, even you.
There's never a shortage of money, only a question of priorities. And, it's a heck of a question. |
| | | Calibrate Your Compass
Read our exclusive RedPaper to guide you through this evolving situation.
The coronavirus crisis caused a short-term economic crisis for many medical groups. Our RedPaper shows you the way out. Plus, many of the concepts discussed are applicable during both good times and bad.
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| | Help Us Help You With Helpful Content
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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| | | | 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.
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| 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 Free.
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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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