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| Dear Friend,
Have you protected your practice from being handed over to someone else?
I have a friend, a physician, Tom, who’s always wanted to become a carpenter. Not the frame a house-type carpenter, but one who builds beautiful cabinets and fine furniture. I’ve seen his work, and I can attest that he would have been the Leonardo Da Vinci of woodworkers.
If you wouldn’t have gone into medicine, what would you have done? Let’s pretend that, whatever it was, it was run out of a storefront located in a high-end mall. Maybe your store would sell only those Buscemi brand sneakers I wrote about, you know, the ones that sell for $800 a pair.
So you’ve got maybe $250,000 in inventory. Perhaps another $300,000 in computers and displays and other property. And, because you need to provide very high-end service to folks buying $800 sneakers, you searched high and low and hired the best staff you could find; you trained them well.
But then your lease is terminated. Let’s say it’s because the mall manager doesn’t like you. In fact, the mall manager has leased your store to one of your competitors, Soulless Soles. Can the mall manager simply lock you out, hand Soulless the keys and tell them they’re free to keep the entire contents of your store, and your staff?
You’d be on the phone to me in five minutes: “Let’s sue!"
But this is exactly what happens to medical groups when they don’t protect their practices, including their staff, from being handed over by a hospital to a competitor as a result of an RFP process or simply as a result of a de facto lock-out.
For example, consider the fictitiously named Jones Group, cardiothoracic surgeons who’ve developed a strong multi-physician practice based out of the fictitiously named St. Mark’s Community Memorial Hospital. Under pressure from one of the members of the group who seeks more power, the hospital announces that that surgeon, together with some surgeons from across town, will become the new hospital-sponsored group working from the hospital-run cardiothoracic clinic. That new clinic will be located in the office space currently (well, for the next 90 days, the without-cause termination period) leased by the Jones Group. The rest of the Jones Group docs are sent scurrying for new office space and new referral sources, or for new jobs across the country. The goodwill of the Jones group has essentially been pulled right out from under them.
Or, for example, consider the hospital-based Smith Group that provided services at St. Mark’s for 15 years. The hospital wants to consolidate Smith’s services with that of another hospital-based department and awards the combined contract to another group. The new group offers to hire all of Smith Group’s docs, except for its shareholders who are sent packing.
There are many tools available to protect your “store" from being turned over to the new tenants. Don’t just wait for it to happen and then decide to do something about it. The damage will already be done. You’ll have made it easier for your relationship to be terminated, easier for your business to be destroyed.
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| | Tuesday - “No Poach” Case Leads to Guilty Plea – What You Need to Know - Success in Motion
Watch the video here, or just keep reading below for a slightly polished transcript:
Let’s talk about deals to allocate employees.
This is a story about a healthcare staffing company in Nevada that just pleaded guilty and agreed to pay a total of around $139k in fines and restitution to employees as a result of a deal with a competitor to not poach one another’s employees.
These are called “no-poach” agreements, and they are a form of antitrust law violation.
Antitrust law isn’t just civil, it can be criminal, and, in this case, that's how it was charged.
No poach agreements are deals in which one company agrees not to hire the competitors' employees, thus holding down wages.
This kind of illegal deal can come up in many different healthcare contexts. For example, it could come up in the context of two hospital-based groups in a geographic area agreeing that they will staff only to a certain level, and that they won’t use any physician who has worked with the other group for some period of time, in order to make it difficult for the physician to switch jobs. The effect is to avoid (illegally) a situation in which the two groups are competing for the same pool of employees.
Note that the Biden administration is picking up the pace and intensity of antitrust law scrutiny and in this case, prosecution.
Be extremely careful about allocating markets, including markets for your staff and the staff of a competitor. |
| | Wednesday - Disruptive Physician or Nonconformist Medical Group Asset? - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
Disruptive physicians. Previously, I wrote about the importance of getting disruptive physicians out of your medical group before they take you down. But what if the physician isn't actually disruptive, but simply nonconformist or challenging? Then, cutting him or her from your medical group might be like cutting off your nose to spite your face. (Translation: a bad move.) Intellectually, the problem is knowing how to tell the difference. True, there's no test that I know of. Practically, though, it's not that hard to tell if Dr. Bob's actions are disruptive. Is he bad-mouthing your group to the hospital CEO? Is he trying to get another group member to team up with him to steal your exclusive contract? Is he working with your competitor to undermine your group? Is he screaming at nurses — with bonus points for doing this in front of patients? Unfortunately, those are all real-world examples of disruptive behavior. I could go on, at the risk of developing carpal tunnel. Or, is she just someone who's nonconformist or contrarian, someone who doesn't fit in the mold out of which popped the other members of your medical group? The nonconformist is not trying to take your group down. She's not conspiring against your leadership or the group's future. Instead, she's questioning, even acting out a challenge to, how things are done. Why does your medical group do something a certain way? What's the "why" underlying your answer to that? "It's always done that way," or "because we read that it's a 'best-practice,'" aren't ultimate "whys." Sometimes there is no ultimate "why," or, at least, one that makes any real sense. In the popular press, this sort of challenge is often portrayed as generational. But that's silly, because no generation is lock-step. It's comprised of individuals. You can just as easily have a nonconformist 62-year-old in your group as a nonconformist 26-year-old. Seen for what it can truly be, nonconformity is an asset, a cross-pollinator of ideas and of ways to think. It's a Darwinian stressor. Yes, some management may be required to keep the nonconformity positively channeled. It's still essential that disruptive physicians must be removed from a medical group. Removed quickly. But, as a medical group leader, don't judge immediately. Pause and question motives. Pause and question whether the symptoms are truly disruptive action or, instead, nonconformity that can be made to be beneficial to your medical group's long-term success. As someone once quipped, "yes, it works in practice, but will it work in theory?" Who cares. |
| | | Listen to the podcast here, or just keep reading for the transcript.
Recently, I read a thought provoking post on Ken Cohn's Healthcare Collaboration Blog. Ken, a practicing surgeon, is passionate about helping physicians, nurses, hospital leaders, and board members work together.
In my practice, I see a tremendous amount of tension, especially when it comes to the relationship between administration and hospital based groups. On one level, this tension results from the business relationship between them – the exclusive contracting process and especially the issues relating to stipend support.
Unlike Ken, rather than wish this tension did not exist, I find it rather healthy in that it creates a robust atmosphere for the negotiating process.
On another level, that of the operational relationship (perhaps better thought of as the “professional” relationship) between the hospital and the hospital-based group (and here’s where Ken and I are more or less on the same page, I believe) I work hard with my clients to create not simply smooth, but “delighting” relationships.
However (and here’s where Ken and I part ways again) those "collaborative" relationships are themselves a part of the negotiation process (for the renewal of the contract relationship) and can be used both passively and actively (e.g., “delight” as a weapon) to achieve the group’s and the hospital’s goals.
Hospital administrators often manipulate the operational relationship in a quite aggressive way, setting up failure, triggering breaches, etc. My clients understand this and have tools to combat it. After all, this sort of behavior on the part of administrators simply indicates that they, too, share my long term view of what negotiation really is.
The relationship between a hospital-based group and each of the facilities at which it practices requires this long term view (see The Strategic Group Process™). Each of the touch points between your group and a facility, as well as between your group and other members of the medical staff and between your group and your patients and their families, is, in actuality, a part of the negotiation with the facility.
Harness your power to influence those relationships and transform your practice.
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| | | 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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| | | | 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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