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| Dear Friend,
Perception and hospital-physician deals.
What an odd color Mercedes; pink, like cotton candy.
But what color is that pink? The pink in your mind’s eye is different from that in mine, and from that of each other reader.
That’s because colors are perceptions made by each of us.
***
The three students filed into the room and took seats facing the large screen. A block of color was projected onto it.
“What color is the block?” asked a voice from the back of the room.
“Blue – Blue – Blue,” they replied.
“And this?”
“White – White – White.”
“And this block?”
“Green – Green – Wait, that block isn’t green, it’s pink!”
No, not a difference in perception, but a college psych study of compliance. Will the test subject, the third student, parrot the obviously erroneous answer of the two confederates? Will he say that pink is green?
***
So what’s the right way of looking at physician alignment, hospital-physician collaboration, and other initiatives to bind physicians and their groups to hospitals?
Is it that I, like you, see the true color – control not alignment, top down authority not participation, lockstep factory medicine as opposed to individualized patient care, cookbook versus innovation?
Or is it simply a matter of seeing the same color in slightly different ways?
The test, I suppose, is to construct a collaborative deal in the manner of what’s commonly referred to as a Dutch auction: One party names the price and the other chooses to be the buyer or the seller. Or your brother splits the brownie and you choose the bigger “half.”
So, if collaboration really is the real thing, let the hospital design the deal, but your group controls it.
The hospital’s CEO is turning pink! What color, exactly?
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| | Wednesday - The "Problem" with Healthcare Might Not Be the Problem - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript: ACO's. Competition by hospital employed physicians. Commoditization. Just a few of the "problems" that physician group leaders struggle with. But are those really the problems? Perhaps they are actually symptoms of a different problem or set of problems. For example, the problem of increasing "We" think and, especially, the problem of increasing bureaucratization and centralization of medical care. Or, perhaps, the lack of self esteem and an overdose of guilt. Albert Einstein said we can't solve problems by using the same kind of thinking we used when we created them. As I've written before, medical groups are at what I call the Great Junction™, with one road leading to commoditization and the other to creating an experience monopoly. The first route doesn't require new thinking beyond figuring out if you can maximize the value of the sale of your practice, if it can be sold at all, an element not be demeaned. Taking the second route won't be easy: it's risky and you might crash and burn. But there's freedom and potential reward with no cap on the upside. Taking the second route requires new thinking. That's part of why it's so much fun. Let's get started on your future today. It's there, after all. Don't you want to shape it before it shapes you? |
| | | Listen to the podcast here, or just keep reading for the transcript.
The move by hospitals to "strengthen" hospital-based departments, and the hospital's own finances, by outsourcing to so-called national groups and "contract management companies" might just result in the destruction of the hospital. The chances are even higher that it will end the careers of many hospital executives.
Over the last 30 to 40 years, both hospital-based physician groups and hospitals have flourished due to a kind of symbiosis.
The hospitals needed a stable source of particular medical expertise and the assurance that those specialists would contract with health plans. The physicians, through the formation of groups to contract with the hospitals, gained economic clout, exclusivity, and a degree of stability.
Inherent in that relationship was the fact that the physician members of the contracted groups developed long and deep ties to the community, both the community in general and the medical staff community at the particular hospital.
Certainly, these groups were run as businesses attempting to maximize their profitability, but it was an aim of maximizing profitability over the long run, not a quick killing of this year and next, over the two-year term of their contract, and then adiós sucker.
As a result, local groups developed a very keen interest in working with administrators and their colleagues in other medical staff departments to not only deliver the services required, but to do so in a way that supports the peculiar needs of that facility. Times may be tough this year, but by devoting resources to support a new service line, or by shrinking to end an unprofitable one, the relationship, in the long run, remains mutually beneficial and successful.
National groups and, even more so, contract management companies, don't have the same view of, or need for, that type of symbiotic relationship with the hospital. Yes, they want profitable relationships to last, but their profit horizon is not the same as that of a local group.
Think about this in terms of restaurants. A local group is equivalent to a family owned burger stand. The family members would go to great lengths to keep their economic engine alive through hard times. It's their sole source of revenue. They have their reputation in the community to preserve. They have real relationships with their customers. On the other hand, a contract management company is equivalent to the owner of a chain of fast food joints. If location number 78 is having difficulty, sure they'll try to save it. But if it becomes more trouble than it's worth, they'll simply shutter it.
This difference in motivation holds true at the physician level as well. Physicians with roots in the community, physicians who see a group as their career, with ownership a possibility or a promise, have a reason to remain, good times or bad. Sure, there's no absolute guarantee that anyone will stay. But compare this with physicians working for the local branch of a national contract management firm, paid, essentially, as itinerant workers. How likely is it that they will stay long term? How likely is it that the contract holder will replace them when someone else can be found to do their job for slightly less? How likely is it that high quality physicians will come to, or remain with, the management firm, and while they're there at community hospital number 11 of their career, how much will they care about establishing a relationship with the hospital and its community?
Which group, the local group or the masters of "store number 78," is more likely to tie its success to that of the hospital?
In the short run, hospital CEOs may be seen as geniuses, and paid bonuses—the real point, right?—as a result of their seeming "costs savings."
On the other hand, five years down the road, when the national group has left because there is no profit working at that facility, when the staff in the anesthesia or radiology or, coming soon, cardiac surgery, department is as stable as a pool of itinerant fieldworkers, what will the impact be on the hospital? What will the impact be on the CEO? . . . That is, unless he or she saved their bonuses and left in time to enjoy their skewed memories of success, sipping cocktails on a sandy beach while the hospital board attempts to put the pieces back together again.
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| | Help Us Help You With Helpful Content
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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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