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Dear Friend,
You get what you pay for.
Herman Cain withdrew his name from consideration for a Fed seat because he couldn’t afford (or didn’t want) to work for the relatively low pay.
So, how can you expect one of your partners to devote time to running your medical group, if you won’t compensate him or her for it?
After all, you get what you pay for.
If you try to get it without paying for it, you won’t get much of it, at least not of high quality.
And you are probably stealing. The irony is that you are stealing from yourself, from your future.
Medical Group Compensation Plans
What does your medical group’s compensation plan compensate for? The usual answer is “productivity,” whether measured in units or minutes or by some other standard.
If your group compensates for X, you will get more of X. So if X is units, your group’s physicians will be motivated to maximize their production of units.
But if your group compensates for X and also wants Y, you will get a lot of X and not very much, if any, Y.
For many medical groups, Y is leadership. They want their group leaders to lead, but their compensation plans incentivize only the production of units.
Is it any surprise that the “leadership stuff” is relegated to the wee hours of the night or even to the wee hours of never? Is it any surprise that there’s no actual leadership, only “consensus?” Is it any surprise that the leaders schedule business meetings at 7 pm or on weekends, signaling amateur status?
If you don’t pay for leadership, you won’t get much, if any, of it. You will create tension. You will create resentment. But you will not create leadership.
You’ll be stealing from the leaders – either from their ability to generate units or from their time for themselves or with their families.
And, as a result you will get a very weak form of leadership, one that results in your group stealing from its own future in the form of poor decisions and lost opportunities.
You’ve got great plans to take over the region or to simply protect your position at one facility. You expect your leaders to achieve that goal. Yet you’ve incentivized them away from your goal. Don’t blame them when you never get there. Blame yourself.
It’s time to make sure that your group’s compensation plan is in synch with your group’s business strategy and future.
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| | Tuesday - Success in Motion Video: Leadership Mindset And Medical Group Success
Watch Tuesday's video here, or just keep reading below for a slightly polished transcript: |
| I’m thinking this morning about mindset, and about how slight changes in the mindset of a medical group’s leader or leaders could make a significant difference to the group and its success.
Up the road are two large hardware stores, “do it yourself” centers: a Lowes, and then further up the street, a Home Depot. There are many things that group leaders can do themselves, but if you were going to build a kitchen in your house, would you do it yourself?
Now there are some outliers. I have a physician friend whom I’ve spoken about before who is a master woodworker, and I’ve seen the cabinets he could build in your kitchen. The only problem is you can’t afford them – they are that exquisite, and that expensive.
The reality is, though, that he can’t really afford to build you those cabinets, because building those cabinets is not the highest and best use of his time. Just like learning to do podiatric surgery on my left foot isn’t the best use of my time, even assuming that I could get my left foot numb enough to allow me to embark on my part-time podiatry career.
So what holds many groups back is the inability to grasp and to change the mindset that many of the things they need to do, whether it’s in terms of personnel, whether it’s terms of outside expert advice, whether it’s in terms of any sort of “spot” knowledge, or even ongoing knowledge that is outside the normal skill set of the group . . . that purchasing that isn’t a cost. If it’s viewed simply as a cost, then of course you’re going to minimize your costs.
But if you look at the return that could be generated, both from spending your own time on your, in essence, highest and best use, within what Dan Sullivan in the coaching program I go to, Strategic Coach, calls your “unique ability,” and allowing others to exercise and perform for you in theirs, it produces a tremendous return for your business, a return on the investment, a return on relationship.
Just a simple switch, the switch from “cost” to “investment.” It might sound trite, but the reality is that it makes a world of difference.
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| | | Wednesday - Medical Group Minute Video: The Problem Of Perception: Healthcare Collaboration – Rebroadcast
Watch the video here, or just keep reading below for a slightly polished transcript:
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| 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.
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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 ACOs, physician alignment, hospital-physician collaboration and other initiatives to bind physicians 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 the physicians control it.
The hospital’s CEO is turning pink! What color, exactly?
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| | Thursday - Podcast: Complain. Get Fired. Get $17.5 Million. |
| Listen to the podcast here, or just keep reading for the transcript
The next thing you know she was fired.
Unfortunately, it’s an all too common experience.
A physician raises honest criticism or files a heartfelt complaint concerning another member of the medical staff or another member of her group. She’s fired.
The lead surgeon in a hospital-supported cardiac clinic questions the impact on patient care of a decision by hospital administration. He’s replaced.
The group negotiating for the renewal of an exclusive contract questions a hospital demand as violative of the federal Anti-Kickback Statute. They’re terminated.
Suck it up and go home? Or say “$%^& it” and go sue?
Last month, the Seattle Times featured a story concerning David Newell, M.D., a neurosurgeon once employed by Swedish Health of Seattle.
In 2016, Swedish Health fired Dr. Newell, allegedly because he didn’t notify the employer that he had been arrested in a prostitution sting.
Newell didn’t deny his brush with the law. In fact, he pleaded guilty to the charges, paid a fine, and performed community service.
But Newell alleged that that wasn’t the actual cause of his termination.
In a claim filed against Swedish Health, he alleged that the real reason behind his termination was that he was one of several hospital staff who had filed internal complaints regarding star Swedish Health surgeon Johnny Delashaw, M.D. who later resigned from Swedish Health and had his Washington medical license suspended. In complaints to Swedish Health, Newell said that Delashaw was trying to marginalize him, steal his cases, and get him fired on flimsy grounds.
Newell alleged in arbitration that Swedish and its parent organization, Providence, engaged in a pattern of targeting and interfering with his and other neurosurgeons’ practices, retaliatory behavior relating to his reporting of Delashaw, and a disregard for patient safety. He alleged that they “stole” his practice by firing him.
The arbitrator agreed, awarding him $16.5 million in compensatory damages and $1 million for emotional distress.
Swedish Hospital and its parent, Providence, are challenging the arbitrator’s award in court.
Although we know what the arbitrator found, neither you nor I know the actual reasons behind Newell’s termination. That said, the situation serves as a flashpoint to discuss the situation of retaliatory termination and of claims of retaliation.
The arbitrator’s award to Newell signals the significant damages that can result from a finding of retaliatory termination. Does this mean that employers or hospitals will simply “dress up” termination to make it appear as if it were for a valid reason? If Swedish Hospital’s prostitution sting rationale were a “pig in a dress” excuse, it was still a pig, at least up to and including the arbitrator’s award.
Does it mean that employees or even contracting parties will take strategic action to create a history of complaints and reports to block future termination? We’d have to be lying to ourselves if we didn’t admit that hospitals and medical staffs have engaged in that sort of behavior in the reverse for years, even decades.
Retaliation is real. So, too, are false claims of it. No arbitrator or court has a laser beam into “the truth” of the situation, if purity of cause even exists in the absolute sense.
From a practical standpoint, this means that individuals and entities on the receiving end of retaliation must make the tough choice about whether to take a stand against it, knowing that the individuals and entities on the delivering end will themselves claim, rightly or wrongly, a legally valid reason for their action.
From a practical standpoint, it also means that the circumstances can and will be “gamed.” No system is perfect.
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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 here.
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| | | Come listen to Mark speak in sunny Las Vegas at the Advanced Institute for Anesthesia Billing and Practice Management Conference. Celebrating its 20th year, the AIABPM conference is the recognized leader in preparing physician and nurse leaders, practice managers, coders and attorneys to secure the future of anesthesia practices. |
| | | | 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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