| View this email online if it doesn't display correctly |
|
|
|
| |
Dear Friend,
It's likely you've heard the pitch: “You didn’t go to medical school to run a business. We’ll run the business. You get to practice medicine!”
If you haven’t read it already, take a quick look at last Monday’s blog post, Physician Discontent With Hospital Employment Beginning To Boil. In that post, I discuss the epidemic of discontent among hospital-employed physicians. Instead of seeing the outbreak as a negative, my post explores some of the opportunities that this trend presents.
In a subsequent email exchange, my friend Devona Slater of ACE (Auditing for Compliance and Education), commented that she, too, sees the exit of hospital employed physicians as an opportunity. But then she made a very interesting observation, which I’ve edited slightly for presentation: “It’s just part of the cycle of ‘the grass is always greener,’ but, truly, there are weeds in every yard.”
Many physicians opted for hospital employment, some straight from residency and others from independent practice, because they bought the line that hospitals fed them: “You didn’t go to medical school to run a business. We’ll run the business. You get to practice medicine!”
But the word “hospital” means “bureaucracy.”
I’m seeing several interesting trends. Over the past three or four months I’ve worked on four or five consumer focused medicine projects with physicians, both office practice and hospital-based, who were leaving hospital employment. And, I’m beginning to work with internal medicine physicians pulling out of hospital-affiliated clinic settings to establish rather unique group practices.
Certainly, some physicians will remain hospital employees and, for newly minted physicians with an employee mindset, it will continue to be a viable option. That is, until the worsening financial condition of hospitals renders them unable to support employed and affiliated physician groups.
But for most physicians, having to fill in requisition forms, attend moronic meetings, and report to the clinic medical director, who reports to the regional medical director, who reports to the chief medical officer, who reports to the CEO, isn’t exactly hassle free.
Riffing off of Devona’s “weed” analogy, the layers of bureaucracy that were supposedly meant to insulate the doctors from the “hassles of running a medical practice” out hassled the actual “hassles of running a medical practice.” Go figure. |
| | Tuesday - Success in Motion Video: Medical Group Leaders: What Signals Are You Sending?
Watch Tuesday's video here, or just keep reading below for a slightly polished transcript: |
| Up ahead of me there’s a guy signaling that he’s turning left. You know, signals – they call them “tells” in card games or cons. These are signals that we send, sometimes unconsciously, as in cons or cards. And sometimes consciously, as perhaps in cards.
A signal foretells something that is going to occur.
If you’re a medical group leader, you’re undoubtedly sending signals all the time. Whether they’re the right signals or not is a different story. Let’s walk through an example.
Let’s say that you’re a leader of a hospital-based group – we can pick radiology today – and you’re negotiating with a hospital administrator over the renewal of an exclusive contract. The only problem is, the administrator is dragging you out, the administrator is saying “I’ll get back to you in a week,” but doesn’t.
So what are you doing?
Are you signaling that if the deal isn’t timely discussed and renewed, that you have other options? Or are you signaling total passivity, that you’ll just sit there and wait?
Now, I’m not saying which is the better signal to send at any particular time - there are times and practical purposes for both of those sorts of signals. But are you aware of the signals that you’re sending? Because I guarantee you that you’re sending them.
Try to be conscious of those signals. Look for opportunities where you can use signaling both, for example, vis-à-vis the hospital administrator, as well as in connection with your own dealings with, say, the other members of your group, to your own advantage.
Just like when you’re driving, use those signals.
|
| | | Wednesday - Medical Group Minute Video: Negotiation Rules: Hallway Chat = Boardroom Meeting
Watch the video here, or just keep reading below for a slightly polished transcript:
|
| Picture the following situation:
A large hospital-based group provides contracted services at multiple facilities, including at a hospital that we’ll call Community Memorial St. Mark’s.
The group is in the midst of renegotiating its exclusive contract with the hospital. Early on, the group and the hospital settled on coverage of some newly added slots from 7:00 a.m. to 3:00 p.m. Monday through Friday. The overall coverage obligations became the basis for a fair market valuation analysis.
Then, one morning at around 6:15 a.m., the hospital’s COO passed the group’s leader at the facility, Dr. Bob, in a hospital hallway. The COO said a quick hello and then, in a completely off the cuff, chatty manner, said something to the effect of “think we can handle running those new slots until 5?” Dr. Bob said “yeah” and continued on his way. In retrospect, Dr. Bob doesn’t think that he even stopped walking, the exchange having taken perhaps 3 or 4 seconds.
A few days later, the hospital’s attorney generated a new draft of the revised exclusive contract. It now included a 5:00 p.m. end time, a two-hour increase in coverage in connection with the new slots. Despite the increase in workload, the amount of financial support from the hospital remained the same.
Dr. Bob was furious. To him, the hallway “chat” was just that: an exchange of pleasantries and an optimistic expression of the growth of the venture. But it was absolutely not a part of the current negotiation process. To Bob, the COO had engaged in “drive by” negotiation.
The COO, on the other hand, didn’t see anything wrong with the conversation. To him, it was a brief exchange on an important deal point, one on which he obtained Dr. Bob’s assent.
What went wrong, and why?
It boils down to a matter of perception of the negotiating process.
Physicians inexperienced in business often mistakenly regard hospital negotiation as a formal process separate from day to day activities at the facility. When at the facility, they are on their way to render patient care or are headed back to the office or out the door. Hallways are not negotiation tables. For many physicians, location is a factor in negotiation – the physical context controls the question of whether or not there is intended content.
To a hospital administrator, all discussions with contracting parties, whenever and wherever, are part of the negotiation process. The executive’s office, the board room, the wash room, or the hallway, even the check out line at the local market, are all simply locations – and to him or her, location is not important; it is content, not physical context, that controls.
Because you can count on the fact that hospital administrators are not going to change their perception of the immateriality of physical location to negotiation, it’s incumbent on physicians to learn this lesson and learn it well. Any communication with, or within earshot of, an administrator is a part of the negotiation process.
Physicians can never have an “off the record” conversation with an administrator. The only alternative is to have no communication at all; hardly an effective strategy. Understanding this rule allows physicians leaders to both protect their negotiating positions and to use “informal” communication with administration proactively to inform and dis-inform in the context of a controlled negotiation.
|
| | Thursday - Podcast: Don’t Confuse Strategy With Tactics (Or With Garbage) |
| Listen to the podcast here, or just keep reading for the transcript
I was asked about strategy versus tactics and thought that I’d revive and revise a prior post on the topic.
Several years ago, I read a review in a magazine for consultants of a new book by an “expert” who advises that since business now moves at the speed of light, the “old” strategic question of “where do you want to be X years from now?” must now be “where do you want to be a few days from now?” That’s total B.S.!
Perhaps if doing business is limited to posting on Twitter, imagining until next Tuesday is a long term view. But it is sheer lunacy if you are running a real business, especially a medical group or other healthcare business.
Too many physician groups either have no strategic plan and are therefore totally reactive to events, or have a plan of sorts that actually consists of unintegrated tactics. This has contributed in no small part to physicians’ loss of control over healthcare.
Strategy is the map of your intended destination, not simply of each individual stop along a way that is left to chance. Tactics are steps in the implementation of strategy.
You want to be able to implement tactics and to change them as necessary as quickly as possible — on a few days or even a few moments notice. But those tactics are only important if they are aligned with your group’s overall business strategy; they are not a substitute for a strategy. And, if you plan on being in business a few years from now, your strategic view has to be at least that long … or much longer.
|
| | | | 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.
|
| | | | 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. |
| | | |
|
