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| | Dear Friend,
This past Monday, the blog explored Mayo Clinic's announced hospital closure.
The tides of healthcare ebb and flow like the width of men’s ties and the political affiliation of Michael Bloomberg.
Seemingly set with a huge population of baby boomers needing their wares to remain healthy or, metaphorically speaking, to “come in for a soft landing,” and spurred on by politicians who thought they were anointed to nudge us, they grew rapaciously.
But now the tide’s going out.
A bit more than a week ago, the Mayo Clinic Health System announced that it was shuttering a hospital and two related clinics located in Springfield and Lamberton, Minnesota.
Among the multiple factors that Mayo cited for the shutdown were the growth in other healthcare options and their inability to recruit physicians.
Seemingly, though, a dose of mismanagement and staff model thinking contributed to the mess: The hospital used its staff of emergency department providers to care for hospitalized patients. Apparently, it took them too long to realize that emergency medicine physicians aren’t internists or hospitalists.
According to a press release, James Hebl, M.D., Mayo’s regional vice president, said that “the skills required for each can be vastly different.” (You can’t make this stuff up.)
The story is another breadcrumb on the trail of the Impending Death of Hospitals. For physicians, it leads to the conclusion that:
1. There is no longer safety in hospital employment.
2. That contracted medical groups, especially hospital-based groups such as anesthesiologists and radiologists, can’t be dependent upon any single hospital or single hospital system relationship.
3. That there is huge opportunity in alternatives to hospitals, such as ASCs and MOCs™, physician-owned Massive Outpatient Clinics™. |
| | Tuesday - Success in Motion Video: There Are Few Do Overs In Deals
Watch Tuesday's video here, or just keep reading below for a revised, more polished transcript: |
| | I want to talk with you today about "do overs." The fact is that in many cases, medical groups don’t get a "do over."
I’m heading into the office this morning. A few minutes ago, I realized that I left my cell phone at home, so I turned around and went back to get it. I’m sure you’ve done the same thing more than once. I know I have.
But in terms of many, not all, but many of the decisions that medical group leaders or practice leaders, even if it’s a solo practice, have to make, there’s no "do over" possible.
For example, maybe it's a deal in which you're putting together a venture in which the other party is going to be billing for you. Is that something that will get you into significant compliance issues later? (Often the answer is a resounding "yes.")
Or, for example, maybe it's making a decision to assign a physician to a work at some new location, when no thought was put into your ability to do so when crafting that person’s employment contract. Will that later come back and result in a multi-million dollar lawsuit? (It has.)
These are just the equivalent of the old carpenter rule of “measure twice, cut once.”
I understand that sometimes, in the heat of things, deals move quickly, and people don’t want to slow down and do the proper thinking. I understand that sometimes there’s a strange belief that not vetting a deal up front will save money, when the reality is that it can cost you millions. You’re a hero when you saved the group $20,000 up front. You're a goat when it later ends up costing the group $5 million.
Sure, in some instances, it’s possible to turn around. You’ve gone down the wrong road, so turn around and go back.
But in many instances, that’s not possible.
The better rule, the safer rule, the simpler rule, the sort of quick-and-dirty heuristic, is to actually plan up front. Slow down, take enough time to make sure you have the right advice. Make sure that you’ve considered as many of the issues as possible. And then make your decision.
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| | Wednesday - Medical Group Minute Video: Driverless Cars and the Death of Hospitals
Watch the video here, or just keep reading below for a slightly polished transcript:
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| I’ve yet to see a driverless car, but I bet that it’s headed to the funeral of some hospital.
Google’s driverless cars have logged over 100,000 miles without incident. I don’t know how many car drivers will want to give up the control, but I’d bet that large trucking companies are doing the calculations: fewer accidents, no caps on hours driven per day, and, most important, no drivers to pay.
And, I’m not talking twenty years out, I’m talking two or three years, max.
Technological leaps of the same magnitude are impacting healthcare and the pace is certain to increase. For example, robotics in hospitals, from the delivery of supplies to robot-assisted surgery will impact both the labor needs within a hospital and the potential location of the surgery and the surgeon (if one is needed at all). Or, for example, the miniaturization of equipment, including monitors.
Ponder what this means for the future of hospitals, at least in their present configuration. And ponder what it means, both in negative impact and in opportunities, for you.
Hospitals are, essentially, large factories. Those factories can be broken down into components. Chief among them are their main economic engine, the operating rooms, and their hotel-like, patient bed functions.
Compare this with freestanding ambulatory surgery centers. They’re hospitals minus the hotel functions.
So, if cars can drive themselves, trucks will be self-driving soon. And if trucks can self-drive, so can ambulances. And here’s the quite plausible leap: if ambulances can self-drive, so can, taking advantage of computerization, robotization and miniaturization, hospital rooms.
Imagine a hospital that’s akin to an ASC and an airport terminal. Patients are picked up at home in a shipping crate size, self contained, self-driving hospital room pod. The pod travels to the hospital and “docks.” The patient has the procedure inside the facility’s O.R., and returns to the pod.
The pod could be un-docked and shifted to an area adjacent to the building, and stacked and sorted robotically in the manner of shipping containers within a present day storage facility. When it’s safe to send the patient farther away from the hospital hub, the pod would be driven back to the patient’s home, where it would remain until discharge.
Due to the effects of miniaturization and remote monitoring, the patient would be under constant supervision, chiefly robotic but with some human participation. Some follow up procedures could be performed remotely. And, if a problem were to arise, there’d be no need to call an ambulance; the entire “room” would start driving to the hospital and could even be met part way by paramedics or other responders.
Or, for minor surgery, those procedures commonly performed today in an ASC, the entire O.R. and its now minimal staff could be contained in the pod and transported to the patient’s home. The procedure would take place and the patient then assisted back into their home; the “O.R.” would then drive to the next case. What’s lost in terms of case turnover is gained in term of huge reduction in operating expenses. Little staff, little space. In fact, if the procedure could be performed remotely or completely robotically, the notion of turnover time between cases might go the way of the covered wagon.
Sure, I could be wrong about some of this, but not all of this.
How will this impact referral patters? How will this impact where physicians work? How will this impact the notion of exclusive contracting or ACOs? Or, just as physicians branched out to ACOs taking procedures away from hospitals, will physician-owned mobile units obviate the need for hospitals themselves except for the most serious of surgical cases?
It’s not that the rules will be changing. The whole game will change.
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| | Thursday - Podcast: Disruptive Physicians And Avoiding The Death Of Your Medical Group |
| Listen to the podcast here, or just keep reading for the transcript
As humans, we’re primed by evolutionary forces to fear the loss of something much more than we value an equivalent gain.
That’s why many medical group leaders are concerned that market and other pressures will have a significantly negative impact on their group. From competition from hospital-aligned physicians, to the failure of the hospital, to increasing pressure from far better capitalized, venture backed practices, these and other concerns actually do keep you up at night.
But while medical group leaders are keenly focused on the dangers from the outside, there are dangers lurking inside groups, as well, just as dangerous, or maybe even more so.
You recruit Dr. Stacy because of the sterling CV and other credentials. College in Cambridge, medical school in Cambridge (the other one), and trained at an even more famous place at the elbow of a Nobel laureate.
And then six months later, you learn that Stacy might just be a pathological a-hole. Stacy badmouths your group to the hospital CEO. Stacy questions your leadership abilities in the cafeteria, but never in a conference room with you present. Stacy works with your competitor to undermine your group. Stacy screams at nurses. Stacy might even throw scalpels, not as a hobby at children’s birthday parties, but in the actual operating room. Yes, these are all real-life examples of real-life Stacy, an amalgam of Stacies, of course.
It’s important to distinguish your Stacy, the poster child for disruptive physicians, from a simple nonconformist. Nonconformists aren’t trying to take your group down. Nonconformists aren’t conspiring against your leadership or the group’s future. As they say, they simply march to the beat of a different drummer – they didn’t pop out of the same mold as the rest of the group. Nonconformists can easily be contained and even harnessed to the group’s benefit.
But there’s no pH strip or imaging procedure that definitively diagnoses the difference. (Some from former Eastern Bloc countries have hinted that there may be a highly invasive procedure, but that’s another story.)
Fortunately, disruptive physicians leave snail-like trails. Before jumping to the conclusion that your Stacy is a disruptor, pause and question motives at the same time that you’re examining evidence. Is it truly disruptive action that should lead to, perhaps, one warning and then termination, or is it, instead, nonconformity that can be made to be beneficial to your group’s success.
Because wrongful termination claims are far more common than thrown scalpels, it also pays to get legal advice in connection with the determination and, certainly, before any actual termination.
The worst thing you can do is to do nothing. Lopping off a gangrenous toe, after an attempt to resolve it less drastically, is better than letting the patient (or your medical group) die.
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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 on January 17, 2020, at the American Society of Anesthesiologists Conference on Practice Management.
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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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