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| | Dear Friend,
Monday's blog post explored how to make your medical group more resilient.
In the book Antifragile, author Nassim Taleb points out that there’s no word that describes the opposite of fragile.
“Fragile” describes something that is injured when shaken.
Something that is resilient isn’t the actual opposite of fragile — it isn’t made better when shaken — it’s just able to withstand being shaken.
But antifragile, in Taleb-speak, describes something that is actually improved when subjected to stress.
We’re at a point in time where there is increasing complexity and change in healthcare and its regulation. Depending on what happens in the 2020 election, we could be heading deep down the drain of healthcare for all, whatever that means. Would that be Medicare for all or VA for all or even something akin to that existing in Great Britain, the National Health Service, in which private practice continues to exist as a separate track. Who knows, any of those are possible.
Is it possible to apply the concept of antifragility to a medical group or a healthcare business? I’m not sure. But, certainly, there are things that you can do now to put your group or other healthcare venture into a better position, should one of those changes occur.
You can use my concept of the Scenario Survey Process™ (read about it here) to develop potential future scenarios and then to devise a strategy that will help you not only survive, but thrive, in as many of those futures as possible.
For example, consider a group or a practice that is currently dependent upon a single hospital or a single referral source. Those relationships are certain to become far more stressed in coming months. They are fragile.
Through the use of the Scenario Survey Process™ the group or practice can examine potential scenarios such as no change in the current regulatory regime, a scenario in which there is only a government option, or a scenario in which there is both a government option and a private option. Those are only examples and many more scenarios could be created.
How then could you begin to best hedge against any such scenario? What relationships can you create and to which facilities might you expand to not only devise a softer landing, but perhaps build a better launching pad no matter what happens?
I don’t have the one, simple solution to this. Nobody does. But that doesn’t mean you shouldn’t start thinking about it today. |
| | Tuesday - Success in Motion Video: Efficiency vs. Efficacy Rebroadcast
Watch Tuesday's video here, or just keep reading below for a revised, more polished transcript: |
| I’ve been thinking about the issue of efficiency vs. efficacy.
Efficiency is simply doing the task the right way, but efficacy has a qualitative difference. Efficacy is doing the right thing the right way.
Recently, I was in Charleston, SC. As I was leaving, I was at the airport a bit early. I heard the gate agent who was moving from gate to gate to assist with departing flights making a similar announcement each time. It went something like “Flight So-and-so to Such-and-such place is about to depart. The doors will be closing in five minutes and will not be re-opening.”
Now, years ago, if you got to a plane a little bit late, they reopened the door. After all, the plane was still sitting there. Sometimes it’s still sitting there for twenty minutes before backing away from the gate.
So why don’t they open them?
The reason they don’t open them is that airlines are now graded for their on-time departures based upon when the gate closes. They then pull the jetway back and magically the plane has “departed” even though it’s still sitting there.
It’s efficient for the airline to close the door and not let crying Mrs. Smith on, and I’ve seen lots of crying people who’ve now had their rest of their day of travel all screwed up.
It’s efficient because they got a wonderful score for having departed on time, when all they did was game the system.
Think about that next time, in the context of healthcare, you’re told that such-and-such is the measure by which you’ll be paid, the measure by which you’ll get the extra slice of money or some other higher form of reimbursement. Does it really make sense? Is that the right thing to be doing?
Consider if it’s simply efficient but not very efficacious.
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| | Wednesday - Medical Group Minute Video: Hospitals Beg to Be Aligned by Physicians
Watch the video here, or just keep reading below for a slightly polished transcript:
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| Over the past decade or so, hospitals have spent countless hundreds of millions of dollars “aligning” physicians.
This so-called alignment has included acquiring physician practices, employing physicians in states without corporate practice of medicine restrictions, and, in states where hospitals can’t directly employ, employment through captive medical groups or foundations.
Hospitals claim that the idea is to “coordinate care.” But the actual goal is to control cash.
More recently, though, there’s been an increasing tide of procedures flowing out of the hospital to outpatient facilities, chiefly to ambulatory surgery centers (ASCs). [If you haven’t already read my book The Impending Death of Hospitals, you should pick up a copy. You can get in on Amazon or you can download a PDF version for free on my website.]
The notion is that as technology advances and as the safety of procedures in the ASC setting increases, more and more procedures are being added to Medicare’s list of approved outpatient surgery center procedures.
Because many if not all private payers follow Medicare’s lead on this, private payers, too, are pushing procedures out to ASCs because reimbursement is much lower and because outcomes are much greater: less chance of infection, more efficiency, happier patients paying lower copays and having much better patient care experiences.
And now we’re seeing something very interesting. In connection with my ASC work – my physician clients forming physician-owned ASCs – we’re seeing hospitals chasing those physician deals, asking, and sometimes begging, to be included as investors in the deal: They want physicians to “align” the hospital!
Hospitals understand that soon they will no longer be able to compete for many procedures that had been done on an inpatient basis and now and forevermore will be done on outpatient basis. They can no longer compete on the basis of having those cases performed in hospital outpatient departments (HOPDs) because reimbursement for the same procedure is up to 80% higher in HOPDs than in ASCs.
As a result, hospitals want to burrow their way into your ASC deal. But why would you want them to align with you? They’re simply after the control, and the profit, that they’re losing on the “hospital” side.
Many would answer that with, “Well, I want money from the hospital to help seed the ASC.”
But the bottom line is that if you vet the decision and the numbers in connection with whether it makes sense to form an ASC – and it does – why do you need even a million dollars from a hospital when in a year or two you could potentially be pumping out two million a year in facility fee profits without them?
Yes, it might be a short-term gain. But “hospital as co-owner” is usually long-term pain.
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| | Thursday - Podcast: Why You Must Know This Negotiation Strategy: Think Like A Buyer Not A Seller |
| Listen to the podcast here, or just keep reading for the transcript
It sounds simple, but in reality, it’s very difficult.
Difficult, that is, to control what appears to be a built-in human nature: The impulse, when dealing with a potential deal partner, to have the mindset of a seller.
Let’s step back for a moment.
Note that I said “mindset” to distinguish the concept of inner talk and expectations from the fact of the matter that you will still engage in activities to, in essence, “sell” the deal, as you desire it, to the potential deal partner, whether we’re talking about a deal with a hospital, a hospital system, a referral source, or with anyone else.
It’s one thing to engage in activities to convince the opposite side to engage your services, or to acquire whatever it is that you’re selling or providing. However, and here’s the point, it is an entirely different thing to do so from the mindset that you are somehow less than, or will be lucky to be selected, or that you are some sort of a supplicant to the other side.
The best way to put this is that even when you are, in actuality, selling, your mindset should be that of a buyer. Would you buy what the other side is selling you?
Let’s put this into a very easy to understand context.
Even in the situation in which your entity is doing a deal, for example, with a hospital system, in which the system will be providing stipend support to you, don’t negotiate as if that stipend support is a gift or a handout or a “May we have more please?”. Instead, view the deal and evaluate it as if you are a buyer of that relationship, with something extremely valuable to offer.
Let your deal partner prove itself worthy of what you have to offer.
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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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