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| Dear Friend,
Do you have a dream for a bigger and better future?
That's the subject of this past Monday's blog post, What Are You Dreaming? Follow that link to the blog or just keep reading for the rest of the story:
It’s Martin Luther King Day and we honor the civil rights leader who had a dream.
Quoting from his speech on August 28, 1963, King stated, “I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin, but by the content of their character. I have a dream today!”
When Rev. King used the term “dream,” he was not speaking of something past, something simply nocturnally ephemeral, but of an active belief, one that will be instantiated, one that will influence action and outcome.
Certainly, the discussions on this blog are at the business level, not that of the civil rights plane. However, even at that level, the business level, the notion of a dream, a belief, an intention, can and does drive action and change the future.
Some might argue that facts are facts and that mindset can’t change them. But what might play out in the uncertain future can’t yet be called facts and mindset drives action that can and does impact the to-become-facts as they unfold for you.
At a recent conference, an instant survey of physician attendants indicated that most believed their incomes will be lower 5 years out.
Will payers attempt to reduce physician reimbursement over the next 5 years? Yes, probably.
Will more physicians become hospital or large group employees over the intervening years and will those employers attempt to ratchet down their compensation? Yes, it’s possible.
But those outcomes are not certain and neither controls total income nor one’s own particular income.
The problem with believing that your own income will be down is that you’re telling yourself to accept it and accept it you will.
Although thoughts alone won’t change a thing, thoughts influence actions and actions influence outcomes.
How would a baseball team play if the players believed they were going to lose? Poorly; why even try. Would the team play differently if the players knew they were going to win? You bet it would.
It’s your future. You can do what you want.
But if you ask me, why not believe not only that your income will be up 5 years from now, but that it will be up 10 times or more. Either way, believing you’ll be better off or worse off 5 years from now takes the same mental energy. But those beliefs will impact your choices and your actions.
And, as an added bonus, you can employ all those other docs who are setting themselves up to accept less.
It’ll be win-win. Everyone’s expectations will be met. |
| | Tuesday - Success in Motion Video: What A Bad Waiter Can Teach Medical Leaders
Watch Tuesday's video here, or just keep reading below for a revised, more polished transcript: |
| If you’re like most people, in fact if you’re like anyone, you’ve had a bad dining experience.
Think of a time that you went to a very nice restaurant. Maybe it was an intimate, personal, dining experience. Or, maybe it was the equivalent version of a business meal, where you wanted to engage in a serious discussion.
But the waiter, instead of simply taking your order and coming by once in a while to check up on how you’re doing, he or she is hovering around you, interrupting you.
It’s the quintessential, “how’s the food?”, when it’s clear you haven’t tasted it yet. Or “do you need anything else?”, when you’ve just stuck a forkful of food in your mouth and you’re chewing.
Of course, there’s the opposite kind of bad dining experience where the waiter can’t be found. You need more coffee (no waiter), or more water (no waiter), or you need your check (no waiter).
And of course, there’s that happy medium, the sweet spot where the waiter is attentive, but not too attentive.
That’s the same model, that attentive-yet-not-too-attentive waiter model that you can apply to relationships - how you stroke and curry relationships in business.
How often do you touch base with referral sources and contracting partners? Do you touch base with them enough to see how things are going, but not touch base with them too much?
If you’re not touching base with them at all unless there’s a problem, then you’re missing out on a very large opportunity. An opportunity that could help you extend your contractual relationships, that could help you get additional referrals, and potentially help you get referrals to other referral sources.
Think about the waiter experience . . . and not just when you’re dining.
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| | Wednesday - Medical Group Minute Video: Hospital Abandons Physician ASC Partners
Watch the video here, or just keep reading below for a slightly polished transcript:
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| I read a news piece on a health system in Memphis called Methodist Le Bonheur Healthcare that had announced that it would be closing the joint venture ASC that it operates in concert with over one hundred physician partners.
The hospital system announced that it no longer made sense to perform outpatient surgery via a joint ventured ASC.
That leads to the question: it no longer made sense for whom?
Let’s try to unpack this. I have no inside track on this, but did it make sense for a hospital to run a joint venture? Well, what are its options?
One option is it doesn’t run a joint venture ASC, it runs an on-campus facility as a hospital outpatient department. If it runs a hospital outpatient department, it will receive higher fees, not only because the outpatient department is 100% hospital owned, but also because the fee for each procedure will be higher than that on the ASC fee schedule. That’s because it will be paid for pursuant to the richer hospital outpatient fee schedule.
However, the writing is already on the wall that HOPD fees will be cut down to the ASC level sooner or later. While it might provide some sort of short-term benefit to the hospital, it’s not a very effective long-term strategy.
Or, was it the hospital’s decision at all? Perhaps it was the decision of the physicians that they no longer needed a hospital partner to operate an ASC?
After all, what do hospitals add to joint ventures?
They add demands for control. This is especially true of non-profit hospitals who claim that control is essential to maintain their non-profit status – but that isn’t true.
They generally add layers and layers of hospital administration, which is completely out of touch with running an efficient and efficacious ASC.
Other than putting some money into the deal which can easily be borrowed or raised from physician partners in the deal, there’s very little that a hospital can add, which leads to a few points.
1.) If you’re in a position like those joint venture physicians were of having a hospital partner, you have to question whether hospitals will see the writing on the wall and sooner or later pull out, either in an attempt to reap some remaining benefit from the HOPD fee schedule, or because they simply realize that they’re going to be cut by the physicians sooner or later.
2.) You must question whether you need not only a hospital partner at all, but any equity-based developer of your surgery center. There are tremendous opportunities for physicians to completely own surgery centers whether these are solo facilities or whether these are facilities owned by many physicians. Whether they’re single-specialty or multi-specialty, the analysis turns on the same factors each time and that is whether you have a sufficient number of cases with CPT codes that generate sufficient cash flow to make the operation a success.
The place to start is asking questions and performing that initial analysis, and then you go from there.
If you’re not asking the question, you’re never going to know.
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| | Thursday - Podcast: Walmart Explores New Healthcare Delivery Concept |
| Listen to the podcast here, or just keep reading for the transcript.
I came across a news release about another healthcare venture by Wal-Mart. This one’s interesting.
So, picture a large Wal-Mart store, with an extremely large parking lot sitting in front of it. In some cases that parking lot is bigger than what’s required by codes.
So Wal-Mart is now exploring the concept of creating Wal-Mart “town centers” which are essentially the creation of a parking lot “mall” around the Wal-Mart, in which they’ll lease space to stores that don’t compete with Wal-Mart but sort of compliment the offerings of the Wal-Mart.
Of course, one of the area’s they’re looking at is placing healthcare practice or service type entities into those town centers.
So, a couple things:
1.) Once Wal-Mart establishes the proof-of-concept, you can be pretty sure they’re going to big or go home. In other words, it’s either going to be something they pursue in many areas of the country, or it’s going to be something that they discover doesn’t work and they’ll simply lease to non-healthcare ventures
2.) Even more importantly, it means an interesting type of new opportunity for physician-led ventures. Whether that’s the establishment of a clinic or office location at a Wal-Mart town center, or probably more likely looking for other big-box type draws akin to the mall situation, in which a mall developer places very large department stores at central points in the mall and then leases at far more profit to lots of specialty retailers in between.
Maybe that’s a model that’s dying in parts of the country due to Amazon, but certainly the Wal-Marts and other similar big-box draws pull in tremendous foot traffic – patient traffic.
So what kind of deals can be made with those types of patient magnets for more consumer type medicine facilities?
In concert with my development partner, we’re looking not only at other surgery center ventures, but a wide range of real estate-oriented ventures, whether it’s improved lease space or built-out space for surgery centers, medical office buildings, imaging facilities, what I term to be “Massive Outpatient Clinics”, ventures with all of the elements of a hospital without the money-sucking sorts, the type that requires union labor and too-big box.
So get ahold of me if you want to talk about this in any way, any event. Consider these sorts of opportunities of new ways of looking at your practice, business, or at how you look at what you do.
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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 June 5, 2020, at The Advanced Institute for Anesthesia Billing and 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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