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| Dear Friend,
Fear.
That's the subject of Monday's blog post, FOBO – Fear of Branching Out. Follow that link to the blog, or keep reading for the entire post.
You’re undoubtedly familiar with the term “FOMO” – Fear Of Missing Out – used to described the situation in which someone is terrified that unless they jump to do this or that, they will somehow miss out on some fantastic opportunity.
However, the opposite problem, what I would call “Fear of Branching Out,” or FOBO, impacts many medical group leaders.
Let’s pick an avatar; the leader of the Cautious Anesthesia Group at Community Memorial St. Mark’s Hospital in Someburg, USA, with a cohort of seventy anesthesiologists, and maybe some CRNAs, too. The group provides services pursuant to an exclusive contract that’s been running, with extensions, for fifteen years.
Now another opportunity comes at a hospital five miles away. Does Cautious’s leader pursue that opportunity?
No. But why? In the words of the group’s leader, “we have to show we’re dedicated to Community Memorial St. Mark’s. What if Community Memorial finds out we’re working someplace else? What it we can’t manage both facilities?”
But these days, having a contractual relationship with only one facility is a sign of tremendous weakness, and it’s being signaled loud and clear by Cautious to Community Memorial St. Mark’s.
As a result, Community Memorial St. Mark’s now knows that if Cautious doesn’t bend to its demands in connection with the next renewal of the contract, there’s no further reason for the group to continue to exist.
If you’re the hospital administrator, think how much pressure you could put on them!
The same dynamic exists in many other contexts. It could be an imaging facility with MRIs that cost a prohibitive amount to move; you’re the landlord demanding high rent upon lease renewal — just how high is high?
Sure, I’ve represented clients who’ve been put in a take it or leave it situation by the single facility they covered . . . and the group just pulled the plug. But most groups won’t walk; most groups cave.
Don’t put yourself in the position of having to cave simply to preserve whatever vestige of business remains. Build your negotiating strength and do it through building your options.
Think about it. The more options you have, well, the more options you have. |
| | | Business Life in the Time of Coronavirus Mini-Series
The coronavirus crisis caused a short term economic crisis for many medical groups. Our mini-series shows you the way out. Plus, many of the concepts discussed are applicable during both good times and bad.
[If you haven't already seen them, follow this link to watch our entire series.] |
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Watch Tuesday's video here, or just keep reading below for a revised, more polished transcript:
I want to talk with you today about dirigibles, lighter than air craft, and cakes.
There are other examples we could use, but I think it's a good place to start.
It's often bemoaned that industries, or experts in an industry, or leaders in an industry, suffer from being in an echo chamber. All they know about is the way that other health care deals, or other ASCs, or other whatever are organized.
But that's a shame, because there are many valuable lessons from other industries.
And that's one of the things that I've drawn on over a career that started with working in restaurants, being a janitor, doing real estate deals, and so on.
But, even if you haven't done any of that, there are some tools you can use to imagine different ways of structuring your business, whether your business is an anesthesia group, a hospital, a whatever.
Much of what I’m going to talk to you about today is inspired by a book by Mark Fox called Da Vinci and the 40 Answers. In the book, Fox interprets concepts developed in the former Soviet Union by Genrich Altshuller. At one point, Altshuller was an employee in the equivalent of the patent office. He was also some sort of an inventor, a scientist who realized over the course of assessing patent applications that ideas could be put into a number of categories. Fox identified 40. I'm not sure if Altshuller identified 40 or 36 or 62; it doesn't make any difference.
The acronym for Altshuller's thinking was either pronounced “tris” or “trees”, I'm not sure. In English text it appears as TRIZ. The notion is that there are models or basic formulae to follow, to guide your thinking, in inventing or in making improvements.
So, for example, the concept of the dirigible, a lighter than air craft, is something that floats above an existing structure and the notion of the cake is cutting something up into pieces, Into constituent parts. (As I'm driving, I'm not sure if either of these examples are ones that Fox or Altshuller used, but they describe the concepts.)
Think about this in the context of healthcare. An ambulatory surgery center is simply the O.R. cut out of a hospital.
A free-standing emergency room, which exists in some states, is another example. It's the ER cut out of a hospital and then made into a free-standing entity.
The concept of an MSO could be conceived of multiple ways.
It could be conceived of as something like the dirigible that floats above an existing structure or structures and acts to perform centralized functions - in essence providing a service to multiple medical groups.
Or, an MSO could be conceived of as cutting something out, in which an existing group takes its own business structure, removes it from itself, uses it to manage itself, and then expands by bringing in other customers, that is, other medical groups to which the MSO provides services. Perhaps in the end, the concept morphs into one of combination, with the MSO forming the center piece of a merger of the various managed groups.
Think about how other structures, other concepts can be used as models for your current business or for a new business. Don't simply "want an ASC," but use the various underlying concepts to guide the structure and development of your entity.
This is something we do for clients on a regular basis in connection with strategy level work. I'd be happy to talk with you about it - contact me.
I also suggest that you find the book Da Vinci and the 40 Answers by Mark Fox. It's a very good read. |
| | How to Deploy the Secret Sauce of Opportunistic Strategy
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They say that COVID-19 has changed the world, creating the "new normal." Many of your colleagues and many hospital administrators are running scared.
Others, leaders like you, know that crisis means opportunity.
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Others see a crisis and freeze in fear. Learn how to see the opportunities and obtain the tools to increase your odds of obtaining them.
The price to attend is $479. The cost of not attending is astronomical. |
| | | | 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, hospital systems 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™.
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| | | Listen to the podcast here, or just keep reading for the transcript.
Both state and national level politicians certainly know what side the bread is buttered on, and who’s doing the buttering. There are far more patients than there are physicians, thus the rush to fix the problem they’ve defined as “surprise medical bills.”
Sure, just like I’m surprised when I pay good money for admission to a baseball game and then find out that the beer isn’t free! What? It’s completely unfair!
By framing the issue from the position of the average voter, politicians think the solution to the problem that they’ve defined as “surprise” is to force physicians to take contracted rates that they never bargained for or, and why not, simply go to arbitration.
But wait, will you be “surprised” when you find out that arbitration isn’t free or even discounted? What do you mean, why isn’t it free? Will there be legislation to remedy the surprise arbitration cost problem? Don’t hold your breath.
Physicians can’t change the fact that most politicians are simply second handers who create nothing, but crave power. But at least physicians can make an attempt to define the language used in the out of network situation to gain traction in framing what the issue really is: Insurance companies refuse to contract at reasonable rates. Insurance companies want to cut out the cost of contracting and still force “contracted” rates down physician’s throats. By narrowly contacting, insurance companies can then put their fingers on the scale of what contacted rates in “the community” (supposedly) are.
But, of course, if insurance companies don’t have a contract with someone to accept a lower, contracted rate, why should they be entitled to any rate other than full rates? The one-sided “right” to impose a discount is, in essence, imposing a form of slavery on the non-contracted physicians: it’s taking value from you without paying you an agreed upon value in return.
Perhaps physicians are afraid to talk this way.
So how about this frame: Why should anyone be forced to accept a contracted rate they didn’t contract for? If insurance companies are interested in contracting they should reach out and do it. If they’re not, then either they or the patient should be responsible for the full fee. It’s as simple as that. Just like my ticket to the game doesn’t get me free beer unless I bought some sort of package deal.
If you simply sit back and leave it up to political power, then the situation will become what is attributed to Benjamin Franklin (I know, I know, he probably didn’t actually say it), “democracy is two wolves and a lamb sitting down to the vote on what to have for lunch.”
Unless you frame the issue, you will continue to be on the menu.
Hungry anyone? |
| | | Calibrate Your Compass
Read our exclusive RedPaper to guide you through this evolving situation.
The coronavirus crisis caused a short term economic crisis for many medical groups. Our RedPaper shows you the way out. Plus, many of the concepts discussed are applicable during both good times and bad.
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| | Help Us Help You With Helpful Content
What tailored content would you most like to see during this time? How can we focus on solutions to your most pressing strategic concerns?
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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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| | | | | | 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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