Is Your Medical Practice A Social Service Or A Business?

Is your practice a social service or is it a business? These are two entirely different goals and if a definitive answer doesn’t immediately pop out of your mouth you’re in trouble. A dog may have four legs, but it can only walk in one direction at a time. Today, with the communal notions of …

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Physicians Must Brand Their Role in Healthcare – Podcast

As hospitals quicken their pace to replace physicians with paraprofessionals, physicians must brand their role in healthcare or suffer the consequences.

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St. Bully Medical Center

Bully. We’re not talking Teddy Roosevelt, we’re talking intimidation. There’s been a lot of talk about bullying of hospital staff by physicians and even of bullying by nurses of junior staff and of younger physicians.  Hospitals, through their personnel function, and medical staffs, by way of medical staff discipline and physician wellbeing, are expected to police …

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Who Asked The Patient If She Wants A Hospitalist?

Sally hired Beth, the most sought after wedding planner in Centerville to coordinate her wedding at the Community House, a high-end hotel.  Beth planned the flowers, the menu and every other aspect of the ceremony and reception. You see, Sally had hired Beth for her expertise; the Community House was just the place, a nice …

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Two Wolves and A Lamb – Podcast

Hospitals and the government have decided that physicians must collaborate financially in order to deliver quality healthcare. Of course, that’s a lie.

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Is Your Medical Practice A Social Service Or A Business?Physicians Must Brand Their Role in Healthcare – PodcastSt. Bully Medical CenterWho Asked The Patient If She Wants A Hospitalist?Two Wolves and A Lamb – Podcast

Feb
06

Is Your Medical Practice A Social Service Or A Business?

Is your practice a social service or is it a business?

These are two entirely different goals and if a definitive answer doesn’t immediately pop out of your mouth you’re in trouble. A dog may have four legs, but it can only walk in one direction at a time.

Today, with the communal notions of the “We” society in full swing, physicians are, in essence, being told by politicians, pundits and the press that you are in social services: They don’t see a healthcare market; they see a healthcare system, one that exists to serve the public, a significant portion of which believes that healthcare is a right and that it should be as free as air — or at least free to them . . . the “rich” should pay for it.

Of course, not everyone that says this believes it. Some say it just to get votes. Some say it just to get free stuff. And hospitals that want to herd you into an ACO or want to employee you at bargain basement (oops, I mean fair market value) compensation tell you that you need to economically align with them in order to deliver quality care to the public —  that’s our mission, isn’t it?

Now I’m not saying that you should not be focused on delivering quality care, but you first have to make the decision if, for you, you’re doing this as a viable business in which you have control over your future or whether you’re doing this as a cog in the wheel of the healthcare factory run by the hospital or the government.

If it’s the former, then you need to become much more active in conducting your practice as a business, both in order to compete with the large groups operating in many of the medical specialties which absolutely operate as businesses, as well as to push back against the trend toward the socialization of healthcare.

There is another alternative of course, there always is. And that’s that as opposed to going back to school, as so many physicians did, to get MBAs to understand how to run practices in the face of managed care, perhaps you should go back to school and get a masters in social work.

Mark F. Weiss

Feb
03

Physicians Must Brand Their Role in Healthcare – Podcast

As hospitals quicken their pace to replace physicians with paraprofessionals, physicians must brand their role in healthcare or suffer the consequences.

Play

Podcast: Play in new window | Download

Feb
01

St. Bully Medical Center

Bully.

We’re not talking Teddy Roosevelt, we’re talking intimidation.

There’s been a lot of talk about bullying of hospital staff by physicians and even of bullying by nurses of junior staff and of younger physicians.  Hospitals, through their personnel function, and medical staffs, by way of medical staff discipline and physician wellbeing, are expected to police this behavior.

But what about hospitals that tolerate or even institute cultures of corruption, cultures that incentivise nurses and other staff members to intimidate physicians through incident reports that are judged administratively, outside of medical staff due process?

As the relationship between physicians and hospitals becomes more strained due to hospital-centric notions of healthcare, hospitals are becoming more coercive in thinning the medical staff ranks of independent physicians and twisting arms in order to get the other arms voting for closer “collaboration.”

Mark F. Weiss

 

 

 

 

Jan
30

Who Asked The Patient If She Wants A Hospitalist?

Sally hired Beth, the most sought after wedding planner in Centerville to coordinate her wedding at the Community House, a high-end hotel.  Beth planned the flowers, the menu and every other aspect of the ceremony and reception. You see, Sally had hired Beth for her expertise; the Community House was just the place, a nice place, where the event would occur.

But when the big day came, Sally, and Beth, were shocked to find that the Community House’s on-staff event manager change the theme from sophisticated charm to down-home country. No more roses, but daisies. No more jazz band, but country fiddler.

This is the same experience that patients suffer when the post-surgical care that they expect to receive from the surgeon performing their operation is countermanded by a hospitalist hired by, or contracted to, and economically beholden to the hospital.

This is a growing issue for office practice physicians, who don’t view themselves as mere technicians but as actually having a physician-patient relationship with their patients. Hospitals, on the other hand, want to relegate physicians to technician status, so, sorry Doc, the guy we hired will take over your patient’s care.

We can argue back and forth, I suppose, over the two physicians’ relative positions (but I am right).

However, I consider the issue of what the patient expected to be of paramount importance.

If I wanted a team approach I would establish a relationship with a team from the outset. If I wanted a relationship with a surgeon and that surgeon needs a team and explains that to me then I would understand.

But for the hospital, or for the hospitalist, to make that decision should result in battery, a tort.

This is the future that were heading into if hospitals, pundits, and the prevalently popular politicians get their way. I will say “I told you so.”

Mark F. Weiss

Jan
27

Two Wolves and A Lamb – Podcast

Hospitals and the government have decided that physicians must collaborate financially in order to deliver quality healthcare. Of course, that’s a lie.

Jan
25

When You Have Time To Gripe

I was 16 and it was my third “real” job – working at McDonald’s.

It’s been, well, a lot of years, but the lessons learned on that job still stick.  During my McDonald’s training, I was bombarded with sayings that not only gave direction to the work level that was expected of me, but which transferred the organization’s culture:  ”When you have time to gripe, you have time to wipe.” ”When you have time to lean, you have time to clean.”

There’s a prevalent school of thought that professionals — physicians for our purposes — can’t be managed and indoctrinated culturally in the same manner as 16 year old hamburger flippers.  Why not?  Especially when the future success of your practice may depend on it.

Yes, I acknowledge that there’s an expectation of independent professional judgment on the part of physician employees and subcontractors that’s not encouraged by McDonald’s (which, for some reason frowns upon Sally whipping up a five patty Bigger Mac).  And, I’m not suggesting that you engineer out professional discretion.

What I am suggesting is that on another level, the level of how all physicians in the group present themselves to, and comport themselves with, referring physicians, other medical staff colleagues, hospital administrators and so on, makes an incredible difference in how your group is perceived.

The real benefit of that professionalism (or the abhorrent lack thereof) is that it creates valuable experiences that serve as a part of a larger strategy of providing an Experience Monopoly.

In turn, that Experience Monopoly goes a long way to cementing your group’s relationships which is money in the bank.

The process requires a global approach: it’s not just being clear on expectations, it’s teaching by example, it’s stimulating performance through tie ins to the physicians’s employment agreements, subcontracts and even the group’s partnership agreement or shareholders agreement, its regular reviews and mentoring, and it’s more.

Mark F. Weiss

 

 

Jan
23

Physician “Alignment” – When $X Does Not Equal $X

In my podcast on How the Downward Spiral of Fair Market Valuation Will Destroy Your Future, I discuss how valuation consultants’ refusal to opine at higher than the 75th percentile is taking the fairness out of fair market valuation and robbing you of your income.  

There’s another angle to this:  And that’s the fact that earning $X, net, self-employed and earning $X, net, as an employee are two very different things.  $X as an employee comes subject to being fired subject, subject to being told what to do, and subject to a plethora of rules — that’s a much poorer compensation package

Hospital administrators misunderstand this because they’re clueless as to the issue.  They’ve never been or will be entrepreneurs – people who create value.  They are bureaucrats — people who destroy value.  

Therefore when they tell you that will match your compensation or that the national group that’s picking up your exclusive contract of service will pay you the same dollars — they’re not doing you any favors.

Mark F. Weiss

Jan
20

How Much Should You Charge To Respond To That RFP? – Podcast

RFPs for physician services come in several varieties – some real, some scams. Responding to any RFP takes considerable time and requires significant investment. So how much should your group charge to provide its proposal?

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Podcast: Play in new window | Download

Jan
18

Lewis And Clark On Medical Group – Hospital Deals

Lewis and Clark, yes, that Lewis and Clark, the explorers, can teach medical group leaders an important lesson in respect of negotiating with hospitials.

Journal Entry September 2, 1803

“Suppose it best to send out two or three men to engage some oxen or horses to assist us [in crossing the sandbar] obtain one horse and an ox, which enabled us very readily to get over . . . . paid the man his charge which was one dollar [that’s about $350 in today’s money]; the inhabitants who live near these [sand bars] live much by the distressed situation of the traveler, are generally lazy, charge extravagantly when they are called on for assistance and have no philanthropy or conscience.”

What’s the lesson?  You’ve got no room to bargain when the seller knows you need a horse.

Likewise, there’s no room to bargain when the hospital knows that your group’s continued existence depends on getting the deal.

Mark F. Weiss

 

Jan
16

RBRVS And “Units” Are Not A True Measure Of Value

The method used in determining most physician reimbursement, the resource-based relative value scale, or as it’s commonly known, “RBRVS,” is based on efforts, another way of looking at cost.

But the cost to deliver is not a measure of value.  It’s Marx. If effort creates value, then the plain old rock dug from a mine would be as valuable as the diamond pulled out at the same time.

The shortcuts physicians accepted in order to get paid, the Medicare fee schedule and unit based billing, are not tools to increase your earnings, they are tools to suppress your earnings.

Your value is not the input: the time or the effort. Your value is the output:  health and and life.

Work on receiving that value. That’s true healthcare reform.

Mark F. Weiss

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