Continue reading »]]> Secrecy. Data gathering. Keeping safe from those who want to do you harm.

Hot topics in the news as I write this. But I’m not writing from a political point of view. At least not this time.

Instead, I’m writing about protecting your medical group’s financial and performance data and about guarding its yet unfolded strategies.

In particular, I’m writing about the question of how much transparency should exist within your group.

The answer requires a particular balance, one that must be determined on a group by group basis: there is no hard and fast rule.

However, keep in mind that the most successful groups, the Strategic Groups™, are not run as clubs. They are not completely transparent.

On the other hand, sharing some amount of performance data across the entire group, whether you see that as only owner physicians, or as all providers, can be a tremendous motivator in the development of a cohesive team.

But pure matters of strategy and your group’s essential financial information should be held much closer to the vest. Those entrusted with it should be bound by fiduciary duty and by confidentiality agreements. Unfortunately, any of your inner circle might be tomorrow’s competitor.

There is no advantage to be gained in claiming to be the most transparent while actually being anything but. There’s also no advantage to disclosing willy-nilly what should be protected information. Instead, find the right balance for your group and clearly establish walls beyond which information is closely guarded against attack both from outside and from inside your group.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> I recently received a box of books from someone I know…well, let me restate that: I received the box minus 2/3 of the books. It seems as if the post office destroyed the box but, instead of putting the rest of the books back in, simply taped the heck out of the box and just kept the rest of the books. Perhaps putting books back in a destroyed box is not part of the job description, while taping up the box is.

It occurred to me that this is a graphic illustration of what commodity healthcare looks like. “We delivered the box. What are you complaining about?!!”

There’s no need to show you a picture of a FedEx box. The chances that it would be damaged are almost nil. If it were damaged, the driver would repackage it and make sure it got to you.

Some people are willing to pay a huge dollar premium to ship FedEx.

Soon, some people will be willing to pay a huge dollar premium to receive non-commodity healthcare.

If you simply want to tape ‘em up, then the payoff will be at the commodity level. On the other hand, if you’re interested in providing an Experience Monopoly™ to your patients, and in being paid accordingly, this is the time to seriously strategize for that future.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Get ready for subsidized care — I’m talking both subsidized health exchange premiums courtesy of your tax dollars, and the very real possibility that you’ll be further subsidizing exchange participants’ care 100% on the dollar.

Although the Affordable Care Act requires that an insurer must give three months’ notice to subsidized healthcare exchange participants who fail to pay their share of premiums before the insurer can cancel coverage, the insurer has no obligation to pay for the participants’ care after the first month of that three month period.

So, who pays for care if the participant doesn’t reinstate his coverage on time: You do.

To complicate matters, these people will be “covered” the entire time, at least in terms of having coverage in place. However, they’ll have actual coverage…the kind that you can put in the bank…only for the first month. So, you’ll only learn that you’ll be stuck after the fact.

In fact, it’s conceivable that the carrier will pay you, only to claw the payment back after the entire three month period runs without reinstatement, due to no legal liability to have made the payment in the first place.

What’s this mean for you, other than, of course, that you’ve become a social welfare agency?

You must review all payor contracts for the way that they impact your liability under these circumstances and renegotiate if necessary. For hospital based groups, consider ways to shift risk to the hospital as a part of your exclusive contract negotiations.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> I read an article in the Wall Street Journal reporting that more states are regulating Medi-Spa ownership and placing scope of practice restrictions on the procedures performed at those facilities.

It seems as if they’ve discovered that nurses and other paraprofessionals, and in some cases, even beauticians, are performing what many, most, or, perhaps, nearly all, physicians would say are medical procedures.

So, states are rushing to regulate: In some locations, physicians must own or control the spa, and in other cases, states are making sure that physicians actually supervise these procedures.

Yet, in the loony world in which these states regulate, many are also rushing to expand the scope of practice of paraprofessionals in the traditional healthcare setting, e.g., office practice and at the hospital, due to the existing, and soon to be worse, physician shortage resulting from Obamacare.

So, on the one hand, your tattoo may have to be removed by a physician, but your appendectomy might be performed by a nurse practitioner. Go figure.

On the one hand, there’s good news here: Physicians pulling out of traditional practice will soon be able to open a Medi-Spa with less competition from those pesky beauticians and allied health professionals.

I feel better, don’t you?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Hospital based medical groups are often faced with a choice upon exclusive contract renewal:  The expectation or demand on the part of the hospital that the group must provide its services, perhaps even at a higher level of intensity, for lower or no stipend support.

A group enters into an exclusive contract in order to protect its turf. In return, it takes on the obligation to provide coverage. But if, without stipend support from the hospital at an acceptable level, the group cannot recruit and retain its providers, then, if we assume that its billing and collections have already been maximized, the group has only a few choices if it wishes to remain committed to the obligation to provide coverage:

1. It can negotiate a more efficient coverage schedule.
2. It can reduce compensation to its existing providers.
3. It can attempt to find new providers willing to work for less.
4. If applicable in the medical specialty, it can shift work to allied healthcare professionals.

Alternatively, and usually not considered, the group can choose not to renew the contract. If the group had adopted a business-like attitude, it will have already expanded its business to other facilities. If it hadn’t expanded, the choices are closing up shop — there’d be no reason to exist — or to attempt to continue to provide services at the facility on a request only basis, perhaps with a pared down staff.

Most group leaders will probably consider that last option unworkable.  But query whether, with more hospitals pushing for lower to no stipends, and with regional groups having the power to walk away from unprofitable deals, whether more hospitals will be left begging for any assistance at all from hospital-based specialists?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> I’m not really one for documentaries, but I recently watched, for the second time, Jiro Dreams of Sushi.

Facially about an octogenarian’s lifelong quest to serve the best sushi possible, it’s true lesson is the role of mastery, the continuous path of excellence in an endeavor.

Physicians, no, all professionals, should be on a similar route to continuous improvement.

But for medical group leaders, the real question in both hiring and retaining physicians is what is within the scope of mastery.

Clearly, mastery in patient care, while absolutely required, is no longer sufficient. Physicians seeking only medical mastery will not advance your group’s interests. The scope of the quest must be broader.

Think of an airline flight from Los Angeles to Chicago. The mastery of the pilots, who even after flying for decades are still involved in training and improvement, got you to the destination safely and on time. Yet often the overall experience falls short, from the hassles of boarding to delayed or lost luggage.

Mastery for medical groups, like for airlines or my own services, must broaden to cover the entire customer experience.

The process for your group starts with hiring the right people, people who are on this quest. Then, your employment agreements or independent contractor agreements and the group’s compensation plan and rules and regulations must all support and incentivize this broader notion of mastery. And, you must continue to train and reinforce the group’s expectations.

Years ago, many, many years ago, I had surgery on my wrist. Almost miraculously, from a lay perspective, I was “cured.” Yet to this day, I vividly recall the hand surgeon’s complete lack of personality and the anesthesiologist screaming at his divorce lawyer over the phone in both pre-op and post-op. True masters of their craft? Each would say “yes” and so too might their certifying Boards. But would I ever recommend them? Hardly.

In today’s market, as medicine becomes more commoditized, as referral and exclusive contract relationships are destabilized, overall mastery is more important than ever in distinguishing what your group provides, in creating an Experience Monopoly™ — an experience for your patients, referral sources and facilities that they cannot get from anyone else.

People fly from around the world to have dinner at Jiro’s, paying around $300 for 15 or so pieces of sushi. His fish aren’t swimming in the sea of “good enough,” and neither should yours.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Speed and size are often an advantage, but in some situations, and in some markets, they’re not. For medical groups, the current healthcare market is one of them.

For example, pointing to the work of John Boyd, speed alone in terms of fighter jets isn’t the key; it’s speed, plus maneuverability, plus the ability to quickly increase and quickly decrease speed. Similarly, we’re all familiar with the concept of the inability of a large ship to change direction quickly.

For entrepreneurial medical groups, relatively smaller size can be a tremendous advantage in an uncertain and unclear market. That’s the market we’re in now.. But that’s only the case if the group’s leadership has in place the governance structure to enable it to make and implement decisions quickly. And of course, that’s only the case if those in leadership roles have the time, ability and inclination to actually exercise their power.

How maneuverable is your group? Titanic heading for an iceberg or highly maneuverable speedboat?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> As the chill of Obamacare becomes felt, more and more physicians are looking for alternatives to commoditized medical practice.

For example, practice alternatives include concierge medicine, mobile practice, franchise operations, and what I term “disruptive medicine” – the creation of either, or both, new technologies and new delivery systems.

Within the four walls of what is now viewed as traditional medical practice, physicians are generally placed, and have placed themselves, into silo-like specialties. In some cases, specialists within one specialty complain that those from another are “poaching” their territory — take imaging studies being done by cardiologists, for example, and the reaction that engenders among radiologists.

On the other hand, many of the ways out require that physicians see themselves in roles larger than a single specialty or see the walls of their specialty as subject to a retrofit. Take, for example, the cardiologists in the above example.

So, allow me to knock down some walls and really mix metaphors: If you’re on a ship that you know is sinking, and sinking fast, you can take the lifeboat, or swim for safety. You can also stay on board and cry about your “fate.” You do have a choice.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Many medical groups operate as partnerships, generally partnerships of professional corporations. The reason for that structure is simple: it allows maximum flexibility in terms of each owner’s management of his or her related business and tax attributes, while preserving a high degree of protection from liability.

Note that I said “a high degree” because there is never a situation in which there can be total protection from liability.

At the same time, many groups have compensation plans that reward different partners, or different classes of partners, differently, such that there is a spread, sometimes a wide spread, in compensation.

One complication of this type structure is that while all partners are jointly and severally liable for the debts of the partnership, some partners are reaping a much greater financial reward. And, in some instances, that reward is not tied to the fact that they are devoting more time, or harder effort, or even smarter effort to the venture.

In some cases, this situation is intended and understood by all. But in others, it is a situation arrived at blindly.

When did you last look at your partnership agreement? Does it create the liability result that was intended?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> It’s often said that countries’ militaries are mired in fighting the last war.

For example, navies build more large ships to combat the memory of the last war’s naval battles, which are also the battles projected to come. But the future is not always a repeat of the past and the next threat, perhaps attack by a swarm of small ships, may leave large ships at a decided disadvantage.

So, too, many physician groups are fighting the last war, imagining that the threat to their existence is from, say, the hospital, or from a certain type of other specialists.

But the reality may be very different.

Many of the scenarios that medical groups consider in setting their strategy, if they engage in strategy work at all, and if they consider alternative scenarios at all, are mired in the past:  Past battles that were either won or lost, but past all the same.

The pace of change in healthcare is accelerating dramatically. At the same time that the federal government is poised to grab more control through the implementation of Obamacare, so too will some states begin to implement other “reform.”

And, at the same time, disruptive providers, hospitals, large employers, new technologies, and entrepreneurial thinkers will change the landscape on which your group’s competitiveness will be measured.

It’s no longer business as usual. It is business as unusual. And that requires a new way of thinking.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> The old hotel stood on a corner 10 or 15 blocks from the new center of downtown, run-down curtains visible through the windows of its 10 story dirty brick hulk. But it was the red neon sign, with letters at least 5 feet high stretched all the way across the building just beneath the roof line that caught my attention: “100% Air Conditioned.”

At the time the building was built, my guess is the 1930′s, a completely air-conditioned hotel was an incredible competitive advantage. I imagine that guests flocked to it, ready to plunk down cash – this was way before credit cards – to do business with the hotel. But today, air conditioning is not even a question on the minds of potential guests.

It’s not much different when it comes to the question of a medical group’s competitive advantage in attracting contracting partners. Do you have one?

Competitive advantages are developed, excluding competitors from the equation. But as soon as one’s competitors catch up, what was once an advantage becomes simply the price of admission.

Negotiating a contract and properly documenting it are important functions, but they can only take place in a larger context, the context being a decision by the parties to do business together. The advantage your group offers a prospective contracting partner is the glue that binds.

So what exactly is your group’s competitive advantage? Does it have one? Have you revisited it and updated for the current market? Or, is it something akin to “100% air-conditioned?”

What do you think?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> In my April 8, 2013, blog post Amorality Of Institutions – An Additional Argument For Physician Control Of Hospitals, I argued that hospitals, as institutions, are at best amoral. At the same time, they are driven by profit and their executives bear no true downside risk, no risk of going negative in terms of personal liability. Those points, I posit, support the fact that physicians should run hospitals.

And now, more recently, comes a Wall Street Journal article (Treatment Woes Can Bolster Profits, April 17, 2013) revealing that the campaign to battle hospital complications is being slowed by the fact that hospitals profit from patient complications. On top of that, it costs hospitals significant money to reduce complications.

So what we have are institutions that avoid doing the right thing because it will cost them money out of pocket to achieve a result that will cost them far more in prospective profits.

Obviously, what’s needed is a counter-weight. I suggested two in my April 8, 2013, post: Make hospital executives and administrators personally liable for their decisions. Shift control of healthcare to physicians, putting hospitals back into the position they occupied when hospitals first came into being.

What do you think?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Here’s something you can absolutely plan on: most planning done by medical groups, especially that common variety, the “strategic planning retreat,” is a complete waste of time.

Determining strategy has nothing to do with planning. Planning is a process of projecting from the present, while strategy is the opposite: it’s selecting a desired future from among alternatives, which future is then harnessed to pull you toward it.

Developing strategy only starts at a meeting such as a retreat: that’s simply a step in a complete, larger, ongoing process.

Sure, spending $10,000 or $20,000 to facilitate a “planning retreat” is far less than the investment required to develop a true strategy, but the reality is that it’s $10,000 or $20,000 wasted.

Let’s get strategic.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> I’m too busy right now.

There’s too much going on.

Mañana.

Maybe next year.

Medical group leaders are busy focusing on day to day activities: Most are deeply involved in direct patient care. Some, yes, some, also devote some time to working on their business.

But there’s a pressing need to engage in strategy. And you have to address the tough issues, like governance, succession planning, compliance, expansion of your business, and many more.

Yes, you’re right, it’s not the right time. In fact, it’s never the right time.

So if there’s never a right time but you have to take action anyway, then consider that it’s always the right time.

Get started. Because one thing’s for sure. The “unexpected” really isn’t and it’s better to be prepared.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> I recently read in a magazine aimed at the hospital administrator market that administrators make the decision to terminate their facility’s relationship with a physician group because it makes business sense to do so, and that emotion is not a part of the equation.

Although I have certainly met many hospital administrators who had no personality, or at least no readily ascertainable redeeming characteristics, they were still, to the best of my knowledge, people.

And people can’t separate emotions from decision-making. They can lie about it and claim emotions are not a factor, but it’s frankly impossible for emotions not to be a major driver of decision-making.

The lesson here is not that physician groups can ignore the quality of their service, including the quality of responsiveness to a hospital administration’s issues. That would be foolish.

But it would be equally foolish to believe that strategies based on emotion have little value when in fact behavioral economists and psychologists who study decision-making clearly acknowledge how irrational our emotion laden decision-making it really is.

Knowing how to develop emotion-based strategies and how to implement them are simply among the “combined arms” tools that medical groups must develop in order to thrive.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Although, unfortunately, it’s too late for physicians to rally against the imposition of Obamacare (but never too late to lend support to those who will repeal it), it’s not too late to see that unless physicians plot their own future, the hospitals (and the government and, to the extent they will long exist…that’s another topic…health insurers) have a future planned for you.

I’ve written about the issue of the spiraling down of compensation that’s resulting from increased hospital employment of physicians.

On top of that, there’s a tipping point reached in a community once a significant number of physicians are “aligned” – the result is that the physicians on the outside of “alignment” don’t receive enough referrals and go away, while those on the inside are surely commoditized and can be replaced more easily than ever.

Clinical alignment is a great thing. Complete economic alignment is stupid.

[A shout out to Renee Slater, CPA for the email exchange that led to this posting.]

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com  

Continue reading »]]> Henry grew his restaurant from a shack selling hot dogs into a wildly successful business generating an incredible profit. It took years of labor, great service, and development of superb relationships with customers.

Then it ended.

You see, the restaurant was Henry’s sole business. And, it was located smack dab in the middle of a county fairground.

The fact that the county leased the facility out multiple times each week for large events which drew tens or even hundreds of thousands of people, most of whom where hungry and who had no option of eating somewhere else on the grounds, was no longer of any consequence when the county refused to renew Henry’s contract and, in essence, gave his business to a new “vendor.”

In reality, Henry never really owned his business. He was simply its caretaker. He just realized it a bit too late.

in essence, this is the same situation many hospital-based groups have created for themselves. Their entire business is, in essence, located on “leased space,” that is, at a single hospital. And, that lease is probably abysmally short, it might even be subject to termination at any time on 90 days notice.

And soon, due to the wave of financial alignment with hospitals, office-based specialists will increasingly be in the same boat.

More and more hospitals are more and more upfront about the vendor status they have placed you in. Even if you resisted expansion of your business for years out of some misplaced notion that you would be poaching on your colleagues down the road, pay attention to the lesson of Henry and his restaurant: It was a concession stand — just as is, in many hospital administrators’ minds, your practice.

Whose mind will be easier to change, the administrator’s about your vendor status or your own about the need to strategize, and then act, to preserve your future?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> The Rock Solid Group, a fictitious name for what was once a very real group, had a lock on the services that it provided to St. Mark’s Community Memorial Hospital, again a disguise for a very real place. And then . . . poof! . . . it all evaporated, leaving the former members of the former group as shocked as if an elephant had disappeared off of an illusionist’s stage.

For years, Rock Solid had not only performed well, its owner–physicians earned close to 100% more than what the MGMA would report as 75th percentile compensation.

But what they didn’t do when they were riding high, because they were blinded by riding high, was expand their business significantly beyond their relationship with St. Mark’s.

They misunderstood the risky place they were in. Sure, the odds that the contract between Rock Solid and St. Mark’s Community Memorial would come to a screeching halt were low, but they ignored the fact that low odds times the life changing magnitude of the end that relationship yielded an extremely high risk. Later, of course, that lesson was made all too clear to them.

Medical groups of all shapes, sizes and specialties must take this lesson to heart. Just because things are going well doesn’t mean that you don’t need to strategize for your future. In fact, when things are going well you are in the best position to strategize for your future.

What potential risks does your group face? Where are you vulnerable? What alternatives and opportunities exist to reduce the risk and vulnerability? Which ones should you pursue? What is the first step in pursuing them?

The processes that I’ve written about in other posts, including Focus on the Future™, the Strategic Group Process™, and the Scenario Survey Process™ are all tools that you can use, and should use, now.

Just because you don’t see a problem on the horizon doesn’t mean it doesn’t exist. Absence of proof is not proof of absence.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> There’s a management saying that what’s measured improves. As a result, managers love to measure things. But measuring does not always indicate value.

Take for example a family of three with total income of $200,000 a year. The parents have another child. Should grandma call the parents to commiserate because the family’s per capita income just dropped from $66,666 to $50,000?

So clearly, you’ve got to be measuring the right thing.

The family comedy described above has a medical group analogy. Groups must distinguish between measuring things which are efficient and measuring things which create a much improved or larger experience for the recipient.

What if you were running a restaurant instead of a medical group. Let’s say you decide to measure and reward on the basis of the time a waiter or waitress takes to picks up food in the kitchen and deliver it to the table. Soon, waiters would be jogging through the joint, tossing plates onto the tables. Slopping the food onto the table with a smirk would still be 99th percentile performance, but the total customer experience would be at rock bottom.

So clearly, some things that measurement says are now “improved” aren’t anything of the sort.

Now back to running a medical group. Take a look at your group’s compensation plan. If you simply measure units produced by your group members–that is, you pay by units only–then you are encouraging fast delivery, not courteous service: tossing the plates, so to speak. On the other hand, if you’ve adopted a fixed compensation system, $X per month as salary, you’ve taken away the incentive to work harder, and you’ve ignored the notion of an incentive for better performance. Of course, that still begs the question, what is better performance?

Correctly formulated, a group compensation plan is not just about encouraging efficiency, it’s about encouraging effective performance in a broad sense. Some of that performance is capable of meaningful objective measurement, but a significant potion is not — but that portion can’t be ignored, it still has to be considered and group members must be cognizant of its impact of their overall compensation.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> If you’ve been reading the international news, you’re probably familiar with the fact that the government of Cyprus, a European Union member, is under pressure from the European Central Bank to seize funds in private depositors’ bank accounts to bail out Cypriot banks.

Although when first floated, all accounts were targeted for seizure in varying percentages, the latest plan seems to include only those who were good at saving, those with more than 100,000 Euros in the bank. Up to 60% of the amount on deposit might be seized.

Imagine someone who works their whole life, saves their money and keeps it liquid in a bank account – no crazy speculation for him! – only to find that he’s paying the price for the bank’s foolish behavior. Depositors like him, who never stood to realize an upside in terms of distributions of the bank’s profits, got only the downside via confiscation.

Upon reflection, how different is balancing a banking system failure on the heads of the productive from balancing the books of the healthcare system by reducing reimbursement to physicians? Same work. Less pay. But hey, it’s patriotic.

Still complaining? Don’t you know that you’re just paying your fair share?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> In my November 28, 2011, post, All Hospitals Should Be Physician Controlled, I discussed the fact that, as a result society’s current communal tide, the trend toward a “we” society, healthcare is becoming increasingly hospital-centric with looming negative impact.

Keeping that in mind, consider now that people, not institutions, are capable of morality. At best, institutions are amoral. At worst, they are immoral.

This doesn’t necessarily mean that hospital executives are amoral or immoral in the conduct of their personal lives, or whether they don’t have good intentions in their work lives. What it does mean is that institutions—corporations and other entities, whether their tax status is for profit or nonprofit—must make a profit or otherwise meet financial targets in order to continue to survive. The executives get significant salaries and great bonuses if they deliver profit and, at worst, lose bonuses or (sometimes) their jobs if they fail.

But in no case does a hospital executive go truly at risk…at no point does he or she have to dip into his or her personal funds, or declare bankruptcy, if their decisions lead to loss. This is true in terms of the overall push to make a profit and in terms of the impact of withholding care, of cutting corners, of doing just enough but no more.

Individuals, physicians in this discussion, are capable of morality and my experience is that most are highly moral. Sure, there are some bad apples, there are in any subset of society. But no matter where Dr. X lies on moral scale, he or she is ultimately liable for his or her decisions, for his or her actions.

Who would you rather empower to make decisions affecting your personal health: An individual truly at risk, someone with “skin in the game,” or an institution that one way or another restricts its employees’ actions, led by executives whose chances of suffering from bad decisions are seldom negative at all, and whose most likely ultimate risk is capped at the loss of a bonus?

There are several solutions. One is make hospital executives and administrators personally liable for their decisions. Another is to shift control of healthcare to physicians, putting hospitals back into the position they occupied when hospitals first came into being.

Care to weigh in on this?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Imagine learning archery. After a year of lessons, you’re still missing not only the bulls eye, but the entire bale of hay on which the target is pinned.

Would you then simply decide that the entire bale of hay was the target, and award yourself a gold medal once you hit it?

Laugh if you must, but isn’t this akin to what doctors are being told every day? Lower your goals. Earn less, be happy.

Lowering your goals just to tell yourself that you’ve hit them is a crime against your potential.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> In a very well written article by Cat Vasko, editor of Medical Imaging Review, Accountable Radiology: Eliminating Sleepless Nights, Vasko covers the comments of James Reinertsen, M.D. of the Reinertsen Group, a consultant, at a 2012 American College of Radiology conference.

In a nutshell, Reinertsen states that radiologists should reconcile themselves to lower incomes and simply focus on quality.

Although all should laud Dr. Reinertsen’s comments about the need to focus on quality of care, he does a wonderful job of explaining the future of radiology, indeed, of all physicians, from the hospital and government perspective:

– You should see world as half empty.

– You will work for less.

– Suck it up, no one in the real world cares if your income drops 30%, you’re still among the 1%.

Just as obviously, any radiologist who wants to be successful should see that this Reinertsen fellow’s advice to settle for less is worthless, that is, unless you like the future he has planned for you.

The reason why fixed salary systems lauded by this guy drive cooperation between specialists and reduce “overuse” is that they create a perverse incentive not to work. Visit your local department of motor vehicles office and see how it plays out.

In my work with radiologists and other physician groups across the country, I often encounter this same defeatist attitude from physicians, and hear the same advice to get used to the new world of less pay from hospital administrators and their industry consultants.

Instead, assuming that your specialty is in for a 30% reduction in volume (which does not necessarily mean a 30% reduction in reimbursement), strategic group leaders need to think how to adjust staffing and how to expand their business to counter negative pressure on overall compensation.

Reinertsen is quoted as saying that the ACO is about accountability to patients. It’s not: It’s about accountability to the accountant types who will judge your quality based upon what’s easy to measure, engage in past-based cost accounting, and award you your little slice of their pie.

Smarter medical groups leaders will instead seek to make their group’s pie bigger.

It’s time to get baking.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Too many medical groups simply don’t believe in themselves.

How else could you explain why a group leader would spend $600 on dinner but not $300,000 to preserve the group’s $20,000,000 a year business?

The first offers little to no ROI (it does provide a few hours of satisfaction and some nutrients) while the other would yield a 6,500% return over first year alone. Try getting that at the bank.

It’s not the price tag. Depending on the medical specialty, the $20,000,000 a year group devotes well over $300,000 to many categories on the expense-side.

Perhaps it’s the naive belief that the group’s business will simply continue, year after year, like some perpetual motion machine, powered only by the first push.

Or perhaps it’s the failure to realize that not devoting the proper resources to your future is the far more expensive alternative.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> If you want to go to the movies but your spouse wants to go to a play, you’ve reached an impasse. But that’s simply a minor issue, one that can, of course, grow.

But if you always want to go to the movies and your spouse never does, while your spouse always wants to go to plays but you never do, then you have a much bigger problem.

Now shift this over to any business organization, in your case, probably your medical group. The same dynamic appears when one partner or one set of partners wants to move the business in one direction while the others want to go in another, or even more likely, don’t want to go in any direction at all.

If this were your weekend basketball team, you’d be concerned.

It’s your life, treat is as seriously.

Consider a twenty-some person medical group with polarized groups of members. At one end of the spectrum, some of the owners want to expand the group to other sites and to aggressively compete for new business. At the other end, no one wants to expend a cent — just keep the distributions to the owners as high as possible.

We all know that there are tectonic shifts impacting the healthcare industry. If your group can’t develop a strategy for its future because of internal dissension, then, by default, you’re allowing someone else — the hospital, the government, your competitors — to choose a future for you. (It won’t be very pretty.)

Resolve the impasse or resolve to choose another career path, because this one’s a dead end.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Your practice has worked hard to expand to a second location or a third or a fourth. These can be other ASCs at which your group provides anesthesia, satellite offices for your cardiology group, or additional G.I. centers for your gastroenterology practice — the story runs across all medical specialties.

But what happens when one of the members of your group who is assigned to work at different sites, acts out on his or her bias against working at a particular location, perhaps by showing up late, or by making untoward comments to the staff, or by engaging in some other type of disruptive behavior?

The answer, of course, is that slowly but surely it begins to destroy your business opportunities. An anesthesiologist showing up late at a surgery center can be the beginning of the end of your group’s entire relationship with that facility. The cardiologist who doesn’t like working at your satellite office in the suburbs can easily telegraph this to referring physicians, drying up streams of business.

Certainly, there are personnel, management, and contractual issues involved. But on the purely contractual side, your practice’s employment agreement or subcontract agreement with physicians must either delineate level of service expectations or make reference to policies and procedures that must be complied with. And your group must have “teeth” to enforce compliance as well as the will to do so.

Practices fall apart from the inside more often than most realize.

Take the time to analyze the contractual protections your group has developed, or hasn’t developed, now, before you need to start looking at what you can enforce.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Just because something is difficult to measure or evaluate doesn’t mean that it shouldn’t be taken into consideration in connection with your group’s compensation plan.

Most medical group compensation plans take productivity, and only productivity, into account.

I’m a believer in paying for productivity, both because it creates a proper incentive to generate income for the group and because my experience with groups that have paid on a fixed share basis (for example, three partners each receive one third of the distributable cash) is that it ends up creating a perverse incentive not to work, at least for morally-challenged group members.

However, paying only for productivity measured in time devoted or units generated or even some other variant, alone, wastes the opportunity to drive behavior by incentivizing it with pay.

I was recently reading about the current financial woes of the J.C. Penney chain. Although apparently having been mismanaged for years, the chain originally grew to national prominence in the early decades of the 20th Century through a system in which store managers received a one third share of their store’s profits. They were directly, and tremendously, incentivized to follow Penney’s marketing plan based in large part around how customers were treated.

Tailoring your compensation plan to achieve similar results is one of the keys to your group’s long-term success and, perhaps, even its survival.

Let’s talk.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Jean-Baptiste Say, the late-18th and early-19th Century businessman and economist, defined an entrepreneur as someone who shifts economic resources out of an area of lower and into an area of higher productivity and greater yield.

At its heart this is about creating value, value for the buyer, whether the buyer is a customer, client, patient or however described. Creating value in the context of a professional service involves delivering both an exceptional service and an exceptional experience. The mindset of an entrepreneur is tuned to deliver accordingly.

Distinguish this from the mindset of a bureaucrat – someone who goes about his or her tasks just following the rules but not creating anything of value.

No matter how much attention you, as a group leader, may have devoted to developing an Experience Monopoly™ for your group’s customers, the facilities, referral sources and patients, if your group’s members lack an entrepreneurial drive, the chances are great that although there may be delivering good care, that’s all they’re delivering.

How would you describe the mindset of the members of your group?

Are they simply delivering medical care at, or even above, the level of the community standard? No negligence there, but no delight created, either.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Although many in healthcare operate on a purely commodity-level basis, in reality, it’s not simply about money – it hardly ever is.

Rather, it’s about delivering value.

In some medical specialties, notably the hospital-based specialties, over the past several years there has clearly been a trend toward national and large regional groups expanding at the expense of local groups. Many times, these groups trade on the fact that they are willing to gain market share by way of demanding low, or in some cases no, stipend support from hospitals.

But as is evidenced now from the fact that large groups as well as small groups are losing contracts due to their inability to provide the actual service, it’s becoming more clear that groups that can actually provide value – value being determined in the mind of the customer, whoever the customer happens to be — have an advantage over those who simply offer the lowest price and talk a good game.

The secret is to create, deliver, and demonstrate value.

How is your group doing that?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]>

1. Look before you leap. CHECK.

2. Measure twice, cut once.  CHECK.

3. Document your deal with your partners before commencing joint practice. WHAT?

As simple as it seems, many disputes between physicians, from office sharing deals gone wrong, to full on disputes over the compensation from a practice partnership, occur because no one bothered to work out the details and preserve them in a contact before the deal began.

Yes, only three steps: 1. Plan it out. 2. Memorialize the deal. 3. Do steps 1 and 2 before starting the business of the venture.

“But it takes time!” “But it costs money.” Yes and yes. But the effort and investment involved pale in comparison to the effort and investment you will devote to the dispute that will follow if you don’t make the effort and the investment ahead of time.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Strength in numbers. Or is there?

Medical groups seeking alternatives to the sale of their practice to a hospital often consider merging with another group.

There’s nothing wrong with the notion of a merger. Often, there’s something right. But not always.

For example, merging two weak performing groups rarely creates a strong one. Think Sears plus Kmart.

Merging even two strong groups can be problematic, as there’s far more to a successful merger than balance sheets — focus, personnel, management style and group culture play determinative roles.

I’m not saying don’t consider a merger: If you’re looking at alternatives you have to. But seek the right merger partner — a strategic merger, one in which one plus one equals 3 or more. Bad math, but good business.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> “When I use a word,” Humpty Dumpty said, in rather a scornful tone, “it means just what I choose it to mean — neither more nor less.” – From Through The Looking Glass by Lewis Carroll.

***

Let’s say you’re running a restaurant and because you’ll only pay your meat supplier $100 a week for hamburger, all he delivers is 50 lbs. of the stuff. But you need 100 lbs. to meet the demand of your customers. What do you do? Do you go out and buy 50 lbs. of textured soy protein and pass it off has hamburger? You’d be tossed in jail.

But recently, hardly anyone even yawned when the State of California announced that it was considering expanding the scope of paraprofessional practice because there weren’t enough physicians to go around. Perhaps, the bureaucrats floated, nurse practitioners could practice independently? Perhaps other healthcare licensees could also practice well beyond the scope currently permitted? And with a Ph.D. as the terminal degree in many of these fields, they’ll be doctors.

Not enough hamburger? Mix in soy. Not enough physicians? Let others perform many of the same services – we’ll just call them all providers, or better yet, doctors.

Look, I’m not belittling the role of non-physicians in healthcare professions, I’m just saying that they’re not physicians.

Was restricting to physicians certain areas of practice simply a scam? Were the years of training given to physicians simply a scam? Was patient health what was really being protected?

Was the State of California lying to its citizens before, or is it lying to them now?

One thing hasn’t change though: mix your hamburger with soy protein and you’re off to jail. After all, a burger must still be a burger.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> If you don’t like all of this change going on around you in health care, start instituting some change on your own.

Too many physicians think that they don’t have any control over the future, but many of the structures they feel trapped in didn’t even exist five years ago. Someone created those structures–that is, someone instituted that change.

Prohibitions as to new physician owned Medicare certified hospitals stifling you? Start another type of facility or one that’s not aimed at Medicare patients.

Referring physicians pressuring you for a share of your fees (yes, it’s illegal)? Your feet aren’t cemented, walk.

Complaining, though, won’t get you very far.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> I see two very common problems with medical groups.

They move too slow.

They do what everyone else does.

In this market – a still-sick economy, the push toward ACOs and other so-called “alignment,” and the other ills of Obamacare – many are pushing toward becoming large.  But large makes them fragile — prone to eventual failure — they just don’t realize it.

Instead, you want to develop speed — speed in making decisions, speed in setting strategy, speed in adjusting strategy, speed in implementing tactics.

Too much hassle? Just want to treat patients? Then just close up your practice and go get a job.

Look, the end game is going to be won through speed and innovation, not size.

Sure, almost everyone else is going to say you’re wrong, that that’s not what everyone else is doing.

But that’s why they’re average — they are doing what everyone else is doing.

You need to take a hammer to average.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> There’s no more room for average in terms of any medical practice’s business approach. This applies regardless of specialty or whether you are hospital-based or office-based. This applies whether you are in solo practice or with a group.

Medical practice is becoming stratified. Some practices are aligning with ACO’s. Some practices are taking action to go a completely independent route. Some practices are merging or forming other alignment with other practices as opposed to with hospitals. Some practices are opting out of government financed care completely.

In some instances in life and in business, it pays to wait and see. In other instances, after weighing alternatives, it pays to do nothing. But this is neither of those instances.

Rather, not taking any action puts your practice into a position equivalent to that of a ship dead in the water.

It’s obvious that the current system is broken – no matter who you think broke it.

Doing nothing is not the cure.

Wait and see is what got you into this mess.

Set a strategy for your group’s future and implement it. Note that unlike a ship, your group can hedge its bets and adopt more than one strategy – that is not the same as doing nothing.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> There’s an old negotiating story about two sisters arguing (negotiating) over the one remaining orange in the house. Each one wants it and is not willing to split it in half.

The moral of the story, and the point of this post, is the importance of the question, “Why?”  So, in the orange negotiation, “Why do you want it?”

It turns out that in the case of the two sisters, one wanted the zest for a recipe and the other wanted the juice. For those unfamiliar with oranges, this means that they both could have received exactly what they wanted: A de-zested (zestless?) orange still has all of its juice.

Most negotiation in real life isn’t that simple, and (unfortunately for those who spent money on the book by the title) it’s generally not win-win.

But that doesn’t lessen the importance of the simple question, “Why?,” in negotiation. In fact, I suggest that you use the rule of “Why times 5,” asking and re-asking to drill down until you can identify what your negotiating opponent is really after – it is usually not facially apparent. Once you know the real “why,” it’s much easier to offer a real solution, one that’s perhaps totally acceptable to you.

Of course, it doesn’t have to be 5 “whys,” it can be 12. Or, it can be 3. The point is to ask.

For example, in a negotiation, the opposing side demanded a fixed payment in respect of licensing a product they had developed. We wanted to pay a percentage based on sales. Why did they want the fixed price? “Because it’s easier?” Why is it easier? “There’s no accounting involved?” Why is accounting a problem? “It takes time and effort.” We then offered a transparent reporting system with open access and agreed to bear the price of monitoring. They accepted and we got our percentage deal.

Have trouble getting this? Why?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Technology is neither inherently good nor inherently bad. It’s good only if it does something beneficial – makes things faster, easier, cheaper, or better. And then, of course, the question is faster, easier, cheaper or better for whom?

I recently went with my son to a trendy burger place in Westwood, adjacent to UCLA. For an upscale fast food place, the interior design was top-notch. However, as opposed to ordering from an employee at the counter, you’re directed to one of two iPads mounted on the wall, each mated with a credit card reader.

Very trendy, but very slow. First you build your burger, then you order fries, then you order a drink — one at a time. We moved through the process as quickly as it allowed, but it took at least 4 minutes from start to finish.

Because we beat the lunch crowd, and had only a few minutes wait to use the iPad, the time spent was not much of a problem. However, within a few minutes there was a line out the door.

Yes, the technology certainly looked trendy. It enabled the restaurant to have one employee at the counter to monitor things and deliver the food, as opposed to having a larger payroll. However, if I had to stand in a long line to wait for an iPad to open up, I’d probably go someplace else.

It occurs to me that the indiscriminate use of technology, or the use of it to benefit the wrong party, is akin to the adoption and enforcement of rules.

Take, for example, a rule requiring the completion of a certain form in your practice that duplicates information captured elsewhere. Perhaps it’s a form required of patients. Perhaps it’s a form required of your group’s physicians. For whose benefit was the rule adopted? How can it be made to also benefit the person having to comply? What incentives can be tied to compliance?

What the burger place thought was cool technology that reduced their labor costs was, from the customer’s perspective, a pain in the ass. It would’ve taken 45 seconds to place the order with a live person as opposed to 4 minutes with the machine. And, the restaurant completely overlooked the notion of programming any attempt to up-sell the order – “Would you like fries with that?”

Are your group’s rules built from the same stuff? Are the hospital’s?

When you have trouble with compliance, think about it from that perspective.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> I recently heard a news story announcing that General Motors was, per its agreement with the Auto Workers Union, making bonus distributions of, as I recall, $8,300 per worker.

Asked to comment, the union spokesperson said that although the workers appreciated the bonus money, it did make up for the fact that they had not received wage hikes for several years.

Completely missing from her comments, and probably from her mind, was the fact that it’s only because of a bailout with our money do any of those union members still have jobs at General Motors.

There is a major disconnect here between efforts and the creation of value. This disease doesn’t afflict only those working on the manufacturing line at General Motors, but those in the corporate office as well. All of their previous efforts, and I have no reason to doubt that they devoted huge amounts of time and effort to their tasks, resulted in an overall loss of value: cars that didn’t sell and costs that ate the company alive.

Value, on the other hand, is determined by the customer.

Of course, this holds true in all areas (excepting those in which the government has meddled, causing more harm than good, say, as in public schools) including healthcare.

Many physician group members, from leaders to newly hired employees, think that merely showing up and doing their cases is what creates value in terms of the ongoing relationship with their facility. It doesn’t.

Look, I’m not saying that treating patients isn’t of value. What I am saying is that those efforts are not equivalent to the creation of value in terms of the relationship with facilities. The same holds true in connection with the creation of value as to the relationship with referral sources.

One thing’s for certain, the government’s not going to bail out your medical group.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> It was a breezy day. Dozens of sailboats dotted the sea outside of the safety of the Santa Barbara harbor.

Many were running with the wind, being propelled quickly in the direction chosen by it.

Others were heading, in general but not absolute terms, against it by tacking at angles across it.

L’air du temps, the spirit of the times, in healthcare is not much different from the wind buffeting those sailboats: Communal, “we” not “me,” top down not bottom up.

For your medical group to succeed, you need to understand the direction of the societal wind. You might like it. You might hate it. Either way, it’s still windy.

Just as the boat captain must deal with the wind, not ignore it, medical group leaders must in any event accept that l’air du temps is real, that it exists.

If you want to go where that wind is pushing you, then go for it and adopt a business strategy in conformity with it. If you find l’air du temps to be polluted, then chart a course across it, not into it.

But in any event, you can’t simply allow the wind to buffet against you without navigation, and you can’t simply drop sail and pray to be rescued.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Tension, lots of tension about what to do, but that doesn’t mean that always doing nothing is the right response.

It’s certainly true that knowing what not to do, from individual actions to projects that could be pursued but which are passed on, is as important as taking affirmative action on those projects that will be pursued. At the same time, however, this is a very different concept from devoting close to all of your attention on preserving your current position which, really is equivalent to preserving the past.

Physician groups are under tremendous pressure, the bull’s-eye of the target toward which the arrows of ACOs, hospital-centric healthcare, physician employment, Obamacare, national group competition, and more, are aimed.

What’s needed is for group leaders to devote significant time to how they’re going to transform their businesses to not only evade those attacks, but to capture new ground themselves.

I’m not suggesting that groups abandon their present relationships – certainly, you need to hedge more speculative ventures with a strong base. But query how strong that base really is.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Growing up in the 1960′s and early 1970′s, it was a common assumption that going to college and getting a job with a large company was the key to financial security. How did that work out for the millions of corporate employees who saw their jobs disappear when their companies failed, when they were laid off in a downsizing (oh, sorry, “right sizing”), or simply replaced by someone who’d work for less?

Today many so-called experts are telling physicians that the key to financial security is in close alignment with – read that as employment by – hospitals.

Do they really think you’re that blind?

Sorry, but there is no security, at least nothing absolute, nothing that can be assured you. Large organizations are not more stable than small ones. There are very few, if any economies of scale.

No matter what, you are bearing the risk. Wouldn’t you rather hedge your chances by having more control over your destiny?

Being free to practice medicine without the attendant worries of running a business is the recruiting poster for those who want to pay you at the median of last year’s salary survey, a continuously decreasing sum.

It’s a con, a long con, and you’re the mark.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Hospitals often use surveys as a weapon to attack hospital-based groups. No matter who runs the survey, they are prone to error, misuse and out right abuse.

In fact over the last three decades, I’ve never seen a medical staff survey that wasn’t defective. Querying all of the psychiatrists on staff about the quality of the anesthesia department is, well, crazy.

But, since hospitals love surveys, they are a good tool for you to start sponsoring yourself.  Query your patients, query referring physicians and even query hospital staff.

Of course, the survey has to be designed properly. Consider also that the scope of the questions doesn’t have to relate simply to the services provided by your group – it might also inquire as to the level of services provided by other physicians and by the hospital itself.

The beauty of this type of survey is that you control whether the results are released. It’s a bit like creating evidence, only favorable evidence, to support your case.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> The move by hospitals to “strengthen” hospital-based departments, and the hospital’s own finances, by outsourcing to so-called national groups and “contract management companies” might just result in the destruction of the hospital. The chances are even higher that it will end the careers of many hospital executives.

Over the last 30 to 40 years, both hospital-based physician groups and hospitals have flourished due to a kind of symbiosis.

The hospitals needed a stable source of particular medical expertise and the assurance that those specialists would contract with health plans. The physicians, through the formation of groups to contract with the hospitals, gained economic clout, exclusivity, and a degree of stability.

Inherent in that relationship was the fact that the physician members of the contracted groups developed long and deep ties to the community, both the community in general and the medical staff community at the particular hospital.

Certainly, these groups were run as businesses attempting to maximize their profitability, but it was an aim of maximizing profitability over the long run, not a quick killing of this year and next, over the two-year term of their contract, and then adiós sucker.

As a result, local groups developed a very keen interest in working with administrators and their colleagues in other medical staff departments to not only deliver the services required, but to do so in a way that supports the peculiar needs of that facility. Times may be tough this year, but by devoting resources to support a new service line, or by shrinking to end an unprofitable one, the relationship, in the long run, remains mutually beneficial and successful.

National groups and, even more so, contract management companies, don’t have the same view of, or need for, that type of symbiotic relationship with the hospital. Yes, they want profitable relationships to last, but their profit horizon is not the same as that of a local group.

Think about this in terms of restaurants. A local group is equivalent to a family owned burger stand. The family members would go to great lengths to keep their economic engine alive through hard times. It’s their sole source of revenue. They have their reputation in the community to preserve. They have real relationships with their customers. On the other hand, a contract management company is equivalent to the owner of a chain of fast food joints. If location number 78 is having difficulty, sure they’ll try to save it. But if it becomes more trouble than it’s worth, they’ll simply shutter it.

This difference in motivation holds true at the physician level as well. Physicians with roots in the community, physicians who see a group as their career, with ownership a possibility or a promise, have a reason to remain, good times or bad. Sure, there’s no absolute guarantee that anyone will stay. But compare this with physicians working for the local branch of a national contract management firm, paid, essentially, as itinerant workers. How likely is it that they will stay long term? How likely is it that the contract holder will replace them when someone else can be found to do their job for slightly less? How likely is it that high quality physicians will come to, or remain with, the management firm, and while they’re there at community hospital number 11 of their career, how much will they care about establishing a relationship with the hospital and its community?

Which group, the local group or the masters of “store number 78,” is more likely to tie its success to that of the hospital?

In the short run, hospital CEOs may be seen as geniuses, and paid bonuses—the real point, right?—as a result of their seeming “costs savings.”

On the other hand, five years down the road, when the national group has left because there is no profit working at that facility, when the staff in the anesthesia or radiology or, coming soon, cardiac surgery, department is as stable as a pool of itinerant fieldworkers, what will the impact be on the hospital? What will the impact be on the CEO? . . .  That is, unless he or she saved their bonuses and left in time to enjoy their skewed memories of success, sipping cocktails on a sandy beach while the hospital board attempts to put the pieces back together again.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Have they got a deal for you.

As a physician, you’re concerned about increasing competition, declining reimbursement, and, of course, the looming impact of Obamacare.

So, you’ve been thinking, as have many, many of your colleagues, that it’s time to give up independent practice, whether truly solo practice or as a member of a group. There’s so much more security in hospital employment and a regular paycheck. Or so you and they think.

But what security is there in an agreement with a one or two year term? Or even a 7 year term…with a 60 or 90 day termination without cause provision? There is none.

Across the country, employees in many industries are just days away from a layoff or termination. Or, because they have no control over the decision, they fear that they are, which is just as bad.

Hospital employment? Sure, it’s security . . . in some alternative universe.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Is your medical group slowing down success, wasting time in management meetings?

Imagine a group that holds a meeting of its bloated board each week. Over a dozen people sit at the table, each putting in his three or four cents worth, even when he or she has so sense. Protecting fiefdoms. Feigning expertise. Micromanaging. (Micromanagement by an individual is bad enough, but micromanagement by committee is sheer hell.)

Sure, there are a few legitimate reasons for groups to have leadership meetings, whether face to face or electronically, such as when you need to pull together a number of ideas to plan a new initiative.

But the majority of meetings, those devoted to exchanging information, are a pure waste of time. Send a memo. Send an email.  Or even a note by carrier pigeon. But don’t waste time and meet.

Sure, business decisions require some thinking. But the question is who should be doing the thinking, and the answer is as few people as possible.

And, those people, those leaders of your group, must be empowered to make decisions – that is, empowered to lead. It doesn’t matter whether your leaders are elected or chosen as a result of the drawing the short stick. Heck, just throw a dart at a list of your group’s owners and anoint the holey one as the leader. Any of those is better than management by committee.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> For hundreds of years, innovation has driven improvement in medicine. Innovation in patient care. Innovation in business models. Innovation in treatment.

Dramatic innovation requires a chaotic marketplace—a marketplace for business as well as a marketplace for ideas.

Conformity is innovation’s enemy.

Now take a look at the following visual:

On the left side, you see the situation before ObamaCare. There are multiple competitors in the market—here, in our example, cardiologists. In order to succeed, they had to deliver a better experience to their referral sources, they had to deliver a better experience to their patients, and they had to develop high levels of medical expertise. This required innovation across the board, not simply doing the minimum required to keep their doors open.

As we move toward the right on the visual, with increasing regulation and, importantly with the increasing pressure to align with hospitals, joining ACOs and even becoming employees of hospitals and their affiliates, there are fewer competitors. Those fewer competitors have less reason, and less freedom, to innovate. In order to keep their jobs they must conform. They are now factory workers in someone else’s healthcare factory. The fact that the funnel-like image can be rotated 90 degrees clockwise and appear similar to a meat grinder is not unintentional.

So what happens to innovation? What happens to excellence?

Sorry, but I don’t believe for a moment that medicine will attract the same level of interest among high achievers 20 years from now unless there is a radical change. It might be possible to make more as a plumber. There certainly will be more freedom.

None of this is good for your business. None of this is good for your health, or mine. But the bureaucrats will be able to measure things. They’ll know whether you gave an antibiotic at the  ”right” time. They’ll know how many hours you worked. They’ll measure whether you gave test “A” before test “B.”

The bureaucrats will have exabytes of data on measurable stuff. But the important things, the really important things, will be ignored because they can’t be measured – take, for example, innovation that never occurs.

Over the next several months I’ll post entries on this topic including strategies to opt out of the serfdom that those bureaucrats who (they think) are smarter than you have in store for your future.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> I remember, as a kid, walking around Disneyland, noticing yellow “no parking” size signs labeled Kodak Moment. They indicated a great vantage point for taking a photo.

When Kodak was challenged by Fuji for dominance in the sale of photographic film, Kodak succeeded by changing the value proposition. They were no longer in the photo business, they were in the memory business. And who better to protect your memories, the cheaper alternative, Fuji, or the company synonymous with photography, Kodak? The answer was obvious.

Yet today Kodak is in bankruptcy, its core film business gutted by the digital camera.

What’s darkly funny about this is that Kodak invented digital photography, yet chose largely to ignore it. Perhaps Kodak was too large to truly innovate. Perhaps it was too focused on film to make the switch to digital. Perhaps its employees, from executives to those working in its manufacturing plants, were economically handcuffed to film photography.

The same phenomenon is common in healthcare.

Many medical groups, especially hospital-based medical groups, choose, sometimes intentionally and sometimes simply by default, to ignore the fact that unless they establish an identity separate and apart from hospitals, their businesses will soon be obsolete.

Of course, their medical specialty will likely continue – but it will be controlled by someone else, whether by hospitals or by large groups which disrupt their business relationships.

Start taking action now to avoid having your own Kodak Moment.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Imagine that you are an engineer packing a space vehicle for flight. You’d include what you’d intend be used and toss in some backups – but you certainly wouldn’t include anything that won’t be required.

The same rule holds true with provisions in contracts, from seemingly simple employment agreements to inch-plus thick exclusive contracts.

No matter what the other negotiator says, no matter how lovingly she explains that section such-and-such is simply “corporate policy,” and no matter how wonderful your relationship with her (“She’d never screw the group over, we’ve known her for years!”), each provision in an agreement is a tool that’s intended to be used.

For your safety, consider the phrase “intended to be used” as including “against you.” Just as in packing for a space flight, there is no extra baggage in that contract.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> I’ve sometimes wondered about the amount of importance attached to the arbitrary selection of the date we call January 1, New Years Day, as the date on which to make resolutions about our future behavior. Perhaps I’ve waxed way too philosophical, but why January 1 – after all, prior versions of our calendar began the year on March 1 and didn’t even have a January – and why not make resolutions any day . . . if you intend on keeping them?

But the notion of a fresh start is important; a clean break from the past. At the end of December 2010, I suggested that instead of making resolutions to do something, you consider resolving to stop engaging in some destructive physician business behavior. You can watch the 2010 videocast, New Years UnResolutions, Wisdom. Applied. No. 12, on the ALG website.

This year, I’d like to continue that trend, with some UnResolutions for 2013:

1. Start running your practice as a business. It is one.

2. Each of your employees represents your group. Hire great representatives, ones with more than just top clinical skills, ones with the right personalities.

3. ACO’s are probably here to stay and will quickly be morphing beyond a Medicare payment mechanism. Watch out so that you don’t lose financial control of your group while retaining all of your responsibilities to provide coverage.

4. As reimbursement declines and service expectations rise, be on the alert for an increase in overt and disguised kickbacks. Those with patient control leverage will be looking to maximize their financial interests someway, and not always legally.

5. If there ever was a time to invest in your future, 2013 promises to be it. Your competitors will be investing in theirs. If you’d like them to decide your future, then you can ignore this fifth point—in fact, you can ignore all five points.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> How may times have you heard someone say, or yourself said, that some event that would affect your group, your career, your future, is so remote that it’s impossible.

But, the seemingly “impossible” does happens. The unsinkable ship sinks. An industry dies. The exact same match-up of 16 soccer teams is drawn in rehearsal and then officially.

The important metric to consider isn’t the odds of occurrence, that is, the probability; rather, it’s total risk to your group if the event occurs. That’s measured by multiplying the odds of occurrence by the damage that would result.

So, the odds that the board of Community Memorial St. Mark’s Hospital will choose not to renew your contract, or that your best referral source, an internist you’ve known since high school, will send all of her patients to your competitor, might not be great. But if that results in the loss of a $37 million a year business or the evaporation of half of your income, the risk is still high.

And, even if you think the soccer draw was a scam, there are equivalent risks in healthcare.  For example, the Fictitious RFP™ in which a supposedly open process is really the cover up to veil a predetermined outcome. You’re just as screwed either way.

Plan for both the possible and the “impossible.”

After all, risk happens.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> There’s a lot of talk about branding. Almost all of it is just noise.

On the other hand, the definition of branding cited by David Ogilvy, the advertising genius, “the intangible sum of a product’s attributes” provides an elegant lesson for medical group leaders.

You see, we’re not talking of logos or cute comic book drawings or having everyone in the group wear chartreuse.

Instead, I want you to focus on the fact that your group is actually, and actively, branding itself every day, whether or not you’re aware of it.

“They’re rude.” “They hate nurses.” “They’re all about never calling me back.”

The interactions each of your physicians, and each of your staff, have with patients, referring physicians, hospital personnel and others projects your group’s attributes.

Since you can’t stop it from happening, you’d better figure out how to craft it, how to manage it, how to use that opportunity to your group’s benefit.

Branding happens.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> A minute or two spent Googling “layoffs” yields, Lockheed Martin (approx. 10,000 employees), Stryker Corporation–the medical device manufacturer (1,000 employees), and Orlando Health (400 employees).

Data indicates that approximately 17% of physicians are employed by hospitals, and that half of all physicians hired in 2010 were hired by hospitals.

Many pundits claim, and many physicians believe, that hospital employment is a more stable career path than independent practice. But is that truly the case?

Certainly, no one can predict the future, but what safety is there in a one-year employment contract? What safety is there in a seven year contract if it can be terminated on 90 days notice without cause or, as many physicians have come to realize, with cause if it’s easy for the hospital to manufacture cause?

Hospital employment provides no more safety than any other type of employment.

It certainly does relieve you of having to worry about your future – yeah, right, just as an ostrich with its head in the ground doesn’t need to worry about that lion sneaking up behind it.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Have you ever tried to stretch pizza dough? Pull it too much or too thin, and you end up with a tear.

Many medical groups suffer from the same effect as a result of differing camps within their ownership ranks.

Some members are focused on immediate returns: the amount of their paychecks and the workload required. They are not interested in investing money back into the business of the practice. Other members realize that unless their medical group takes steps to build its future, someone else will be dictating that future.

As a result, like in pizza dough, a tear develops in the fabric of the group.

Groups need to determine why they are in business. Then, when they bring in additional owners, they need to assure that they share the same mindset.

If the mindset is to create a business that’s larger than simply “serving” a hospital, then they’ll strategize for a future that includes growing a strong, independent practice.

If it’s simply to maximize current income, then there’s not much need to strategize for the future, because the group won’t have one.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Prior to a recent speech to medical residents, I was chatting with the Department Chair concerning the growing importance of customer service in healthcare. The chairman and I agreed that there was a need for training on this topic. I strongly believe that great clinical skills are only the “price of admission” and that demonstrating, not just talking about, high touch, high caring service is one of the keys to success in today’s society.

After the lecture, as I crossed the quad, I had a phone conversation with someone who shed a different light on the same subject.

The caller had recently interviewed for a position at a well-known institution, renowned for its world-class status, only to report that most of the people she met with were jerks. She has an extremely even temperament and isn’t prone to hyperbole. She has highly valuable credentials. Even if she’s offered the position, it’s now likely that she’ll reject them.

As strange as it might seem, caring and common courtesy are commodities in short supply. At the same time, they’re cheap and easy to deploy.

If you have members of your group who believe that the universe revolves around them, they are right: they have the ability to destroy the otherwise high-value of their assumedly competent clinical skills by pissing off everyone around them, from patients, to colleagues, to nursing staff, to potential new hires.

Hire the right people, those who understand that delivering care with a smile is the spoonful of sugar that makes the medicine go down.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Many of the acts, actions and activities within the scope of your group’s members’ daily duties are manageable as they relate to your group’s business strategy. They impact the success or failure of your group.

For instance, consider the conduct, comments, and other communication, verbal and nonverbal, between members of your team and patients, referring physicians, hospital staff and hospital administrators.

When untoward events occur, even the quickest action to ameliorate any damage is not the same as undoing the damage. Although I am all in favor of taking action to make the most out of an unfortunate situation through a Situation Transformer™, once the bell has rung, it can’t be un-rung.

It’s not enough to simply adopt strategies and implement tactics on the management level. You must train your group’s members on policies and procedures consistent with the group’s interests. And, you must implement both incentives and disincentives to best ensure compliance.

If not, “stuff” will happen which will lead to the bell ringing.

When that happens, you won’t have to wonder for whom the bell tolls. It will be tolling for you.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Hungry for sweet junk food? I just checked, and a box of 50 Hostess Twinkies is selling on Amazon for over $95.

I haven’t had a Twinkie or a Hostess cupcake for over 20 years, but I’m obviously in the minority as hundreds of thousands of people, or perhaps more, are going crazy over the closure of Hostess, which after being choked to death by the unions, chiefly by the Teamsters which represents the drivers working in its distribution system, has opted to liquidate in bankruptcy.

I can’t help but think that the death of Hostess offers a glimpse into the future of hospital-centric healthcare.

Not all bakers make goods that are in high demand. It doesn’t matter how good their distribution system is, their product is still what it is. Other bakers, such as Hostess, produce goods that are in great demand, yet their delivery system is so bloated, bureaucratic and inefficient that they can’t deliver their product and still remain in business.

Will hospitals inadvertently destroy the quality of their product, “healthcare,” by transforming independent, striving professionals into entitlement zombies, delivering as little as possible before their shift ends?

Or, will hospitals have a high quality product — highly motivated and highly talented physicians — yet be burdened by a delivery system, the bureaucratic world of hospital administration, that results in a product that, like the crops of the old Soviet Union, rots in the metaphoric fields?

I’m not buying any Hostess Twinkies, certainly not at close to $2 each on the Twinkie grey market. But one day I, and you, will certainly need to buy healthcare services. But will we buy it from the hospital? Or from the grey, or even black, market?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> As I sat down to write not this, but another blog post, my dog, Artie, reminded me of an important lesson in connection with negotiation.

Armed with my notes and a rough outline, I prepared to write a post about Hostess Twinkies and hospital-centric healthcare, which will now be, I hope, the post following this one.

Just then, Artie, who, when standing on all fours is tall enough to eat off the dining room table, shoved his face into mine. I told him to sit; he did, but he rested the weight of his head on my lap and on the keyboard of my notebook computer. I then told him to go away. He looked up at me, but other than that, didn’t move. Finally, he lied down on the floor and lifted his paw up to the armrest of my chair. I then put my notes down and gave him a belly rub.

Yes, Artie could be better trained, but that’s not my point.

My point is that Artie has intensity of purpose. To him, the word “no,” which he fully understands, is only the beginning point for further negotiation. He doesn’t give up when told to go away, he just changes his tactic. True, he sometimes settles for less than he initially intended, but he generally gets far more than I intended to give.

Sit! Remember that! Good boy!

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> There’s no doubt that society is becoming more communal. “Giving back” has become so prevalent a saying that it’s near cliché. And even McDonald’s is posting on its walls a quote from its uber-successful founder, Ray Kroc, that “none of us is as good as all of us.

As much as I think this is a crock (sorry, Ray) and that those who tell us that “it takes a village” want to be the mayor of it, I’m wise enough to know that these trends hit society every so many decades and that as much as I might rail against it, trying to stop it it would be like trying to push back against the ocean’s tide. As Franz Kafka said, “in the struggle between yourself and the world, back the world.”

Okay, this certainly explains the push toward hospital-centric healthcare, because hospitals are viewed as communal institutions. But this certainly doesn’t explain why nonphysicians should be running hospitals.

If the philosophical underpinning of Stark and other prohibitions on “self-referral” as well as of the federal anti-kickback statute and its state counterparts is the belief that money is evil and that it is wrong to profit from referrals, then why create exceptions to permit hospitals to profit in the new world of ACOs?

And, why should hospitals be run by nonphysicians? If a committee at Community Memorial Of My Local Town controlling its wholly-owned medical group is going to make a decision on rationing care to me, I want that committee to at least be made up of physicians, not of two physicians and five been counting MBAs.

It will be decades until society swings back away from “it takes a village” to “it takes a strong individual” and the price we’ll pay in the interim will be rationing, death counseling, and other warm and fuzzy attributes of a so-called communal society. Heck, this makes its opposite, the so-called “greed” of rugged individualists, seem timid in comparison.

But as long as we’re on this communal swing, there remains the opportunity to dress the argument in communal clothes while advocating that those actually trained in delivering medical care should be the ones overseeing it.

Prohibiting for-profit hospitals and even nonprofit hospitals run other than by physician control from participating in Medicare, Medicaid or any other federally managed or financed health care programs wouldn’t be any more discriminatory than prohibiting new physician owned hospitals from participating in Medicare, as is the case under current law.

After all, the purpose of this suggested new approach would be improving patient care, delivering it in a more effective and efficient manner, all while reducing costs.

Who could argue against that?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> There’s a lot medical groups can learn from the service aspects of other industries.

Take Carlitos Cafe Y Cantina restaurant on State Street in Santa Barbara, California for instance. The food is great — great enough to have attracted my business on a very regular basis for the past 7 years. But over the past 9 months or so, the service has become so bad, the servers so uninterested in their jobs, that it’s a miracle they’re still in business. I certainly won’t be back.

When I sat there, embarrassed that the referral source I took to lunch had to ask three times for the spicy salsa that never came, or when I had to get up to go from the outside patio into the restaurant to find the server (who was chatting away with two other employees) to get an iced tea refill, I realized that Carlitos is the perfect poster child for the soft underbelly problem of many medical groups.

Like the great food at Carlitos, many groups provide great medical care. And, like Carlitos, great food or great medical care is not nearly enough to ensure continued success. Without great customer service you’ll still go out of business.

For most medical groups the issue of customer service is more complicated than for Carlitos because there are multiple classes of customer: patients, referral sources, and facilities.

But the solution is the same: competent management, clear service expectations, hiring the right employees (and, if you’ve made a hiring mistake, firing the “wrong” employees), and supervision.

Unfortunately, I’ve seem many highly skilled and highly trained groups lose their facility contracts, lose their referral sources, and lose their patients because their group members fought with the “customers” or treated them with the expectation that they’ll always be back.

The group’s leaders are always shocked when, for example, they get the call from the hospital CEO that their contract won’t be renewed and that the hospital is looking for other options.

The fact that they’re shocked is just another example of the deficiency that resulted in the termination.

Carlitos Cafe Y Cantina had many chances to win back my loyalty. You have many chances to win the loyalty of your customers, too — many chances each day. What you don’t want is for the hospital CEO to come to the conclusion, as did I about Carlitos, that despite the great “product” it’s time to cut you loose.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> I counsel my clients to develop broad, deep and wide relationships with the facilities they serve.

But what if your group serves only one facility?

Consider a group that is more successful than most in developing that strong relationship and in providing what I call an Experience Monopoly™ to the facility, to the referring physicians and to the patients. But, they do so only in regard to one facility.

They consider themselves safe:  After all, the facility is a large hospital, prominent in the community and, they believe, in good financial condition.

But consider that no matter how you dress up that relationship, the truth is that if the group does business at only one facility, the group is at huge risk in the event something happens to the facility or to the contract.

Sure, they’ve tied themselves extremely well to that one facility which they see as strong as a rock: But what happens if that rock ends up in an ocean of red ink and pulls the group along with it to the bottom? Or, what happens if that rock breaks the ties that bind?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> The bus hurtles down the road, picking up speed, faster and faster, quickly passing one, then another, and then yet another large yellow sign warning that a sharp curve lies ahead, speed limit 15. But no one’s touching the brakes and, in fact, none of the passengers on the bus is driving. Then, 20 or 30 feet from disaster, a guy sitting in the fifth row gets up and announces “I think we have a problem.”

Your anesthesia group working at Sticky Fingers ASC was told in March by the managing partner of the surgical group that owns the ASC that they’re considering forcing you into a company model arrangement. But now it’s mid-November, you’ve done nothing, and one of your colleagues finally speaks up, asking “what shall we do?”

Realistically, what’s the difference between these two situations? In both cases, the passengers on the bus were given clear warning of the wreck up ahead.

As of this writing, there’s no one clear answer to the question of the legality or illegality of the company model. Based on my experience reviewing many deals, most that I’ve seen are doubtless disguised kickbacks.

If you get wind that you’re going to be presented with a company model situation, the time to start doing something to change the course of events is immediately – it’s not when the bus you’re riding on is going straight while the road veers sharply off to the left.

You have far more control over your professional fate than you might believe, even in current economic times. But control as to any particular situation has a very short half-life. Act immediately, before it’s too late.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> As the societal trend swings even harder toward the communal and the cooperative, it’s more important than ever that medical groups understand that maintaining their relationships with hospitals requires breadth, depth, and length.

This means involvement in a wide range of hospital and medical staff issues, leadership, not just participation, and commitment to a long term course of action.

This is an issue of strategy, not merely tactics.

In other words, it’s the overall approach that counts.

The act, or, rather, done correctly, the string of acts performed in cultivating relationships, is itself a large part of the new contracting process. That’s because those acts demonstrate, not merely announce, your participation.

As I’ve long maintained each of these touch points is a part of the negotiation with the hospital.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> The Wall Street Journal reported that Japan’s 100 year old Sharp Corp. announced that it had doubts that it could remain as a going concern.

Sharp had invested heavily in building liquid crystal display manufacturing plants in order to compete with its South Korean rivals, only to have the market collapse.

Sharp’s president was quoted as saying, “We lacked a sense of speed. The situation could have been different if we took steps more quickly.”

That sense of speed and action is entirely consistent with the philosophy of Col. John Boyd, considered by many to be the greatest military strategist since Sun Tzu, and his OODA loop, OODA being Observe, Orient, Decide, and Act.

Boyd’s concept is that strategic advantage is gained by being able to process information and take action faster than one’s opponent. This is referred to as getting inside your opponent’s OODA loop.

Whether or not Sharp ever heard of the OODA loop, it’s abundantly clear that someone got inside of theirs.

There are two important lessons here for medical groups.

The first: A 100-year-old company, or an office-based practice that has always received referrals from a certain group of internists, or a hospital-based group that has held the exclusive contract for 50 years, are not necessarily guaranteed a satisfactory future.

The second: Strategy and tactics exist. You either use them to your benefit or someone else uses them on you.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> In terms of thinking about the future, are practicing physicians really different from residents?

I recently gave the opening lecture in my series for residents. The first topic: The trends affecting the future of their practice.

Some in the audience paid close attention. Others did’t. An even smaller number came up afterwards to ask in depth questions.

Later that day, I realized that the mix of those oblivious to the future, those paying close attention to it, and those willing to take action to impact it, mirrors my observation of physicians in private practice groups. (It’s the same observation I have of attorneys, shopkeepers and, I suppose if I knew any, shoemakers.)

Someone, or some faceless trend, is always impacting your future. You have no choice but to participate. The real choice boils down to whether you’re going to be a passive or an active participant.

It’s not that tomorrow never comes, it’s that tomorrow always comes.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Contrary to the misfortune that befell the first little pig — you know, the one who built his house out of straw — I’ve recently learned that it’s actually quite possible to build a solid home from bales of straw.

That is, as  long as it’s resting on a solid foundation.

Many medical groups, especially hospital-based groups (but the lesson is becoming ever more important for office-based practices as well), have set, or, rather, bet, their future on the foundation of a single hospital.

How stable is that foundation?

Is the hospital going to survive? Will the hospital shift its own foundation and replace your group?

No matter how strong you build your structure, straw, wood or bricks, make sure that you didn’t construct it simply on someone else’s foundation.  How smart is that?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> As hard as it is for me to say, it’s been 40 years since I had my summer job at McDonald’s.

Yet after all this time, I remember some of the standards-enforcing mechanisms the franchise used, from written instructions on how each of the food items was to be prepared, to cards bearing sayings such as “When you have time to gripe, you have time to wipe,” and, my perennial favorite, “When you have time to lean, you have time to clean.”

No, I’m not suggesting that your medical group should have “cheat cards” as detailed as this. But your group needs to portray an image, an image of a unified group, and it takes work for you, as a group leader, to accomplish that.

All of this accrues to your benefit or to your detriment when you are contracting with the hospital or contracting with your employed or subcontracted physicians.

On the other hand, if you think these little details are unimportant, then stop to wonder why McDonald’s, which certainly doesn’t make the best hamburger, sells billions of them.

Not convinced? Then I want you to know that your competitors thank you for making it easier for them.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> As you may know, the Patient Protection and Affordable Care Act, Obamacare, imposes a requirement – a mandatory requirement — that physician groups adopt compliance programs.

These programs are not simply plans that you document, toss into a notebook and keep on a shelf – they must be living breathing programs revisited on an ongoing basis.

Now most medical groups will view their compliance efforts as completely divorced from their operational issues. So in essence they’ll erect a wall in between compliance and operations and proceed on each of those tracks independently.

But the better performing groups – those that I call the strategic groups — will use a different approach, an approach that I call Operational Compliance^TM, in which compliance efforts are intertwined with the group’s operations in order to address both the need to maintain an ongoing compliance program — that’s the risk management side — and to wring efficiency and profitability out of the group’s operations.

Looking at this another way, traditional compliance work is a cost  – it’s money spent, well spent, managing risk.

But in Operational Compliance^TM, a significant portion of the funds devoted is an investment in identifying potential areas of profit:  For example, this could be improving the speed of coding, billing and collection, it could be mining information for performance improvement, or it could be improving team-level performance – these are merely a few examples.

The fact is that you have to have a compliance program. So the question is do you want to have one that’s a cost incurred for the laudable reason of managing risk, or do you want go the rest of the way and turn a portion of what’s spent into an investment providing ROI – return on investment —  to your group  — an upside, in addition to managing risk.

That’s Operational Compliance^TM.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Sun Tzu, the ancient Chinese military strategist, wrote that, “He will win whose army is animated by the same spirit throughout all its ranks.”

Although running a medical group just sometimes seems like war, the essence of that advice is completely applicable.

Too often treating all group physicians as colleagues entitled to a high degree of autonomy, groups sometimes ignore the fact that, to succeed, all group members, from the leader to the junior most member, must conduct themselves in alignment with the group’s overall strategy.

Of course, this is obvious to everyone in the context of everyday, “real world,” interactions. Consider, for example, your inclination to return to a restaurant after receiving inattentive service from a waiter who was obviously simply going through the paces, or from one who, quite obviously, was unhappy working there.

Why would you think that it’s impossible that one or more of your group members are just going through the paces or, even worse, are signaling that they are unhappy?

What are they doing to your group’s ability to compete — even to your group’s ability to continue to exist?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> How unlikely is it that in twenty years, the only physician actually in the O.R. will be the anesthesiologist?

As surgery becomes more robotic, what difference will it make if the surgeon is actually present?

In fact, as surgery becomes more robotic, will surgeons continue to be physicians or will they be specially trained technicians?

Either way, anesthesiologists, as perioperative physicians, might be the only physicians in the room, indeed, the only physicians in an ambulatory surgery facility.

Think about it.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> It goes without saying as to any hospital-based medical group that top notch clinical skills are required.  But, they merely are the “price of admission;” they get you into the position of holding a hospital contract, not actually holding it, or, in far too many cases, keeping it.

Obviously, I can’t comment on the actual level of your group’s clinical skills, I don’t know the state of your current situation and, even if I did, I’m certainly not the one to evaluate your clinical abilities.

But strange as it may sound, neither is the typical hospital administrator.

He or she has an impression of your group’s skills. And it’s that impression that you have to be concerned with.  So, while I don’t mean to minimize the importance of actual skills, it’s the appearance of those skills: verisimilitude … the appearance of being true or real – that we’re concerned with.

Your job, then, is to create ways to demonstrate and publicize your skills.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> If you build it, you might just chase them away.

The parking lot in front of Fry’s Electronics was massive, but even so, it seemed small in comparison to the 150,000 or so square feet of store space.

But walking in the door with a computer to be repaired, the first step in running the gauntlet of “service” was to be stopped by an unsmiling, clearly unhappy-at-work and willing to share it “customer service representative,” who interrogates you and your broken computer. Frankly, the only thing that surprised me was that I was not read my Miranda rights.

Thinking smooth sailing was ahead, I arrived at the repair service desk to be immediately greeted by a technician. However, after 45 minutes he was still unable to unlock the diagnostic kit, the key to which was apparently entrusted only to his supervisor who was nowhere to be found. Eventually, I could wait no longer and left the computer to be diagnosed, but it took the technician another 10 minutes or so to get his own printer to work to produce the necessary paperwork to be signed.

Why build a large and attractive store and then allow the entire experience to be shattered by strange procedures, uncaring employees and printers (in the service department) that don’t work?

Why build a medical group and then destroy your relationship with referring physicians, the hospital, or patients by way of a rude receptionist, a disgruntled employed physician, or even one of your fellow partners?

I’ve seen $20-$30 million per year practices destroyed as a result of this type of behavior and, frankly, lack of management and training.

Just like Fry’s should be doing, ask yourself if you’re running a success prevention department.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> It’s estimated that the large national anesthesia companies have around 10 percent of the market.

They certainly are on a drive to expand.

To a significant degree, this expansion is driven by private equity and in some cases publicly raised money.

But outside investors will only stay in the game as long as there are profits. When reimbursement for anesthesia services declines, as it will, many of these large groups will be in play or will break up under their own weight.  They are not too big to fail.

As to the position in which this leaves independent groups, there will continue for some time to be intense competition from national groups seeking to consolidate the market.

But, there will be hospitals at which reimbursement is very low and which require stipend support to staff under any circumstances.

With increasing reimbursement pressure, the larger groups will not find those sites attractive and may demand significant stipends to service those facilities. This means that local groups that have developed strategically to deliver a transformational experience customized for that facility may actually be in a better position than national groups to obtain stipend support from those facilities.

On the other hand, there will be facilities which require stipend support to serve but which cannot afford to pay it or which simply choose not to pay it. The advantage large groups have is that they will be able to refuse to do business at those facilities and yet still pursue many other opportunities.

There’s a valuable lesson in that for smaller groups: You, too, have to build a business that is greater than simply serving one facility. In other words, you have to begin finding other locations at which to do business even if, currently, that means leaving the sole facility at which you do business and moving to another to put yourself into a position from which to expand. You, too, have to be in the position of being able to walk from a deal if continuing to provide services there does not result in an acceptable profit.

If this doesn’t fit in with your business plan, then you may not be in business for long.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> I’ve described exclusive contract relationships between hospital-based groups and facilities as being Relationship Contracts™, not Transactional Contracts™.

To recap what I mean by those terms, Transactional Contracts™ are ones in which the parties negotiate for a deal which, essentially, terminates as of the closing. For example, think about the purchase of a car or the purchase of a house. The parties trade consideration and part ways.

Conversely, in a Relationship Contract™ situation, the closing of the deal is the start, not the end, of the relationship. And that’s certainly the key element of an exclusive contract: when the contract is signed then the parties begin a continuing contractual relationship.

I’ve come to think that there’s an additional factor that all hospital based medical groups – and as time proceeds, it looks as if more and more of what have traditionally been office-based practices will indeed themselves be hospital-based – must take into account.

That’s the fact that in order to maintain a Relationship Contract™, top level competitors cannot merely be concerned about maintaining a relationship; they must be concerned about delivering a transformational experience to their relationship partner. I call these Transformational Contracts™.

In other words, I’m talking about creating the impact of a multiplier: doing business with your group has to deliver more to the hospital than simply a combination of one plus one.

It has to be situation in which you are delivering one plus one equals 4, 5, 6 or even 10 to the hospital.

And I don’t mean that what you are doing is suffering a deficit in order to fund an accrual of benefits to the hospital.

What I mean is that the transformational relationship you create multiplies the impact – the value — for each of you.

Sure, I know that energy can’t be created, but we’re not talking about energy here.  We’re talking about your future.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> ACO’s. Competition by hospital employed physicians. Commoditization.

Just a few of the “problems” that physician group leaders struggle with.

But are those really the problems? Perhaps they are actually symptoms of a different problem or set of problems.

For example, the problem of increasing “We” think and, especially, the problem of increasing bureaucratization and centralization of medical care. Or, perhaps, the lack of self esteem and an overdose of guilt.

Albert Einstein said we can’t solve problems by using the same kind of thinking we used when we created them.

As I’ve written before, medical groups are at what I call the Great Junction™, with one road leading to commoditization and the other to creating an experience monopoly.

The first route doesn’t require new thinking beyond figuring out if you can maximize the value of the sale of your practice, if it can be sold at all, an element not be demeaned.

Taking the second route won’t be easy: it’s risky and you might crash and burn. But there’s freedom and potential reward with no cap on the upside.

Taking the second route requires new thinking. That’s part of why it’s so much fun.

Let’s get started on your future today. It’s there, after all. Don’t you want to shape it before it shapes you?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> Options trading.

I don’t mean puts and calls. And this post has nothing to do with the stock market.

I’m talking about hedges. Hedging the bet you’ve made on your group’s future, “bet” being used in the manner of the strategy you’ve adopted to achieve your group’s focused future.

You’ve made that bet, haven’t you?

Hedging comes in the form of creating a strategy using the Scenario Survey™ process that’s flexible enough to operate within many potential futures, and then, periodically, retesting your strategy through the same process and, as required, refocusing it.

Don’t trade away your group’s options.

Don’t trade away your future.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> Entrepreneurial medical practices are constantly seeking ways to expand their business and their profit.

I’m all in favor of that and I’m sure you are, too – of course, as long as it’s done legally. Demands for kickbacks are quite another thing.

You probably think of kickback demands from referring physicians in one or both of the two most popular, “disguised,” flavors: the company model and the management fee type demand.

Those types of kickbacks generally occur in the context of services at ambulatory surgery centers, at other free-standing facilities, and at doctors’ offices.

But disguised kickbacks can also take place within the hospital setting.

For example, a carve out of what would otherwise be services performed by a certain class of specialists in favor of a referring practice or group of independent physicians may be a disguised kickback for their referrals.  Consider the case in which a subset of services is carved out of an anesthesia agreement in favor of the practice of a high referring office based physician. Or the case in which a radiology exclusive contract is amended to permit cardiologists to perform and interpret cardiac CT scans.

Violation of the Federal Anti-Kickback Statue turns on intent — intent that can be inferred from the facts. Violation of the AKS is, therefore, highly fact specific.

But, those facts may be clearly evident where you are least likely to be looking for them: at the hospital, not at the ASC.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> A congressional study compared the performance of San Francisco International (SFO) Airport’s privately contracted screeners with those of LAX’s TSA staffed screeners. SFO’s staff screened 65% more passengers per screener than the government employed TSA personnel at LAX.

To make the comparison even more striking, another study revealed that TSA personnel at LAX missed three times the number of hidden bomb materials than their private counterparts at SFO.

I’m not saying that the TSA isn’t concerned with your safety. However, it’s clear that the profit motive spurs businesses to hire and train motivated employees in order to keep and grow their customer relationships. If the private screening company at SFO doesn’t pass performance tests, it will lose the contract or even go out of business. The TSA doesn’t have the same motivation.

Is your group laboring under the misperception that it has an institutional lock on its relationship with the facilities it works at, on your relationship with its referring physicians, and on the experience you provide to your patients?

Even an institutionalized government agency doesn’t have that lock or there’d be no private screeners at SFO.

Somewhere, right now, as close as a sales representative on the phone with your hospital’s CEO, there’s a competitor motivated to outperform and out-deliver as they grow their relationships.

Let’s start with auditing yours.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> According to a British study, dairy cows given names by their farmers produced close to 4% more milk that those that were simply herded.

It’s likely, of course, that naming itself was not the operative factor. Instead, it’s probably the extra attention that the dairy farm workers give to cows treated almost as pets. The cows are happier. Happier cows apparently make more milk.

Sales people (and persuaders of all stripes) know of a similar approach – the use of the customer’s name – in improving sales. You know this, too, as your name is undoubtedly your most favorite word.

You should be using this same approach with your colleagues, referral sources, hospital administrators and patients. They’re not colleagues, they’re Bob and Sally. They’re not referral sources, they’re Jack and Ruth. They’re not hospital administrators, they’re Alan and Melissa. And they’re not patients, they are Dan and Barbara.

It seems so simple.

The beautiful part is that it is.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> “Ready. Fire!  Aim.”

Maybe you’ve heard that business saying, designed to spur you to action before too much planning bogs you down.

But in reality, it’s a pretty stupid notion:  Your “firing,” that is, your business action, is useless unless you know what the target is.

Without an aim, a strategy to pull your medical group to your Focused Future™, your actions amount to fruitless flailing.

Sure, maybe you’ll get lucky, but the chances are far greater that you’ll shoot yourself in the foot.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]>

Certainly, patient care within your medical specialty involves many complicated and complex issues.

But that doesn’t mean that the way that your practice’s business relates to hospitals, referral sources and patients has to be complicated. And, it doesn’t mean that the way that the arrangements among your practice’s owner physicians, or between your practice entity and its employed or subcontracted physicians, has to be complicated.

Albert Einstein’s comment that “everything should be made as simple as possible but not simpler” might appear obvious, but if it is, then why are so many relationships, so many pronouncements, and so many explanations so complex?

I think it’s because although at first it seems counterintuitive, oftentimes we make things complex because it’s easier than making them simple.

Simple is actually a lot of work, especially in a complex world. But because relationships are based upon communication, complexity clouds the message, it doesn’t clarify it. The object is to advance your business interests – to make you more profitable and to manage your risk of loss. It’s to transform your business in an accelerated manner.

So, certainly, business structures are required and agreements must be drafted, and relationships must be created, but it’s those structures that are only as complex as minimally required — in other words, those that are as simple as possible but not simpler — that serve you best, just as are those agreements which simply and clearly delineate expectations.

For example, consider a partnership governance structure with so many committees and subcommittees all designed as checks and balances when, at its essence, the real issue is if there’s no trust among the partners. The added levels of complexity do nothing to enable the business of the practice to grow – in fact they stymie it.

I know it’s a complex idea, but strive for simple.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> Sorry. None of your patients, referral sources, or the hospitals at which you practice cares about your success.

Surprise! They care about themselves.

The key, then, is to tie, for a moment or for years, to the achievement of your “partner’s” goals by delivering something they value.

Think for a moment of the Girl Scouts. Unless you have a young girl in the organization, it’s not likely that you’ll simply send them a check, no matter how highly you think of their mission of building girls of courage, confidence, and character.

However, they raise $760 million a year by exchanging value for your donation: cookies.

Similarly, for you to succeed, you have to tie into your “partner’s” success by delivering value. The best value is tangible or easily translatable into something tangible such as efficiency which turns into money.

The exact value varies situation to situation.

Just think of it as finding the right “cookie.”

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> You couldn’t ask for a better analogy to illustrate the difference between entrepreneurial practice and the bureaucratic world of one size fits all medicine envisioned by many pundits as the preferable world of the future.

Dinner at the family-type chain restaurant, Rock Fish. Pleasant but not fancy, yet clean and decorated nicely. We were greeted warmly and served promptly. Every five minutes or so the waiter came by to see if anything else was needed. He brought the check at an appropriate time. He was chatty and polite, not cloying.

Standing in line at the Post Office. Dreary but not quite prison-like, trash on the floor, priority mail envelopes not in stock. A line of 15 or so customers. Two clerks behind the counter, but one is simply moving pieces of paper from one pile to another and refusing to make eye contact with anyone. The clock ticking toward five o’clock, bordered by two large signs warning that mail accepted after five will not be processed until the next day. The one remaining clerk walking away from the counter into the back room between “helping” each customer, and, when she deigned to “help” someone, made it abundantly clear that she was bothered by their presence.

Rock Fish wants to succeed and there’s tough competition in the moderately priced family restaurant market. No, their food isn’t fancy, but it’s good and the service is wonderful.

The Post Office, which is a monopoly, can’t even compete against services outside of its protected bounds — consider FedEx which charges at least a 3,700% premium. Their only solution: raise prices more and float the idea of rationing delivery from six days a week to five. Their employees don’t care to elevate the level of service or satisfaction because they almost have to shoot one another, and sometimes do, to be fired.

Of course, this blog post isn’t about restaurants or the Post Office, it’s about bureaucratically controlled and delivered healthcare. And, not just as it impacts you, the reader, as a healthcare provider, but you as a patient as well.

Do you want to take a number and hope it’s called by five?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> I don’t know about you, but when I eat at a sushi bar, I expect the sushi chef to take my order.

After all, for me, that’s the expected, traditional experience. And, it’s what makes it fun.

You order based on what looks fresh, on what the chef suggests, and depending on your appetite – not all up front, but as the meal progresses.

But I’ve noticed that in some parts of the country sushi bars operate like a long skinny table — a waiter or waitress takes your order or, even worse, picks up your self-completed golf scorecard-like order sheet. You can place an additional order, but there’s a tremendous delay between when you turn in your form and when you get your sushi.

These places shouldn’t bill themselves as sushi bars. Maybe they should advertise as Japanese restaurants with a demonstration kitchen. Because as sushi bars, they fail to live up to anything but low expectations — they certainly don’t delight.

The same lesson applies to your medical practice.

Certainly, simply meeting your patients’ expectations in terms of the standard of care is legally and morally sufficient. But that’s just like the “order form” sushi bar which passes health department inspection but doesn’t delight.

For both the sushi bar and your practice, success requires more than just fresh fish.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> As a recent Wall Street Journal article recounts, Japanese manufacturers, once the world’s leaders in electronic goods and especially in cell phone technology, lost big in the switch to smartphones.

The author attributed their fall to the manufacturers’ inward focus: They concentrated their major technological advancement on televisions and, as to the cell phone, simply focused on the peculiar features successful in their home market. The iPhone and its smartphone progeny threw them for a loop both in connection with phone sales and in the way that the smartphone has impacted the manufacturers’ other major product lines: electronic game machines and digital cameras.

This same message plays itself out every day for medical groups that concentrate all of their business firepower on one or a very small handful of business opportunities, from single-facility exclusive contracts to specialty practices dependent on one large referral source. It also plays itself out when groups exclude from consideration any experience from outside their group.

The smartphone has conquered Japan. What is lurking just outside of your group?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> Male hummingbirds, those cute little avian rockets, are absolutely vicious when protecting their turf from other males of their species. They’ll fight to the death.

But for physicians, protecting your turf requires a more balanced approach. Especially when it comes to deciding what to protect.

For example, some physicians believe that they will be able to forever protect the four walls of their specialty from encroachment by other specialties or that ever changing market forces, what Joseph Schumpeter called “creative destruction,” should never impact their territory. That’s wishful thinking at best.

On the other hand, many medical groups have developed significant innovations that create value and can be protected. Innovation can remain proprietary to protect your group’s competitive advantage. Or, it can be licensed to other groups. Of course, this means that the creators must take the time, devote the effort, and, yes, make the investment, to protect their rights in those innovations.

It does little good to glorify the past or to try to stop cold major market forces. Some defense is, of course, required, but in the long run, there is more profit (and sanity) in innovating the future.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> I recently read an article about a physician who had sold his practice to a hospital. The physician was quoted as having stated that he had grown disenchanted with running the business end of his own practice, thus his agreement to “have my practice managed by” the hospital.

The viewpoint of that article was that this signals a disconnect between the physician and the hospital: The physician needed more than management; the physician and the hospital needed to be more aligned as to the hospital’s goals and objectives to be met.

I agree that there’s a disconnect, but I believe that it’s on an entirely different level.

The physician speaks as if he’s simply signed a management agreement in respect of his practice, when the reality is far different: he no longer has a practice, it is owned by the hospital and he is simply an employee, an employee who has to be “aligned” like a flange.

That is, for as long as he’s employed.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> Simply remaining single hospital based is a disaster waiting to happen, failure on the installment plan: a hospital has tremendous leverage in its negotiations with a single-facility medical group because it knows that without its contract your group no longer has any reason to exist.

If it loses one contact, its only contract, your group has lost its business life.

Groups must counter that leverage by developing a true business structure that involves contracting with multiple facilities, mimicking the strategy of the larger competitors, but with a few very important differences, including the fact that management is actually “on the ground,” and the fact that ownership is local and physician-driven.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> You have been coming into work every day for years. Now there’s no need to come in tomorrow because your group no longer exists.

You see, although your group collected over $20 million over the past year, and you and your fellow partners earned a tidy sum, it turns out that your group was simply a service to one hospital, not a real business. When the hospital chose to obtain that service from someone else, proof, there went your group.

There are many things your group can be doing to create leverage to prevent its demise. And they all start with telling the truth about your present situation and with imagining the future as you want it, not as “the hospital” wants it.

Right now, the chances are almost certain that there’s someone – in fact many someones – who want your group’s contract.

Are you going to let them have it?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> Pretend you’re about to invest years of effort and place your economic future on one of the following:

(a) A business totally dependent upon the fact that Gmail will always exist, or

(b) A business dependent upon email on any platform.

Why is it that “b” is an obvious choice in this pretend exercise, but that, for hospital-based physicians, almost all have chosen to stake real years of effort and their actual economic future on a single relationship between their group and a hospital?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> Be honest: Do you own your practice or does it own you?

If your practice owns you, what you have is a job. You might as well go work for someone else. Less headache. Isn’t that the whole point of physician management companies and hospital employment?

But if you want to become successful, and there is no need to apologize for that fact — I laud it — then you need an entirely different mindset and an entirely different business structure.

And, if you have partners who don’t agree, they’re simply holding you back and it’s time to reorganize.

Thanks to government intervention in what used to be a marketplace and is now a system, physicians are quickly coming to what I’ve referred to as the Great Junction™ – one route leading to commoditized medicine and the other to personalized, unique care. You could look at this junction another way, and that’s the divergence between employee and virtual employee physicians and true entrepreneurs.

If you own your practice now but find comfort in the employee track, then there are certainly burgeoning opportunities for the sale of your practice.

And, if you want to build something, this is also the time to do it.

The problem is, you have to decide or understand that the default route is the employee track.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> The first time that I saw a computer there were two in the room. One of them took up most of the south side of a floor of the Computer Science Building and the other took up most of the north side.

To the best of my memory, the first time I saw a hospital it took up much of a city block.

Today, I and millions of you each have have more computing power in our individual smart phones than there was on the entire floor of the Computer Science Building. Computing power, the distribution of new media sources, the ability to put electrical power back onto the grid, and hundreds of other advances all result from the explosion caused by the microchip.

So then why is it that hospitals are getting larger, not smaller? Why is it that hospitals are assuming the functions of physicians, not the other way around?

Eisenhower warned of the military-industrial complex. Is the government – hospital complex just as dangerous? In my mind, it is even more so. Why do large hospitals continue to exist?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> Whether it’s the 83% reported in the press or even half of that, many physicians are questioning their career strategies in light of the Supreme Court’s upholding of the individual mandate within Obamacare.

It appears certain that an increasing number of physicians will be disappointed with Obamacare and the burdensome requirements of its bureaucracy.

From my experience working with concierge type family and internal medicine practices – no insurance accepted, high touch high-quality care – it appears as if there will be a growing market among the professional and executive classes as well as the truly rich for something outside of cattle call medical care.

But what about specialists? Can a cardiologist or a hand surgeon adopt the same kind of practice? In some instances and in some locales it is entirely possible. But in others, even they can’t go “no insurance” on their own, they might be able to create a similar business through alignment with primary care doctors in a concierge network.

Yes, I can hear someone saying that medicine is a profession not a business.

But unless you begin thinking like an entrepreneur, you just might find yourself becoming a government employee.

Contact me if you’d like to continue this conversation for your benefit.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> In the book, Jurassic Park, and in the movie of the same name, it quickly becomes obvious that despite absolute belief and assurance that the system is closed, there is always the chance of a leak.

Shift from dinosaurs on an island to your patients’ protected health information, or “PHI,” which you probably believe to be safely ensconced within your practice’s system or that of your outsourced billing and collection service, all nicely guarded by your compliance program. After all, you have a copy of the compliance binder on your bookshelf.

I can almost guarantee you that there’s a leak. It may not be intentional as in the Jurassic Park character who attempts to abscond with dinosaur embryos. It may simply be inadvertent as in the dinosaurs that find their way off the island.

The downside of an inadvertent PHI leak can be fines couched as civil monetary penalties; a wreckless or purposeful leak can lead to criminal prosecution. That plus the damage to the reputation of your group, jeopardy of its relationship with referral sources and facilities, and potential liability under various legal theories to the patients whose information was disclosed.

In this light, compliance auditing is a must. But the auditing process, and the corrective action taken, must not simply be viewed as correcting a problem; rather, the best return on investment for your group is to dual-purpose compliance – yes, it reduces risk, but it can also be a focal point around which to fine tune and improve your group’s systems and performance.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> I’m on an American Airlines flight.

As I’ve noticed on other flights, the flight attendants are wearing their name tags flipped around so that the back of the tag, not their name, is visible.

What’s their mindset? Is it “excellence” or “I’ll be in trouble?”  The question, of course, is wholly rhetorical.

This should make you wonder which way your group’s physicians’ metaphorical “name tags” are facing.

Are they aiming to please, or are they taking aim?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> Over the past five, ten or twenty years, your group has worked long and hard to develop its business. You’ve become successful.

But now, you see threats everywhere: threats from the hospital that wants to employ you, threats of forced ACO participation, threats of replacement by paraprofessionals, threats of competition from national groups and the staffing services masquerading as groups, threats of competition by breakaway partners, employees and subcontractors who think that they can do it for less (and who fear replacement more than you do), and threats of competition from those of your colleagues who see no need for you to earn a profit in return for your financial contributions and years of management work.

So, as a result, you’re circled the wagons, protecting your group from both internal and external threats.

Not a bad move in and of itself — but bad if that’s where you’ve stopped.

That’s because adopting a purely defensive position can never advance your group’s future, it can only delay something from happening to you.

In order to succeed, you need to cause the “happening,” you need to take charge of creating your own transformative future.

What if your partners won’t agree? That’s why strong leaders are required and why participatory “leadership” is in reality an absence of leadership. Get new partners. Go out on your own.

It won’t work, you say.

You’re right, it won’t work for you. Send me your resume, I may know someone who’s looking to hire, just about when you’ll be looking for a job.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> Almost all physician groups are mired in mediocrity. Only 3 to 4 percent are in the category of top performers, of those who have seized their own futures. Those few are the groups that I call the strategic groups.

There’s a choice, an intersection – the great intersection – and you’ve come to it today. Or better said as to almost all of you, it’s come up on you, come up on you fast. The road most traveled is the one to commodity status. The road less travelled is the one to success.

Don’t bemoan the fact that the future is uncertain and then use that as an excuse. (Don’t worry, most of your colleagues are perfectly happy with a life on emotional and financial crutches.) The only way to escape and to have any degree of certainty as to your own future is to create it yourself.

If you’re interested in coming on the voyage of your life, call me. If not, don’t worry about it.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Let’s assume for a moment that physician compensation surveys are statistically significant.

What’s the problem with them?

Well, I suppose they’re fine, that is, if you’re content with being average.

OK, I can hear it now, some reader yelling that physician compensation surveys indicate more than just what’s average; they show the 70th, 80th and even 90th percentiles as well.

But, once again, what are they measuring?  And, is the yardstick that they are using the yardstick that you want applied to you?

First, and again assuming that these are statistically significant surveys, they are broadly measuring how physicians are being compensated for rendering patient care services. They are not measuring the added value that is obtained outside of providing services, through providing special, or “strategic,” value to the group’s customer, whether a hospital, referring physicians, or patients.

Take for example, one of the purest form of strategic, or entrepreneurial, medical practice: cosmetic surgery.  In some markets, the expertise, or, rather, the appearance of expertise and of a type of celebrity, wholly manufactured in most cases, has such value to potential patients that they will gladly go significantly more out of pocket to obtain treatment from Dr. A as opposed to from Dr. B.

Groups which practice in the traditional hospital based specialties often, quite improperly, view themselves as providing a commodity service. They themselves do not believe that there is a qualitative difference between their group’s Dr. A and another group’s Dr. B, such that there is no strategic value from obtaining services from their group as opposed to from another group. It makes you wonder why they are surprised when they are replaced.

Unless groups structure themselves and position their practices to create a new and different experience, they will be readily replicable and readily replaceable.

At the same time, groups need to understand that even the world’s best buggy maker was mooted by the paradigm shift, the creative destruction, away from horse-drawn transportation to the automobile.

Similarly, in light of the paradigm shift going on now within healthcare and, in particular, the advanced velocity of change going on within some specialties, physician groups must tailor their unique offerings, their unique delivery of service, to either ride the wave of the new paradigm or find a way to swim around that current.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Continue reading »]]> Many contracted medical groups, both those in the traditional hospital based specialties as well as those in office based specialties, quite improperly view themselves as providing a commodity service.

They themselves do not believe that there is a qualitative difference between their group’s “Dr. A” and another group’s “Dr. B,” such that there is no strategic value from obtaining services from their group as opposed to from another group.

It makes you wonder why they are surprised when they are replaced.

The one thing that is certain in the healthcare economy is that there’s nothing that will remain certain. Schumpeter’s concept of creative destruction was spot on, and the pace at which change is being hurled at you is quickening.

Fighting to save what you have is a losing battle.  And, if all you think you have is a commodity, you’ve already lost.

The most complex transformation starts with a simple change – changing your mind as to what your practice provides.

Of course, the next step is action. But without that change in mindset, no action will ever take place.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> In the my blog post entitled Who’s Driving Your Practice’s Bus?, published in April 2012, I wrote that for many medical practices, it appears as if no one is driving the bus; that is, no one is in charge of the group’s business. Instead, the practice operates like a runaway bus — yes, the providers are seeing patients, but where is it headed? Instead of a map with a clearly marked final destination, it’s just rolling along.

Many groups have a related problem: There isn’t a bus driver, there’s a whole committee of them. In fact, for some groups, there is a whole Greyhound bus full of them.

There is no question that the healthcare market is changing rapidly. This means that groups must have the ability to make business decisions rapidly.

Drawing on the work of the late Col. John Boyd, considered by many to be the second greatest military strategist to have lived, success requires a faster cycling through what he termed the OODA loop. In simplified form, the loop consists of observing, orienting, deciding and acting. (The OODA loop is actually much more complex with various internal feedback mechanisms). The point, however, is that the competitor who can cycle faster through the loop gains a tremendous strategic advantage over its opponent.

Whether you take the time to study Boyd or not, it’s axiomatic that a group must be able to make decisions quickly. That requires that someone, not some committee, be in charge.

Please note that I’m not saying that groups need dictators: far from it. However, group leaders must be empowered to lead – and they must actually lead.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Only slightly tongue in cheek, Einstein’s theory of relativity, E=MC², is also the formula that describes the power of any medical specialty exclusive contract.

E = Exclusive (to the exclusion of all other physicians as to the services covered)

m = management (of the business function of delivering that service)

c² = control and cash

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> In 1919, New York hotelier Raymond Orteig announced the Orteig Prize: $25,000 to the first aviation team to fly nonstop between New York and Paris.

In 1996, the X Prize, later named the Ansari X Prize for its major benefactors, offered $10 million to the first private, reusable manned spacecraft to fly into space twice within a two week time period.

Of benefit to physician groups is the fact that both the Lindbergh team that won the Orteig Prize, and the Team One team that won the Ansari X prize, budgeted and spent far more than the amount of the prize to win.

So, it wasn’t actually a profit motive — the dollars what would be won — that motivated the contestants to attempt to win.

Yet the mere announcement of the prizes — of the challenge, of the money and of the recognition that would accompany winning — spurred tremendous competition and resulted in the breaking of barriers.

Importantly, consider that before the prizes were announced, there existed similar economic rewards for the group that could accomplish the feat. For example, the technology that would enable private, reusable manned space flight was just as valuable to its owners whether or not there was a prize attached to the initial success of their venture.

That same human drive to win can be harnessed within your medical group and within a hospital.

Find a way to hitch your group’s success to human nature.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Verisimilitude:  The appearance of being true or real.

Unfortunately, it’s not the fact that your medical group is actually the “best,” which, indeed, it might well be, that governs your group’s success. Rather, it’s whether the hospital, or referring physicians, or patients believe that you’re the best.

Create that perception. It does not happen by itself.

This also is the case for individual physicians within a medical group.  When your group’s leaders see you as among the most valuable group members, when it comes time to make a decision concerning value, you will be rewarded.

Think of it this way: If you were in charge and had to let someone go other than for a seminal event (like shooting a colleague — only slightly tongue in cheek), you’d fire a person whom you believe is delivering low value to the group. But that belief is based on perception.

Sure, those who actually deliver low value can create the perception of higher value. But, unfortunately, its very common for those who actually do deliver great medical care, who are interested in the group’s, as well as their own, success, to not do anything to burnish their reputation as a high-value group member.

Perhaps they believe that their excellence is enough.

It’s not.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> The healthcare tide is strong: pushing forward hospital-centric healthcare, accountable care organizations, and governmental meddling.

But what way are you swimming toward your future? Are you swimming with the tide or against it?

Certainly, some trends are strong and will continue to play out no matter how hard you fight against them. For those interested in swimming with the tide, the strategy required involves aligning yourself with the tide, but doing so in a remarkable way.

So, for example, we have those cases in which physician groups have entered into equal partnerships with hospitals in terms of truly aligned delivery systems.

Others will choose to swim in the opposite direction, not directly into the trends, but around them.

For example, the psychiatrist who’s escaped the relatively low income of his specialty to open specialized centers across the country.

No matter which way you swim, there’s money to be made either way.

But what’s required of you are both a decision on the direction in which you’ll swim, followed by the exertion of effort to move in that direction.

If you simply float you’ll be carried along with the great mass and, despite those who think that it “takes a village,” there’s no real future in that.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> If you are a hospital-based physician, you can be certain that there are one or more so-called national groups targeting your facility. That is, they want to put you out of business.

Probably better said, first they want to take some or all of your current physician staff, and maybe some of your non-physician staff, and then they want to put you out of business.

If you are an office-based physician, this isn’t the time to gloat. That’s because in many office-based specialties, this same trend is beginning to emerge. After all, if hospitals have their way, sooner or later all physicians will be hospital-based.

I’d like to address one of the several grounds on which national groups compete: governance.

National physician groups and the practice management or contract management companies, by whatever name or acronym they are known, masquerading as true physician groups or purporting to be able to provide staffing, generally portray local groups as being disorganized, out of control, and deficient.

In other words, they simply assume you are damaged. Unfortunately, most hospital administrators make the same assumption.

As a result, the national group’s pitch often resonates.

This should both scare and empower you:

Scare you because if you do nothing to improve the governance within your group, you are leaving an open door through which you can expect a competitor will enter.

And, empower you because knowing that your competitors are looking for an open door, and knowing that administrators most likely see your group as lacking in governance, whether it’s true or not makes no difference, enables you to focus on this issue as early as possible, which is right now.

Specifically, we’re looking for two important elements:

The first is adopting a streamlined group management structure. A system that can make decisions and take action quickly.

The second is creating a structure that can deal effectively in managing the behavior of group physicians.

Sure, as in planing a tree, the best time to address governance was many years ago. But the second best time is today.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Like it or not, the practice of medicine is also a business.

In many specialties, your competitors are businesses: the so-called national groups and practice management companies.

Complain about those aggregators as much as you wish – and there’s a lot to complain about – but the one thing that you cannot criticize is that they fully understand the importance of operating as a business.

My advice is that you must adopt the same mindset.

Now, before you complain, I’m not telling you to lessen the compassion you feel for your patients, the time and effort you spend developing expertise, or any other aspect of high quality, high touch patient care. In fact, I believe that that is your competitive advantage: you are small enough, whether you’re a two-person group or a 200 person group, to deliver an experience monopoly to your patients, referring physicians and facilities.

However, your structure has to be that of a business. It has to think be beyond slavish devotion to one facility. It has to deal with administrators, referring physicians and payors as equals, not as “service providers.”

Change your mindset and significant improvement will follow. You are not running a practice: you are running a business which is a practice. You are not a physician: you are an entrepreneur in medicine.

Either that, or you’re an employee, actual or virtual. Go complain. Go unionize. See how far that will get you.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> There was an anesthesia billing service in the 1980′s that marketed by telling its clients that all they had to do was go to the hospital, do their cases, fill in the billing information, go home, and get paid. In fact, if you asked physicians today what they would like in terms of a healthcare system, chances are that a great percentage would say that that system is what they want.

Sure, it’s human nature to head toward pleasure and avoid pain, but it’s quite another thing to ignore reality in favor of illusion.

The fact is that the current healthcare marketplace is very different from that of the 1980′s. In fact, even in the 1980′s, that billing service’s marketing manifesto was completely ludicrous.

I’ve written before about the process that I call Focus on The Future™. The process involves creating your group’s ideal future and then using that future as a magnet to pull your group toward that desired end result. But equally important to understand, the process begins with telling the truth about your group’s current condition in all regards, from relationships within and without the group, from all of its assets to all of its liabilities.

That specific “truth” of your group, combined with the truth of its specific external situation — from the financial condition and aspirations of the hospitals at which you practice, to the demographic trends of the community, to the impact on your group of the national healthcare debate — all combine to create your group’s current situation, which, in terms of your group’s transformation, serves as raw material.

So, as opposed to an idealized return to the past (á la the 1980′s billing service manifesto – which was undoubtedly even then an idealized present), focusing on the future and its required telling of the truth necessitates acceptance:

Acceptance of the group’s current situation. Acceptance of the group’s pluses and minuses. Acceptance of market realities. Acceptance of the fact that “it is what it is” — acceptance of reality.

This first step is absolutely required. Not only does it dispense with the self-delusion that acts as an anchor, holding back against forward movement, it provides the current “location” of your group; you must know where you are in order to understand how to move the group from where it is to its desired new reality.

If this isn’t clear, there’s another way of describing the point that might strike true for you:

Your group’s current situation including all of its attributes, plus the total of the outside factors impacting your practice, combine to form a sort of wave, perhaps even a tidal wave. You can push against it as hard as you possibly can, but that tide will always win in the long run and, if that’s your strategy, you will always lose.

So, as opposed to ignoring reality, or arguing against it, or, even worse, idealizing it, once you’ve identified that wave, you can set a strategy that attempts to skirt it, or, even better yet, ride it.

No one can deny that the trends impacting medical practice induce fear. But there’s also tremendous opportunity within, and as a result of, those trends, and that opportunity is available for those who understand the need to not simply be buffeted, but to navigate.

In conclusion, groups often hold themselves back by having no strategy – no overriding strategy and no specific business strategy. To succeed, groups must strategize for their own desired future and that involves telling the truth about the current state of affairs. Anything less is delusion and that will lead to disaster.

It is what it is. It will be what it will be. Always.

***

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> “I don’t even know where to begin.”

Lately, as a result of the growing financial pressure on physicians and the quickening pace of change in the healthcare market, I often hear heard this, or similar expressions of frustration, when I explain to new clients the concepts of creating an experience monopoly and of the need to strategize for their group’s future.

Of course, a significant part of these group leaders’ frustration results from the fact that physicians generally aren’t trained, or experienced, in business decision making. Two elements of uncertainty combine to cause this paralysis. One is the uncertainty inherent in the healthcare marketplace itself, from questions of the extent of planned government takeover to the impact of the growing role of paraprofessionals. The other is the fact that a group’s success depends on the ability to make decisions under conditions of business certainty: decisions that don’t necessarily have to be “right” to be highly valuable.

Very few physician leaders are comfortable with the fact that their decisions might be wrong. I posit that that’s due to the fact that “wrong” decisions can have dire consequences in physicians’ patient care activities. Additionally, and perhaps equally so, physicians’ educational background is generally science and math heavy – areas in which there are clearly right and clearly wrong answers – coming up with the right ones earns the reward of good grades, gets you into medical school and then, years later, comes back to bite you in the business butt.

Even though that way of thinking delivers success in terms of practicing medicine, it tends to weigh in favor of failure in connection with business decision making. In the context of your groups’ business, and of your leadership of the group, failing forward faster can be just as valuable as a “right” decision, because you’ve learned what doesn’t work and then quickly moved on to another possible solution.

Leveraging off of failure means, of course, that you must remember what didn’t work, and why, and then not make the same mistake again. Although the story has become trite, consider Thomas Edison’s remark in the context of finding the right material for the light bulb filament: “I have not failed. I’ve just found 10,000 ways that won’t work.”

In addition to understanding that failure in this context is not equal to a failing grade, physician leaders must learn to make a decision and to pull the trigger on implementation when they have enough information — not when they have all of the information. Speed of implementation is required.

“Now,” in this context, is the time to start. Other than “now,” the timing will never be optimal.

Develop these skills and the strength to put them into play.

All you have to do is start. There’s no right beginning. But beginning is required to achieve your group’s own end, as opposed to having the end of your group handed to you by someone else.

***

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Is your group playing to win or just playing not to lose?

Are you working at only one facility and hoping that your exclusive contract will be renewed or that your relationship with referring physicians on the facility’s medical staff will continue to result in a stream of patients?

Are you simply laying low and hoping that ACOs and hospital-centric healthcare goes away?

None of this demonstrates a viable group strategy. Instead, it indicates slow decay.

In a dynamic healthcare market, sitting by the sidelines isn’t a strategy. It is a recipe for disaster. The object isn’t simply to survive, it’s to chart a course that leads to a transformationally more successful outcome for your group.

Note that this doesn’t mean that you always have to take affirmative action — to say yes to every project, or to take, in a particular instance, aggressive action in respect of a project or a negotiation.  Rather, it means that you have to take affirmative steps to decide whether or not you are going to take action.

Certainly, the times are turbulent for physicians and medical groups. The government and hospitals are grabbing power. Paraprofessionals believe they’re competent to perform many of your functions and, to some extent, the payers and the public agree.

But that doesn’t mean that you have to accept the fate that those authors are writing for you. There remains tremendous opportunity for those few who are willing to play to win.

Are you among them?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com 

Continue reading »]]> Money. Power. Status. Popularity. The four human interest motivators.

What does this mean for physicians in the context of a hospital-centric healthcare future?

The hospital will control the money, but due to the need to use fair market valuation studies as backup for compliance purposes, which will lead to a spiraling down of physician compensation, sooner or later doctors’ incomes will be as predictable as government employee classifications.

Power will be tempered by cookie-cutter reliance on so-called best practices and by strictly enforced treatment pathways.

Status will decline with income and with the fact that physicians will cease to be the only “doctors” among the plethora of degree-laden providers.

And, popularity will wane as physicians become back room technologists once or twice removed from most direct patient care which will be delivered by advanced practice nurses and other paraprofessionals.

You might think that Charles Dickens has come back to write some new lines for the ghost of Christmas future, but alas, unless physicians act to move the healthcare solar system’s center back onto them and away from hospitals, this future is inevitable.

So you see, this isn’t Dickens’ story: A Christmas Carol had a happy ending – this may turn out to be a tragedy.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com