Jul 05 2011

The “Company Model:” More Than Just an Anesthesia Problem – Podcast

The so-called “Company Model” of providing anesthesia services at an ASC presents serious kickback concerns.  But the problem is far greater than simply anesthesia deals.

Play

Jun 29 2011

Negotiation Ploys – From Autos to ACOs – Podcast

The tactics being used by proponents of accountable care organizations against physicians are eerily reminiscent of those used by auto manufacturers to crush the prices charged by their suppliers.

Play

Jun 28 2011

Harnessing Group Pressure in Negotiation – Podcast

How to apply, and defend against, psychological pressure during your next negotiation session.

Play

Jun 13 2011

Why Discarding Democracy Improves Your Group’s Chances of Success

A few years ago, I wrote two articles on physician group governance, both available on the ALG website, one for AuntMinnie.com, a radiology publication, http://www.advisorylawgroup.com/radiologygroupungov.html , and the other for Anesthesiology News, http://www.advisorylawgroup.com/anesgroupungov.html.

There’s an important reason why physician groups must do away with overly democratic or consensus style systems of governance:  Those approaches make it impossible for the group to adopt a strategic, as opposed to a tactical, outlook.

Take a consensus style group that is unable to come to terms in respect of the expanded office hours demanded by a large number of referring physicians in the community.  From a purely tactical standpoint, the group ventures into the question of the cost of the extra hours of operation and, although unspoken, of the convenience factor as run through each doctor’s personal filter.

But the strategic analysis is very different:  If we value their referrals, how do continue to obtain the ongoing business of the physicians in our community who are already referring to us?  This, of course, requires an understanding of the concept of lifetime value.

As to the question of who should be making that decision, true democracy doesn’t work in business any more than it works in running a city, state or nation.  As I advise clients, I’m a strong proponent of the “strong leader” form of governance.  Whether that leader is grandfathered in or elected every year or two is an issue that turns on the culture of the specific group.  If elections are the culture, that’s where democracy comes into play:  representative democracy.

Leaders must be empowered to lead.  Not all of their decisions will be good ones, so they must be free to fail as well as to succeed.  Requiring a group vote or establishing a board consisting of all of the shareholders guts leadership and replaces it with its poor relation, consensus, which by nature suffers from the defects of peer pressure and compromise.

Lead, follow or get out of the way.  Or, as the English author G.K. Chesterton poetically put it, “I’ve searched all the parks in all the cities and found no statues of committees.”

Mark F. Weiss

www.advisorylawgroup.com

Jun 13 2011

How to Cure Physician Group (Un)Governance – Podcast

Most medical groups are unable to gain strategic advantage due to their own management bureaucracy.  Here’s the cure.

Play

Jun 13 2011

How the Downward Spiral of Fair Market Valuation Will Destroy Your Future – Podcast

Learn how valuation consultants’ refusal to opine at higher than the 75th percentile is taking the fairness out of fair market valuation and robbing you of your income.

Play

Jun 06 2011

Stifling Success

Do hospital CEOs really want your hospital based group to succeed?  As to clinical performance, the answer is “yes.”  But as to everything else the answer is a resounding . . . “maybe.”

For the full story, watch the short Q & A No. 4 video on the ALG website.

Mark F. Weiss

www.advisorylawgroup.com

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Jun 03 2011

How to Navigate The Rising Tide of Aggressive RFPs – Podcast

How to Navigate the Rising Tide of Aggressive RFPs

Play

May 13 2011

Karl Marx, M.D.

For the most part, physicians are stuck in a Marxian world of reimbursement:  Pay is based upon the value of labor, whether measured in ASA units or wRVUs.

It’s a mistake to assign value on the basis of input (labor) when the real measure is in the value of the output, whether seen as cure, palliative relief, assurance or even . . . life.

At the national level, the talk is about controlling the “cost” of healthcare.  Instead of lauding the effort, physicians should be advocating for the revisiting of the basic assumptions behind physician compensation — that means advocating for pay based on the value of the output.  Certainly I understand that there’s only so much in anyone’s budget, individual, government program or private carrier, but perhaps the budget should no longer be balanced on the heads of physicians.

Obviously, this is not a post about controlling the “cost” of healthcare.  It is a post about getting you what you are truly worth.

Mark F. Weiss

www.advisorylawgroup.com

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Mar 23 2011

Weaponized RFPs

More and more hospitals are disrupting their longstanding hospital-based group relationships as they seek to cut stipends and get more for nothing.  The favored tool?  A “weaponized” form of the request for proposal, called a “Fulcrum RFP™, designed to get a group to grovel for the continuation of its contract.

Of course, the concept of an RFP is not new; it’s been used for decades across many industries and by governmental agencies.  But as opposed to its traditional use, identifying vendors for discrete supply orders or for a one time project, the Fulcrum RFP is increasingly being used as club to beat down the expectations of the present provider group.

You can classify RFPs into three distinct categories:

True RFPs™ — These are actual searches for the best quality provider with a favorable quality/cost ratio.  This type of RFP is the closest in relationship to the traditional form used in industry and government.  It’s commonly seen in situations in which the current, or sometimes very recently former, group has “blown up” and can no longer provide coverage, and in situations in which the current group has completely lost the facility’s trust.

Fictitious RFPs™ – These RFPs belie the fact that hospital administration is not interested in the merits of any response; they have already decided to whom they will award the contract.  Yet, for one political reason or another, they’ve decided to issue a phony RFP to project a patina of “fairness” to the medical staff, to the hospital’s own Board, to some third party . . . or perhaps to you.

Fulcrum RFPs™ – This is the increasingly common type of weaponized RFP.  As the name implies, Fulcrum RFPs are designed to create leverage.  The facility intends on renewing with the present group but uses the RFP as a tool to dictate terms by fiat and to pressure the group into negotiating against its own best interests out of fear of replacement.  Nonetheless, the facility is open to competing proposals.

It’s essential to understand in any particular situation what type of RFP you are dealing with in order to calculate your group’s response, or, in some cases, to determine whether or not you will respond at all.

Of course, the best defense is the development of a strong experience monopoly combined with expansion of your business to serve patients at multiple facilities.

As financial pressures on hospitals increase and as commoditization of hospital-based physician services continues, the trend toward RFPs will intensify.  Develop and implement your strategy now, preferably years before you find yourself on the receiving end of an RFP designed to replace you, to force disadvantageous terms, or, even worse, to have you offer to cut your own economic throat in the mistaken belief that a slow bleed is better than a quick chop.

Mark F. Weiss

www.advisorylawgroup.com

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