Dec 14 2011

Medical Groups – Utilizing A Unit Concept To Drive Success

Hospital-based medical groups shouldn’t simply conceptualize their practice as one business.

If you’re a medical group leader, you must view your practice as consisting of several independent, yet coordinated, units, each of which requires a separate focus.

So, for example:

  • There is a group owner unit
  • There is an employee/subcontractor unit
  • There is a hospital unit
  • There is a referral source unit
  • There is a patient unit

Then within each of those units there are multiple elements of required activity.

Finally, each of those elements are valuable only if they are working in coordination and within the scope of the group’s  master business strategy.

Mark F. Weiss


Dec 12 2011

Exploiting The Power of First Impressions

First impressions matter, and this is more than simply a social rule.

Last week, a new notebook computer that we had ordered arrived at the office.  We have other computers,  from Macs and other Apple products to a number of PCs that we use for various functions.

In ordering the new notebook computer, my office administrator evaluated what it would be used for and chose a Dell over a Mac because of the programs it must run.  Because of our good experience with Mac products, especially their design and user interface, we knew there’d be a trade-off — but here’s the point about first impressions:

As I began to open the lid of the new Dell notebook for the first time — just an inch or two open —  I could see that the stickers placed on the lower right hand of the computer’s face were put on crooked.  What do you think my immediate impression was of the Dell?  Yes, that it’s sloppily and cheaply made.  My overall impression was focused through the initial lens.

What first impressions are you and your group giving to patients, referring physicians and hospital administrators?  What can your group do to construct, manage and exploit the power of first impressions?  Have you tied the creation of first impressions together with the provisions of your partnership/shareholders agreement, employment agreements and subcontracts, and the group’s compensation plan?

Mark F. Weiss

Dec 09 2011

Don’t Worry About Your Future – The Hospital Has It All Planned – Podcast

The hospital has written the script for your future. Don’t like it? Grab Your Own Pen.


Dec 07 2011

Stars Don’t Audition. Why Are You Responding To That RFP?

When I first began practice, I worked for a law firm that represented clients in the entertainment industry.

One thing that struck me from each morning’s required reading, Daily Variety, was that although it carried many announcements of auditions for minor roles, stars didn’t have to addition at all – in fact, the paper often reported how many scripts some star was reviewing: the buying/selling or supply/demand situation was completely flipped.

It’s hard to imagine a more common service commodity than actors in Los Angeles – they are everywhere: waiters, secretaries, office support staff, temps, and substitute teachers; in fact some even work as actors.

But some have differentiated themselves and are no longer in the same, well, solar system, they are “stars.”

How different in this regard are most hospital-based physician group members from actors?  Most are stuck, at least in their minds, in the commodity world.

But if stars don’t have to respond to the acting equivalent of RFPs, casting calls and auditions, why don’t you create an experience monopoly practice and do the same?

Mark F. Weiss


Dec 05 2011

Yes, I Agree

I recently heard of a consumer survey done at a hotel in which it was found that the guests’ impressions of every factor tested for, the quality of the service, the attractiveness of the rooms, the cleanliness of the common areas, etc., depended upon their satisfaction with the hotel check-in experience.

This is an example of confirmation bias – the tendency to look for and value things that confirm our beliefs and to ignore and undervalue those that don’t.  The guests who had a great initial experience saw every other element as being relatively great; those who had a poor experience saw everything else in that same shoddy light.

So what’s this mean for you?

Certainly, if you’re an office practice physician, it means that initial patient contacts, whether truly the first (a call to your front desk person from a potential patient), to a patient’s experience when she first arrives at the office, to how you greet her, sets the tone of overall patient satisfaction.  It also impacts the importance of the initial physical aspects of the visit – the neatness of your waiting area, factors such as newer than seven year old copies of Consumer Reports with your home address cut off the cover, and the like.

For hospital-based physicians, generally without control over the physical environment, it makes the value of the initial patient contact even more important.  In connection with scheduled procedures, it opens the possibility of stacking the satisfaction odds in your favor through action taken prior to the first in-person contact.

And, for all, it raises the question of fairness in respect of any process by which your performance is judged or ranked.  Has someone (or can you) placed their finger on the scale?

Mark F. Weiss

Dec 02 2011

The Group-Physician Relationship – Podcast

Why are group-physician relationships so complicated when the rules are so simple?


Nov 30 2011

Physicians Must Brand Their Role in Healthcare or Suffer the Consequences

Hospitals are happily benefitting from the expanding role of paraprofessionals and from the top level professional degrees, the doctorate, those paraprofessionals are now obtaining.

Take, for instance, the push by CRNAs to be recognized as equivalent replacement providers of anesthesia services.  Hospitals, seeking to break the financial and medical staff voting block hold of anesthesia groups, are often more than willing to accept CRNAs in place of anesthesiologists.  They view them as cheaper, more controllable and disposable.

If you’re not an anesthesiologist, don’t think this doesn’t apply to you — in a very real sense, anesthesiologists are simply the “canaries in the coal mine.” Soon, surgical PAs will be pressing for the ability perform some procedures unsupervised.

At the same time, doctorate degrees are becoming the top professional degree in many paraprofessional categories.  Once the nurse specialist performing your function becomes a “doctor,” you will become irrelevant – or so goes the thinking of hospital-centric healthcare pundits.

Physicians do have one important branding tool, the “M.D.” degree.  Of course, as paraprofessionals become branded as doctors also, the value of an M.D. will become diluted.  Physicians cannot allow that to happen and your professional societies must begin now in educating the public on the difference between M.D. delivered medicine and care delivered by nurses and other physician extenders holding doctorates.

Additionally, physician specialty boards, which to the public are generally meaningless (after all, what do all those initials after a physician’s name mean?) must devote significant resources to promote the public’s awareness of the high-level of training and peer-reviewed expertise required in order to earn that designation and, even more importantly, what that means to patients and their families.

It’s bizarrely amusing, in a sick sense of the use of that word, to see hospitals demanding that all physicians in a contracted group operating a hospital-based department be board-certified, while, at the same time happily replacing a significant portion of those doctors with far lesser trained nurses.  If medical specialty boards don’t understand this is an absolute repudiation of the value of board certification, and an attempt to render their members’ roles, and perhaps most if not all physicians’ roles meaningless, and therefore, fail to act, they, and you, will be in for a significant surprise.

Mark F. Weiss

Nov 28 2011

Timing Exclusive Contract Negotiation

When’s the right time to begin negotiating the next renewal of your exclusive contract?

When I asked this question at a national conference of medical group leaders, the majority response was from three to four months prior to the end of the current contact term; a few outliers said 6 months and one, out of an audience of several hundred, yelled one year.

Not bad, they were all wrong.

The time to begin negotiating your next contract is as soon as the ink is dry on your current contract. Sign on November 28, 2011 for a 3 year term; begin negotiating November 28th for the renewal in 2014.

No, I don’t mean to set up a meeting with the hospital’s CEO to discuss the next agreement.

What I mean is that all of your group’s interactions with the hospital, from now to signing the renewal in 2014 are a part of the negotiation process, whether you choose to admit it or not.

Under those circumstances, you might as well harness the fact for your group’s benefit.

Mark F. Weiss


Nov 23 2011

You Are Not A Service

Running a hospital based group as “service” for the hospital, functioning as a sort of clearinghouse for income and expenses, severely limits your group’s future.

It limits the willingness, and the ability, of your group to pursue outside opportunities.  That’s chiefly because there is tremendous pressure to pass through to the owner, and often to the non-owner, physicians all available income, instead of immediately investing in, or creating the capital reserves necessary to pursue, other opportunities.

Additionally, “service” groups often suffer from the mindset that the group was formed to provide services at only that hospital, thus taking off the table completely the consideration of other opportunities, even if the group were able to deal with the notion of holding back what would otherwise be income available for distribution.

Of course, “service status” results in a severely weakened position vis-a-vis the hospital, which knows that your group’s very existence depends on renewal of its exclusive contract.  That is a horrible position for your group to be in, both in terms of the concessions that the hospital may demand, and that your group may be forced to give – not to advance its position in some other respect, but merely to save its own life.

You spend your professional life saving others, literally.  Why not save your own at the same time?

Mark F. Weiss

Nov 21 2011

Same Company. Two Different Experiences. One Big Failure.

I recently read that taken together, the value of all airline shares from the beginning of the industry to date would be a net loss.  Is anyone surprised?

On two recent connecting flights on the same airline, the customer experience was so wildly different that you’d think they were not only different companies, but on different planets.

The first plane was shabby, with a torn seat and service to match.

When the woman across the aisle asked for a ginger ale, the flight attendant retuned with a tray of drinks, and stopped in front of her.  “Is this ginger ale,” the passenger asked.  In response, the flight attendant scowled, “well, that’s what it looks like to me,” when a simple “yes,” would suffice and a simpler “yes, ma’am” would have thrilled.

The second plane is spotless and the service is excellent.  But what do I remember?  The bitchy employee on flight number one, and she wasn’t even talking to me; I just had to bear overhearing it.

You should have guessed by now that I’m not writing this for airline executives — I’m writing this for medical group leaders.  On a daily basis, your group’s physicians are likely delivering widely varying experiences to the group’s patients and perhaps to their families as well.  They are also likely interacting very differently with referring physicians and others.  Why?  What will the blowback be in connection with your next negotiation with a facility?  What referrals will you miss?

With many, many years devoted to medical school and then to post-M.D. training in the performance of the technical side of delivering patient care, you’d think that groups would be sensitized to the need for training in the interpersonal and communications skills that support it. The fact that this is not the case makes this the case for your group to implement it.

Hardly any of your colleagues at competing groups have any understanding of what I’m talking about.  Fewer still will do anything to implement it.  That’s why, for you, it will be like shooting ducks in a barrel.

What behaviors are expected by the group?  What phrases have you tested?   These are but a few of the questions that you need to start asking and then, when you have the answers, implementing.

In fact, ask yourself right now, is your group run as poorly as an airline?

Mark F. Weiss