The One With Earl Ongman of Sierra Health Servcies – Part 1 – Podcast

Mark Weiss interviews Earl Ongman of Sierra Health Services.

I’d Rather Go Somewhere Else

Over lunch one day, my son told me that he had recently bought a Subway sandwich from the location on his college campus at U.C. San Diego. He said that when he asked for olives, the guy behind the counter placed three small olive slices across the foot-long sandwich. When my son asked for additional olives, he said the guy put two more slices on it.

Had he like the product and the service, my son probably wouldn’t have said a thing about it to me or to anyone else. But when he received poor service, a crummy sandwich and no value for the money, he told everyone. And, importantly, he said that if he were hungry and had any choice other than a Subway store, he’d go somewhere else, even though he knows that each store is independently owned.

Of course, this is hardly a new observation – I’m not simply speaking about Subway sandwiches. After all, there are old expressions like “one bad apple spoils the bunch.”

But have you considered that the same effect applies to statements made, and actions taken, by members of your group? That one snide comment to a nurse, one rude remark to a patient, one event of tardiness, can become both a stain on your entire group and a broad brush with which to paint it?

There are multiple lessons for medical groups contained within the Subway story:

Certainly, you need to hire for competence. But you also need to hire for personality and the understanding that no matter what the medical specialty, it is a service business.

There is a need to manage personnel to meet high customer expectations, and that, of course, means that your group must have leadership and that leaders must be permitted the time,and incentivized, to actually manage.

And, your group’s owner and employee/subcontractor physicians must clearly understand the group’s code of conduct and customer service expectations, they must be trained to meet or exceed those standards, and they must be incentivized for good performance.

Of course, you do have a choice: you don’t have to take any of these actions. But then, your “customers” can eat somewhere else.

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

Mark F. Weiss



Pass the Bread and Get the Contract

I remember watching my mother make bread – she always allowed time for the dough to rise before putting it into the oven; it’s a question of timing.

There’s a significant amount of timing involved in respect of the negotiation of agreements between physician groups and hospitals, especially in connection with exclusive contracts.

If the contract is to come “out of the oven” in 18 months, it’s time to start the levening . . . the negotiations . . . now.

The reason so many groups get only the crumbs, or worse, get sliced out of the picture, is that they confuse the final bargaining process — what I call the “face to face” stage in which the parties trade contract drafts and hammer out a deal, or not — with true negotiation, which in connection with a Relationship Contract™ involves the development of strategy and the deployment of tactics over a course of many months prior to the first “face to face” contact.

If you have to ask when it’s the right time to begin the contract negotiating process, the answer is “yesterday.”

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

Mark F. Weiss

Breaking The Chains Of The New Normal – Podcast

Many physicians, even physician group leaders, have trouble with the notion of transformational change because today’s payor and hospital centric status quo is their “normal.”

An Important Lesson From The Insurance Industry

Over the course of the past decade or so, carriers have ratcheted down payment and have begun a concerted shift away from compensating independent professionals to employing them directly at greatly reduced levels.

If you read the prior paragraph quickly, you might think that I was addressing compensation paid to physicians, but you’d be wrong. I was focusing on how insurance companies pay their most valuable business generating individuals, their own agents.

On the other hand, you’d still be right, because this is the same basic plan that is playing itself out in respect of the payment of healthcare providers, whether by insurance carriers which are adopting ACO-type reimbursement schemes, or by hospitals, which flipped with jujitsu like skill the business strength of physicians, seen a decade or two ago as the ultimate gatekeepers into the healthcare system, herding doctors into hospital employment at lower and lower compensation.

The future is bleak for independent insurance agents, who have to contend with salaried cubicle workers and online applications.

Unless physicians begin pushing back and begin seeking alternative structures for their practices, the future won’t be that different for you.

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

Mark F. Weiss

Are Limiting Beliefs Destroying Your Career?

Several weeks ago, I noticed an acquaintance, “Dr. X,” driving out of the upscale shopping center near my house. I waived hello, but wasn’t sure if X had seen me.

Recently, X apologized for not having recognized me that day. He said that he’s uncomfortable when he goes to that shopping area and is so highly focused on leaving, that he doesn’t really notice what’s going on as he drives out.

I asked what made him uncomfortable about the shopping area. The response: “The ‘rich people,’ you know, like plastic surgeons.”

Confused and curious, I asked X what it was about the people at the shopping area that bothered him. The response: “They’re just so stuffy and pretentious.”

Although it is true that the shopping area parking lot sometimes looks like a Rolls-Royce and Aston Martin dealership, my experience with the people there is that they are as friendly or friendlier than the norm in the greater surrounding community: they generally appear happy, are smiling, and readily initiate or return a greeting.

So what is it about “rich people” that really bothered X?

X appears to have a moderately busy practice, but he is definitely not in the “rat race.” Previously, I thought that that was a choice, but perhaps the conversation revealed something else, that he does not want to become more successful because he will become like those “rich people” whom he clearly dislikes.

I’ve noticed a similar phenomenon many times in the course of dealing with clients in their business relationships. Oftentimes, individuals and groups seem to be putting on the brakes, not pushing on the accelerator, out of some mistaken belief that they occupy some fixed rung, as in a caste system, outside of which they are not permitted to tread.

The concept of accepted beliefs, in this case, of limiting beliefs, has been described as a mimeme, or “meme” for short. Just as X might be holding himself back because he doesn’t want to become like those “rich people” whom he believes are stuffy and pretentious, many internists believe that they are somehow “less than” the hospital administrator who tells then that the hospital-employed hospitalist will be seeing all of the internists’ in-patients. And, on a greater level, many physicians today are willing to fall lockstep into line with hospital-centric notions of healthcare.

Have you bought into these, or other, limiting beliefs, and are they holding you or your group back in your career and business success?

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

Mark F. Weiss

Who Asked The Patient If She Wants A Hospitalist? – Podcast

The battle between patients’ physicians and hospitalists rages on. But who asked the patient?

The “Why” in Hospital Employment

Why become a hospital-employed physician?

Scanning the news over the past week or so:

  • GM lays off over a thousand workers.
  • 900 bus drivers in Phoenix and Tempe are on strike.
  • And around half of newly graduated residents and over sixty percent of established physicians moving to new jobs are placed with hospitals or their controlled medical groups.

So what could those doctors accepting hospital employment be thinking? That hospital employment is safer than traditional private practice? That it’s easier? That it avoids the difficulties of independent practice?

But as the industry news also reports, hospital closures are negatively impacting the physician employment market.

And, as I’ve written before, hospital employment comes with an additional “benefit” — a benefit to the hospital: The restrictions of fair market value compensation levels, as defined for healthcare compliance purposes, are neither fair nor at market value. They will result in lower and lower compensation as more physicians come under its purview.

Hospital employment is no cure for the ills of physician practice. And if you think it is, then consider that the cure is worse than the disease.

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

Mark F. Weiss

The Chicken and The Pig and The ACO

I recently heard it said that while it takes both a chicken and a pig to make a ham and egg breakfast, the chicken is merely involved while the pig is fully committed.

How different is this from the relationship between hospital administrators on the one hand, and physicians on the other, in connection with the development of an ACO or another vehicle to bind physicians to the hospital?

Hospital administrators are merely involved in the process. They are in the chicken position. CEO tenure is often short and CEOs don’t tend to have owner or entrepreneur mentalities; they are managers – they will create an alignment structure, then get their raise, and then move on before the chickens come home to roost.

But for the physicians involved – involved in ACO structures, involved in acquisition of their practices or employment by the hospital – you’re being asked to fully commit: That’s the pig into ham position.

Not to stretch this story too far, but it’s entirely possible, actually more than probable, that the administrators will, to use the colloquial expression, lay an egg in respect of the ACO: in the long run it will fail, but those administrators will be long gone, moving on to other “success”. But you’ll be there, cooked.

So why is it that those merely involved are being allowed to shape the destiny of those who are being asked to fully commit?

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

Mark F. Weiss


The Only Thing The Hospital Has To Fear Is Fear Itself – Podcast

Do you know the secrets of using fear of loss as a tactic in hospital negotiations?