Two Wolves and A Lamb – Podcast

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

When You Have Time To Gripe

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

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

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

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

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

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

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

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

Mark F. Weiss



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

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

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

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

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

Mark F. Weiss

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

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

Lewis And Clark On Medical Group – Hospital Deals

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

Journal Entry September 2, 1803

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

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

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

Mark F. Weiss


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

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

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

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

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

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

Mark F. Weiss

The Same Amount Of Money As An Employed Physician Is Worth Less – Podcast

Not only is fair market valuation resulting in a spiraling down of employed physician income, the same amount of money earned as an employee is worth less than that amount earned if you still owned the practice.

Breaking The Chains Of The New Normal

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.”

As a result, they’re consistently playing defense: rolling with the punches and hoping to survive.

On the other hand, the opposition, the payors who will join the government’s ACO bandwagon to cram lower reimbursement down physicians’ throats, the hospitals who are jockeying to put themselves in the position of doing the cramming, and the so-called national groups which are negligently, or in some cases, intentionally, helping to transition medicine from private practice to hospital controlled models, is highly organized.

I’m no psychologist, but it appears as if for many physicians there is a self-esteem problem combined with the harkening back to memories of prior transitions to new experiences. Yes, this may be highly irrational, but remember what it was like moving to a new neighborhood, attending a new school, or your first day of residency — every change, even a positive one, brought with it either some anxiety or a flood of new experience that was, even if exhilarating, exhausting.  And, for course, there is the uncertainty as to whether the new situation will be as favorable to you as the present. But you survived and, in many cases, thrived.

One thing is for certain and that is that unless physicians and physician groups evolve and take an aggressively proactive stance in constructing their future, the healthcare economy will take care of the evolving for you.

This requires a different mindset than the one that has gotten you to where you are today.

Mark F. Weiss

Harnessing “Me to We”

In my October 3, 2011, post From Me to We: From Physician to Provider, I discussed the fact that today’s society is heavily affected by “we” think, from notions of shared sacrifice, to paying your fair share, to “giving back.”

The danger is that hospitals are using this trend to impose hospital-centric control over physicians and physician groups.

But there is a Situation Tranformer™ opportunity for physician groups:  harness the “we” trend to foster the continuation of the relationship basis on which groups have traditionally interfaced with hospitals.

The national physician groups putting pressure on hospitals are simply vendors – they are transactional negotiators — when society’s trend, and the hospitals’ calls for ACO’s and alignment are all symptoms of the “we” society.

Mark F. Weiss

Protecting Your Practice In Today’s “WE” Society – Podcast

In order to thrive in the “WE” society sweeping through healthcare, medical groups must adopt a different focus.