1. Attempt to spread services beyond one hospital. According to Mr. Weiss, many groups provide services at one hospital — a mistake if the group is looking to make more money or gain leverage in negotiations with the hospital. “That doesn’t mean simply expanding to facilities with lower reimbursements,” he says. “But groups should be a lot more active at looking at providing services at facilities if it makes economic sense.” He says working at multiple facilities can increase group leverage in terms of stipend deals, in which a hospital adds a fixed stipend to the physician group’s collections to keep compensation competitive. Because stipends provided by the hospital can vary widely based on the perceived value of the physician group, working at multiple facilities can send a message to the hospital that the group is valuable.
“You want the ability to say, ‘If we’re going to continue providing services here, we need this financial support, and if we don’t get it, we’ll provide services somewhere else,'” Mr. Weiss says. “You don’t want the hospital administration to think your contract with their hospital is the entire reason for the existence of the group. That gives you no leverage.” If your group provides services at multiple facilities, you have the option of dropping a hospital that refuses to provide adequate compensation.
2. Involve the group in ACO development. The structure of ACOs — including how they will distribute compensation — is still unclear, Mr. Weiss says. Money could be distributed from the government as a lump payment to the ACO, or money could be distributed in part to the ACO and in part to the providers. “My gut is that the authors want the entire stream of money for the ACO’s care paid to the ACO and then divvied up within the organization,” he says. “But no matter what, the ACO is going to be responsible for distributing all or some of that money.” He says physician groups must seize the opportunity to get involved in developing the ACO — or else they won’t be able to complain when physicians are poorly compensated.
“Physicians should not just accept the fact that they are on the receiving end [of ACO development],” Mr. Weiss says. “It’s got to be a conversation that goes both ways, and physician groups should be involved in deciding how ACOs are managed and how funds are distributed.” He says there’s no rule that says hospitals must be in control of ACOs, so physician group leaders should approach their hospitals immediately and ask to have a seat on the committees responsible for ACO development.
3. Make the group indispensable to the hospital. According to Mr. Weiss, physician groups have traditionally seen their role as simply providing a service to the hospital. Because of this viewpoint, physicians have become commoditized to the point where hospitals consider one physician as good as any other. He says going forward, groups should try to provide a service that other providers cannot easily replicate. “So many groups have committed themselves to being commoditized that when you ask, “What does your group do that another doesn’t?”, they look at you like you’re nuts,” he says. “Services should be provided in a way that delights the hospital, delights referring physicians and delights the staff you’re working with.”
He says if a visitor came to the hospital and observed your physician group, they shouldn’t immediately know how to provide the package of care you provide. “This makes you much harder to replace and gives you far more leverage in negotiating additional stipend support,” he says. He says an anesthesia group, for example, could go above and beyond the traditional pre-op evaluation of patients, where an anesthesiologist stands a few minutes with the patient prior to surgery. Instead, anesthesia groups should endeavor to create pre-op clinics, where a devoted group of physicians applies consistent standards to every single case. By creating this kind of clinic, anesthesiologists keep surgeons happy by clearing patients for surgery, recommending additional tests or recommending case cancellation well in advance, so surgeries don’t have to be cancelled last minute.
“[Processes like pre-op evaluation] are done in a haphazard manner now, and physicians almost see them as an obligation as opposed to an integral part of patient care,” he says. While it might be more complicated for a physician group to develop new, better practices, those unique features will make the group indispensable to the hospital. Go beyond what’s expected and examine what could be improved, Mr. Weiss says. “Everyone looks at ‘best practices’ to determine how their practice should work, but if best practices were really what everyone should aim at, the wheel would never have been invented,” he says. “We’d have a really great dragging sled.”
He says expanding or improving the group’s services may involve appointing group leaders who have time to lead. The leaders should not be bogged down by clinical duties, and they should be appropriately compensated for the time they spend on innovation.
4. Expand earning potential beyond clinical services. Mr. Weiss says groups can improve their earning potential by developing intellectual property based on their unique delivery of care. Once the group has established services that make the physicians indispensable to the hospital, the group should take those services and use them to teach other physician groups, develop software or add consulting services. “This is extremely rare in actual practice,” he says. “Groups should understand that when they find a unique way of delivering a service, it can be packaged and it can be sold to someone else.”
He says while physicians might have traditionally focused all their efforts on clinical practice, declining reimbursements mean groups must look for other ways to gain capital. This could mean lecturing other groups on how to develop a pre-op clinic, negotiate hospital contracts or provide quality patient care. It could mean developing software that helps physicians accomplish these tasks. Again, physician group leaders should be charged with expanding the reach of the group beyond the hospital, a task that will require fewer clinical hours and more creativity for group leaders than traditional models of service.
