Breaking The Paradigm of Quantity: An Issue for Physician Leadership Considered one of my personal favorite Jackie Mason jokes goes something similar to this. A potential customer enters a store whose sign in the front window proclaims: “WE SELL Not Merely BELOW RETAIL. WE SELL BELOW COST!”. He skeptically approaches the store’s proprietor and asks, “How can you manage to make a living selling below cost?” “Simple” answers the particular owner, “We recover it with volume!”
Once I tell this joke to Hospital CEO’s or CMO’s they laugh until I suggest which they might be doing a similar thing making use of their medical staff strategy: greater is better. The bigger the medical staff and the larger their referring volume the higher the hospital’s bottom line. The greater the magnitude of a physician’s practice the higher the grade of the physician. “He/she should be an excellent doctor, examine the magnitude of his/her practice and the way many patients he/she refers!”.
This unfortunate strategy has resulted in a stampede of practice acquisition, joint ventures, and “institute models” which may have, for a lot of, succeeded in much bigger referral patterns for hospitals. Unfortunately, few of these larger systems are in reality better. The truth is, the acquisition of heterogeneous physician groups with all the accompanying variation in practice styles, work ethic, quality and culture made put further strains for the search for medicine’s holy grail: consistent, measurable, efficient and excellent outcomes.
You possibly can reason that this tactic didn’t make a lot of sense even though it had been embraced in the bygone days of fee for service. It made even less sense when DRG’s were introduced and will prove fatal once bundling of most services and ACO’s (capitation on steroids) take hold. Organizations that may succeed are individuals who invest now in developing excellent physician leaders: those who may influence, model and hold others answerable for consistent, measurable, efficient and excellent outcome. This will often require trimming instead of enhancing the volume of physicians with admitting privileges.
The winners here will likely be those systems that recognize greater isn’t better: better is much better.
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