Gallbladders & Physician Strategy. Getting a ‘Penthouse View’ of Physician Alignment

Yes, it sounds strange, right? Physician advocate blogger writing about her long-lost gallbladder and physician strategy connections. I tend to run pretty hard, and let’s face it, so does anyone working in health care these days. Whether you deliver the care or administrate the setting with which the care happens, your hair is on fire most of the time with pending emergencies of the day, regulatory pressure, lack of staffing, thin margins, payer concerns, pop-up primary care providers, board management and increasing acquisitions. Not to mention COVID-19 implications now. We all know why this industry is a barn burner.  

But let me back up for a second. About a year ago, I began to have short abrupt abdominal pain that I simply blew off. Why? Because it seemed a handful of Tums fixed it, and I related to what Carly Simon once sang: “I haven’t got time for the pain.” Due to my crazed schedule, a sprinkle of underlying unconscious belief I am somehow bulletproof and the tendency to just deal with issues as they come at me, I didn’t dig deeper into what was happening with this acute brief pain. Fast forward weeks later and I landed myself in the hospital for about five days with gallbladder pancreatitis. I was sick as a dog. I had skated around acute abrupt pain and hoped it would just go away. But it didn’t work. The point of this personal diatribe is this: when you blow off “the acute but small” and somehow convince yourself you solved a problem when you didn’t do a thing, that’s not a strategy.

It occurred to me later though that this is what we do in health care because we are all tired and overrun. Smart and savvy but weary, and due to the pressures of health care decision making, we triage by pain. Acute issues such as the non-payment of a physician group when they are a health system’s treasured health partner happens. It’s acute, someone is mad and another someone runs around trying to figure out how to get the physician group paid.  (If you want to wreck a physician relationship by the way, try not paying them!) Temporary crisis averted, or is it? 

In health care, we see this over and over. Very smart people don’t take the time to do what I call getting a “penthouse view” of the situation. Instead, we look at systemic issues from the garden view apartment where you see a lot of sneakers walking by but not the wide big picture. 

Physician contract strategy must be examined thoughtfully. So, here’s what I recommend:

  1. Make sure you are looking at the system as a whole – that is, all the issues around physician strategy and economic alignment, before simply treating one acute pain point like, say, the adjudication of wRVUs via a mass system of excel spreadsheets. Take the elevator ride up from the garden view apartment where one vocal department in the health system dominates the pain issue; trust that there are bigger issues afoot and hidden.
  2. Next, dive deeper into knowing who you’re paying and for what work. At a recent health system meeting, I witnessed different departments surrounding physician strategy, physician compensation, legal, finance and medical affairs discuss various needs with physician payments. I thought I was in Vegas, shouting and clamoring for whose issue holds the most pain around wRVU payments for employed doctors. Let me say this though: the team was whip smart but had no insight into global strategic issues around their own physician economic alignment (i.e., each dollar that every health system spends on a physician group or physician). It was a free for all. 
  3. Don’t fall into a siloed approach. Health care, for all it gains and smartness, comes at physician strategy and economic alignment with a siloed response. Lost contracts, late contracts, the excel spreadsheets cranking out compensation plans and dropped communication to a physician partner all create acute pain points that are only answered episodically. Couple this with the C suite not having insight into the strategic why are we doing this and the giant number for physician contract spend (estimated to be $20 million for an average community hospital, by the way) and you have yourself a proverbial barn burner.  

Assuming everything is okay until it’s not and skipping around the acute pain of dropped, incorrect and missed physician payments or an upset physician partner are not effective strategies. Take care of your health system’s physician strategy holistically – look at it from the top view, know who you’re paying and stay away from a siloed structure. In the end, you’ll save yourself a lot of sleepless nights! 

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