I recently read the report of a presentation given at a medical conference by a well-known hospital-side consultant. In a nutshell, this expert states that physicians should reconcile themselves to lower incomes via fixed salaries (from hospitals, one assumes), and simply focus on quality.
Although all should laud the need to focus on quality of care, this guy does a wonderful job of explaining the future for physicians from the hospital and government perspective: – You should see glass as half empty. – You will work for less. – You should suck it up; no one in the real world cares if your income drops 30%, you’re still among the 1%.
Just as obviously, any physician who wants to be successful should see that this fellow’s advice to settle for less is worthless, that is, unless you like the future that he and his hospital clients have planned for you. The reason why fixed salary systems of the sort lauded by this guy drive, in his words, cooperation between specialists and reduce “overuse,” is that they create a perverse incentive not to work. Visit your local department of motor vehicles office and see how it plays out.
In my work with physician groups across the country, I often encounter this same defeatist attitude from physicians, and hear the same advice to get used to the new world of less pay from hospital administrators and their industry consultants. Instead, assuming that your specialty is in for a 30% reduction in volume (which does not necessarily mean a 30% reduction in reimbursement), strategic group leaders need to think about how to adjust staffing and (this is key) how to expand their business to counter negative pressure on overall compensation.
ACOs, hospital employment and the rest of hospital-centric healthcare are not about accountability to patients. They’re about accountability to the bureaucratic types who will judge your quality based upon what’s easy to measure, engage in past-based cost accounting, and award you a little slice of their pie.
Smarter medical groups leaders will instead seek to make their group’s pie bigger. They’ll start with making the proper adjustments within their group and its structure and then they’ll adopt a strategy for the expansion of their business…not simply to claim bragging rights or “market share,” but to increase their profits. This ain’t the Mickey Mouse Club; it’s your business, it’s your future, it’s your life.