Much bigger Isn’t Better; Better Is Much Better
Breaking The Paradigm of Quantity: A Challenge for Physician Leadership Considered one of my favorite Jackie Mason jokes goes similar to this. A possible customer enters a store whose register front side window proclaims: “WE SELL Not Just 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 owner, “We make it up with volume!”
While I tell this joke to Hospital CEO’s or CMO’s they laugh until I would recommend that they might be doing exactly the same thing with their medical staff strategy: much bigger is much better. The much bigger the medical staff as well as the greater their referring volume the better the hospital’s bottom line. The greater the magnitude of a physician’s practice the greater the standard of the doctor. “He/she should be a fantastic doctor, check out the size of his/her practice and just how many patients he/she refers!”.
This unfortunate strategy has cause a stampede of practice acquisition, joint ventures, and “institute models” which may have, for most, succeeded in greater referral patterns for hospitals. Unfortunately, number of these greater systems are in reality better. In truth, the purchase of heterogeneous physician groups using the accompanying variation in practice styles, work ethic, quality and culture made put further strains within the look for medicine’s ultimate goal: consistent, measurable, efficient and excellent outcomes.
You could argue that this tactic didn’t make a lots of sense regardless if it had been embraced in the bygone days of fee for service. It made even less sense when DRG’s were introduced and can prove fatal once bundling of all services and ACO’s (capitation on steroids) take hold. Organizations that may succeed are those that invest now in developing excellent physician leaders: those who may influence, model and hold others liable for consistent, measurable, efficient and excellent outcome. This can often require trimming as opposed to enhancing the volume of physicians with admitting privileges.
The winners here will be those systems that recognize greater isn’t better: better is better.
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