Employment | Group Culture

What You Need to Know About the Flea That (Metaphorically) Killed the Medical Center CEO

A few days ago, a flea bit and killed the CEO of one of the top-ranked academic medical centers in the nation. Metaphorically speaking, of course.

And the lessons cut both ways for you and your organization, whether it’s a medical group, a hospital, an ASC, or any other sort of business.

In his book, The War of The Flea, the seminal work on guerrilla warfare, Robert Taber wrote about how a small band of guerrilla fighters could emerge victorious in a conflict with a larger, well organized enemy.

“Analogically, the guerrilla fights the war of the flea, and his military enemy suffers the dog’s disadvantages: too much to defend; too small, ubiquitous, and agile an enemy to come to grips with.”

In 2014, Ohio State University concluded a national search for the new leader of its Wexner Medical Center by hiring Sheldon Retchin, M.D. as its CEO. His salary? Close to $1 million per year.

Yet a few days ago, just three letters signed by a handful of the 1,200 physicians that Wexner employs, triggered his resignation.

The first letter, dated May 1, 2017, signed by only 25 physicians, raised complaints about Dr. Retchin’s management style. According to a report in The Lantern, the Ohio State school newspaper, the complaining physicians wrote they had “no confidence” in Dr. Retchin’s leadership. The signers claimed that more than 100 other doctors supported their position, but were afraid to join in the letter.

The two subsequent letters were signed by 6 physicians each.

Even assuming no crossover in the signatories, 37 physicians (yes, some in positions of authority) out of 1,200, that’s only 3%, were able to unseat the king.

Dr. Retchin, the front man for a high and mighty organization, and, one can argue, the organization itself, became the latest victims in the war of the flea.

What’s this mean for your organization and for you, personally?

From the organizational perspective, as in a guerrilla war, change within the organization, as well as within a domain in which the organization interacts, can occur as a result of agitation by a vocal minority. Just as no vote was required for a dictator like Casto to take over Cuba, no medical staff vote, no survey by Press Ganey, no long and drawn out process among “stakeholders,” is required to topple the status quo.

What you think is permanent is only temporary. How temporary is the question.

What you do, and how you do it, within your organization, and how you project it to essential third parties (e.g., hospital-based medical group to hospital) is all-important in maintaining relationships, contracts, and even existence. That’s the flea collar.

And, just the same, from the perspective of the individual, the small, the “out group,” the “flea,” a steadfast, vocal, and somewhat intransigent minority, can kill the dog. The large group can be made irrelevant. The hospital CEO can be forced out. The small organization can ingest the larger. Yes, the dog bites back. No win is guaranteed.

Many say that the world is a tough place. Maybe it is, because it’s not just dog-eat-dog. In Dr. Retchin and Wexner’s world, it’s flea-kills-dog as well.

Whether you’re the metaphorical dog or the metaphorical flea, the same applies to you.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss


Continue Reading...

Group Culture

The Devaluation of Value Based Billing

“Value based billing” remains dominant in the medical industry news, chiefly from the MACRA angle. Mostly, though, it’s a lie because value is determined by the customer, not by some bean counter at CMS. Sure, CMS may be paying the bill for Medicare patients, but the patients are the actual customers and only they can assess whether value was truly delivered.

Yes, I know. I can hear you out there, the third guy from the left, wearing khakis and a white lab coat, muttering, “But, CMS is paying the bill.” And, of course, that’s the problem. Once organized medicine (read that as the letters A, M and A) bought into the concept of Medicare in 1965, physicians opened the doors to government meddling. After all, if the government is going to pay, the government is going to demand something, and something more and more and more, as the price for payment. To quote President Reagan, “The nine most terrifying words in the English language are, ‘I’m from the government and I’m here to help.’”

When you hear the words “value based” in connection with healthcare, just view them as a flare in the night warning you that within the next moment or so you’ll hear something that sounds socially useful but which has nothing, or very little, to do with anything other than figuring out how to pay you less or control you more. This is especially true if the comments are coming from an “economist,” because economics is the study of who gets what in the actual world, while today’s so-called “economists” are those who’re preaching who should get what in their imagined world. Unfortunately, these folks are often paired with those who have guns, i.e., the government, to enforce their nonsensical theories.

If you don’t believe that value is determined by the patient, here’s an interesting story, as noticed on the web from the site of Florida TV station WPTV.

An expectant mother, Paula D’Amore, was in labor and on her way to Boca Raton Regional Hospital with her husband. They were just a wee bit late, as the baby popped on out in the D’Amore’s car in the hospital parking lot with help from Mr. D’Amore followed by some assistance from a few nurses who came on out to their car.

The value issue?

Well, the hospital decided to bill Ms. D’Amore the full charge of the use of its delivery room, over $7,000, even though neither Ms. D’Amore or her baby were ever in the delivery room. (Attention hospital CEOs: neither car nor parking lot equals delivery room.)

Another local news outlet, the Sun-Sentinal newspaper, reports that the hospital’s vice president for marketing said the hospital felt that the delivery room charge was a suitable bill. Perhaps the paper got the guy’s title wrong, because it seems more like “VP of sales prevention” than of marketing.

The point, of course, is that the value of the services received by Ms. D’Amore can only be assessed from her point of view, not the hospital’s. Even more ridiculously, is to assume that someone over a thousand miles away, as in Washington, DC, can determine value.

Yes, the payor can dictate the amount that they will pay. But at least let’s be honest about this and acknowledge that that amount has nothing to do with value. Of course, saying “screw you, this is what we’re paying and this is the data you have to give us before we’ll give you even that” isn’t politically correct, and these folks are, if anything, politically correct.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss


Continue Reading...

Group Culture

You Can Plan on This!

“No plan survives contact with the enemy,” is a famous concept credited to many, bastardized by dozens, and plagiarized by even more. That’s because it’s true.

But the fragility of plans does not mean that you should forsake planning for your medical group’s or healthcare business’ future. In fact, it means just the opposite: You should plan (well, strategize, actually) against multiple potential changes that could impact your business.

I won’t lie to you and tell you that it’s possible to be prepared for any and all possibilities, but it’s far better to be prepared against many than against none.

And, consider the simple fact that when change happens and your plans are destroyed, it’s a bit late to begin thinking about new plans. So, do it ahead of time.

How will your business strategy shift if there’s universal healthcare? What happens if the hospital closes? How will you maneuver if the hospital CEO, with whom you have a very tight relationship, is fired? What if Google does into gastroenterology? What will happen to your retail pharmacies when the Clinton Capsule program kicks in and all drugs are “free?” (OK, just kidding. I hope.) And so on.

This process of identifying potential events and trends, conducting what I call the Scenario Survey Process™, is a necessary part of establishing a vibrant strategy for your business.

Before going further, it’s essential that you understand the important distinction between planning and strategic thinking.

Planning is a process of projection from the present. However, extrapolating future problems based on one’s present situation is never effective; this tactic presumes the facts of your present situation will remain the same. They never will.

Unlike planning, strategic thinking is based on envisioning a future and then strategizing to, in essence, have that future pull you toward its accomplishment. A strategy involves an ongoing, changing process that, if done properly, allows the creators to regularly revisit and alter the approach.

In essence, a Scenario Survey involves identifying as many realistic potential scenarios, or conceivable futures, as possible.

The purpose of the Scenario Survey is not to identify potential scenarios, judge the odds they might occur and estimate the benefit or damage that would result. No matter how expert you are at strategizing, it is impossible to identify and value all potential risks.

Instead, the purpose of the Scenario Survey is to identify classes of underlying trends, issues and questions and to develop a strategy that accounts for as many possible future “worlds” as can be.

There’s no right answer and there’s no wrong answer, at least as an academic exercise. I do this work with my clients and what we’re after is a strategy or set of strategies that will be the most flexible in the face of the highest number of these possible futures.

Do yourself a favor and start now.

After all, as in Mike Tyson’s version, “Everybody has a plan until they get punched in the mouth.”

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss


Continue Reading...