Changing Market | Manage Your Practice

How Walmart’s Latest Healthcare Announcement Can Be Your Key to Higher Prices

According to a recent article in the Wall Street Journal, beginning in January 2019, Walmart is requiring employees needing spine surgery to travel to certain contracted hospitals for their surgery.

The paper reports that among the health systems Walmart will favor are the Mayo Clinic, Geisinger, and Memorial Hermann.

So what’s that mean for you, assuming you’re not a Walmart employee.

Well, this may just be the tip of the iceberg. Will other large employers choose centers of excellence/centers of low cost/centers of what (?) in areas of the country for their employees’ major healthcare treatment? In fact, why think about in terms of “across the country,” when if a patient can fly some appreciable distance, he or she might just as easily be shipped off to a Joint Commission accredited facility in, well, India.

There other ways of looking at this, too. As more patients become comfortable with the notion of traveling to what’s billed as a “center of excellence” in some distant locale, might you, too, work to brand the care that you provide in a way that attracts patients from a larger geographic area, and I’m not just talking about the next county.

And, here’s another view: If someone or something has to travel, why can’t it be you. Not necessarily you, personally. But, you in terms of your brand name, stature, and technique? Whether that’s through branch locations, franchising, licensing, or joint ventures isn’t, at this stage, the point. The point is that there are many ways of looking at how you can increase the catchment area of your practice.

The first step in expanding your practice is to expand your way of thinking.

Let’s talk.

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

Mark F. Weiss

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Manage Your Practice

What Does Partnership Really Mean?

What does partnership mean in a medical group? What does it mean to you? What does it mean for your group? What does it mean if you are setting up a medical group?

I recently heard from someone (a partner in a law firm) who was recounting a story of another lawyer, who, years ago, has lost a major client. As a result, he realized (and he was right) that the writing was on the wall: he’d soon be tossed out of the partnership.

Also, years ago, when I was a partner in a larger firm, one of the partners made a mistake – not a legal malpractice mistake, not even a mistake in judgment. It was just a simple, human mistake, the kind of mistake that anyone might make. Within days, the majority of the partners had voted to terminate him.

We often strive to become a partner, a shareholder, a member – whatever the arrangement is to attain the golden ring, the equity position.

But, seldom do we ask what it means when we get there.

I once had a partner who quipped that it was going to be cheaper to make “Sally” a partner, because then “Sally” would simply receive a draw and we could determine the rest of her compensation at the end of the year, instead of having her remain a very senior associate, in which case we would be required to make a commitment up front as to her base compensation package and probable bonus.

None of these stories is about what most people would call “partnership.”

Instead, they’re stories of business entities that, although styled as “partnerships,” are in reality just a collection of individuals, with a large dose of the notion of fair-weather friends tossed in for good measure.
Are the ties that bind one way or two, from this day forward, for better or for worse, for richer, for poorer, in sickness and in health  . . . or at least until we decide to toss you out on your ass?

Does that type of structure create a business model designed to succeed in the future, or is it simply situational?

The stories, of course, demonstrate the precarious nature of not-too-solid partnership from the partner perspective.

But the issue is the same from the perspective of the partnership itself: What sort of entity have you built, if it’s an entity at all? What sort of message does its structure send to the partners and to those who might desire to become partners?

How does all of this bode for the entity’s, and your, future?

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

Mark F. Weiss

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Manage Your Practice

CVS, Aetna and Your Practice

The Wall Street Journal portrays it as causing panic in the streets.

I’m taking about the pending acquisition of Aetna by CVS Healthcare. It’s stoking fear of the combination of a ubiquitous retail delivery platform, CVS, with the health insurance, managed care, and huge patient database of Aetna. More traditional health insurers and large scale pharmacies are afraid that their days are numbered.

But there’s another lesson here for physician practices, and it’s not directly related to either CVS or Aetna. Instead, it’s something that I touched on before on the blog in the post The Pharmacy Will See Your Patients Now, which discussed the fact that pharmacies are beginning to encroach on physician practice.

Healthcare is increasingly becoming less “silo-ized.” The pretty and neat silos of the pharmacy, insurance company, hospital, medical practice, and so on – the walls between types of entities, organizations, silos have been breaking down over time. And, the walls between healthcare entities and other retail business, too, have become permeable.

Over many decades, retail pharmacies morphed into convenience stores and more recently into platforms for employment of, or collaboration with, physicians, PAs, and nurse practitioners. So, too, have physicians morphed into pharmacies, either via direct ownership or direct dispensing. And, of course, physician practices and medical groups have morphed into retail care – the walk in clinic, the urgent care facility, and, in some states, the freestanding E.R.

The opportunity for physicians and other players smaller than the CVSs of the world is to understand that the membranes between types of organizations and types of professions which were completely impermeable are not only now becoming semi-permeable, they’re becoming almost completely permeable.

The question to ask is how can you take advantage of that in your own business structure.

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

Mark F. Weiss

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