Impending Death of Hospitals | The Business of Healthcare

Hospital Becomes Hole In Ground. ASC Takes Up The Slack.

In what might seem to some like ancient history and to others as a clarion call, in June 2010, New York City’s approximately 400 bed, 160 year old St. Vincent hospital, the last Roman Catholic general hospital in the city, closed its doors for the last time.

In late 2017, a competing non-profit opened the modern variant of a replacement “hospital” right across the street: a 6 O.R. ambulatory surgery center located in a facility with an emergency department, an imaging facility, physician offices, and other healthcare services.

Other than in respect of the freestanding emergency room, which, depending on state law may or may not be possible to license (or even wanted), there’s nothing in the concept of the replacement facility that couldn’t be created by you as a physician-led, physician-owned, for profit venture. In fact, it’s exactly along the lines of what I’ve termed a Massive Outpatient Center™:  A combination of an ASC, a medical office building, and one or more of a menu of complementary offerings.

For some, thinking becomes ossified along historic lines: “Hospitals build hospitals.” “Physicians just practice medicine.” “Physicians can’t own hospitals.” But none of these is necessarily true.  But, even if they were, opportunity is more malleable. What’s functionally like a hospital need not be a hospital.

If I were wrong about this, St. Vincent’s would be celebrating its 168th anniversary. It’s not. A 200-unit condo complex stands in its place.

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

Mark F. Weiss

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Manage Your Practice

The Mismatch Of Story And Culture Within Medical Groups

I had a friend, let’s call him “Bob,” who’d readily make promises and just as readily break them.

All medical groups have a culture, whether or not it’s been purposefully created. It exists.

All medical groups have a story, too. A story its leaders or members or both tell about the group.

So, while culture exists, story itself is a representation or image of culture.

Some say that story is how culture is transmitted. But what I’d like you to focus on is the impact of the match or mismatch between story and culture within a medical group and how it affects the group both internally and externally.

The Community Group prides itself on delivering high quality care and on meeting the needs of its patients and referring physicians. That’s the story they tell themselves.

If that story matches with the actual culture, that is, the group actually delivers high quality care that meets its customers’ needs, then value is being created for the customers and it’s likely that the group is highly performing internally.

On the other hand, if the story remains the same but the group’s physicians are rude and if reports promised to referring physicians are generally late, then there’s trouble in store for the group — they are just fooling themselves and no one else.

The same mismatch can happen internally as well. For example, when a group’s leaders believe (belief being the story) that they have created a culture of mentoring younger group members but the reality is that there is no guidance and that management by yelling around is the rule. That misalignment of story and culture creates a cancer within the group.

My friend Bob thought that he was a man of his word. But that was just a story.

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

Mark F. Weiss

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Group Culture | Manage Your Practice | The Business of Healthcare

Grand Theft Auto

When I was 14, my friend Steve and I were stopped by the police for breaking into a car.

We didn’t actually break into a car. We just walked past it in the parking lot on our way into a store. The cop just decided to hassle us. His idea of fun, maybe. At least he became a cop and not a criminal.

The other day, I heard a potential client tell me that his future was being stopped.

The hospital administrator had told him that if he doesn’t stop pushing to expand the scope of his group’s exclusive contract, the group would be “fired.”

No one’s future is really dependent upon the approval of someone else. This guy I’m talking about, this doctor, may have painted himself and his group into a corner: the hospital might be the only facility at which they work. But that was his doing, not someone else’s.

And, even if they are painted into a corner, they can always bust out through the wall. Take their show on the road, so to speak. But no one ever really thinks of that. If you structure your group correctly, it’s entirely possible. Of course, it would be better to be working at multiple facilities so that if one is no longer desirable to you, you can tell them to take a hike.

This guy’s group really has no future at that place. The reality is that the hospital administrator really has no place to go. He’s just got a job and when he’s fired he’ll have a harder time finding a new position than you anyway. Or, maybe he won’t be fired. Maybe he’ll get some award for cutting costs. Maybe. But who wants to work with a jerk like him, anyway?

Back when I was 14, I thought that that cop was a criminal. A child abuser. Maybe he was.

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

Mark F. Weiss

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