Building a Medical Practice

[militarymd]

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So how do primary care folks and surgeons "build" a practice?

1) referrals from colleagues
2) referrals from other patients
3) self-referrals.

The better service you provide, the more referrals you will get from the same source....

The surgeon who does the best rotator-cuff repair will get more and more referrals from the primary care guy who sees patients with complaints related to rotator cuff injuries....because the patient will go back to the primary care guy and report good outcome, service, etc.

Measures of whether the patient got good care or not will be 360:

outcome, bedside manner, clinic wait time, operative course, hospital course, etc.



Soooo....do anesthesia groups "build" a practice?

In any town where there is more than one anesthesia group...covering different hospitals.....

You compete for surgeons ...by providing better services (that's right...it's like a restaurant...BETTER SERVICES)

1) safety....that is a given...but if you are competing with unsafe groups...you will win hands down
2) bedside manners
3) perioperative course....pain control, nausea control, etc.
4) service to surgeons....minimal cancellations, minimal delays, minmal lab tests.
5) availability...to both surgeons and to the hospiatl.


You do a bad job...the surgeons take their patients somewhere else....

Do anesthesia groups build practices? You can answer that for yourself.

 

[hoboken]

Maybe we should ask Jet how he built his successful practice.

Reading Jet's posts I doubt he missed any of your points. His practice most likely was one of the best in the area but now he is looking for another job.

Why, because in anesthesia you don't build a practice. You are the lap dog of the administration. It does not matter how great you or your practice is when some AMC liar comes to town with a well greased sales pitch and a briefcase full of cash for the administrators. You can be out on your ass in less than 90days.

In an other specialties like Orthopedics, OB-GYN, Cardiology, Dermatology, Pain Medicine and even Family Practice you can apply Mil's techniques and build a practice but not Anesthesia. In Anesthesia you can delude your self into thinking you are building a practice but when the liars in suits come to town and start spreading the cash around you will quickly see that you only have a practice so long as the administrators let you.

 

[militarymd]

Jet was an "employee" of the hospital.

 

[hoboken]

Jet was an "employee" of the hospital.

Because the Administrators did not allow anesthesiologists to have there own practices.


Mil would you be so kind to tell me where I can go to hang out a shingle and build my own practice?

 

[militarymd]

Because the Administrators did not allow anesthesiologists to have there own practices.


Mil would you be so kind to tell me where I can go to hang out a shingle and build my own practice?

Ask UT in Dallas....ask anyone who owns a practice.

Just because you don't understand or you can't imagine it...doesn't mean it doesn't exist.

Do you think a surgeon's or internists practice doesn't exist at the whim of an administrator......

Have you heard of "block time"...."privileges"...etc....it's all the same thing.

 

[Lonestar]

militarymd is spot on. If you do all that he said, it would be hard pressed for any administration to let you go. But never say never, because the color of green is mightier than reason.

 

[hoboken]

Ask UT in Dallas....ask anyone who owns a practice.

Just because you don't understand or you can't imagine it...doesn't mean it doesn't exist.

Do you think a surgeon's or internists practice doesn't exist at the whim of an administrator......

Have you heard of "block time"...."privileges"...etc....it's all the same thing.

Dallas is a very unusual market. There is one big player who most people refuse to work for and the rest are cowboys chasing a surgeons from hospital to hospital.

Surgeons and Internists are have very different practices from anesthesiologists. They bring patients to a hospital and thus have leverage to take them elsewhere. The whim of an administrator is less relevant when you can take your patient to the hospital down the street.

I have seen an administrator grant privileges without bothering to check credentials and rearranging the block schedule to steal a surgeon from the hospital down the street. If you as an anesthesiologist decided to move to the hospital down the street, you would never get the same treatment. You would be told by the administration who owns the contract and would have to kiss their ass the get a job working for them on their terms.

 

[militarymd]

Dallas is a very unusual market. There is one big player who most people refuse to work for and the rest are cowboys chasing a surgeons from hospital to hospital.

Surgeons and Internists are have very different practices from anesthesiologists. They bring patients to a hospital and thus have leverage to take them elsewhere. The whim of an administrator is less relevant when you can take your patient to the hospital down the street.

I have seen an administrator grant privileges without bothering to check credentials and rearranging the block schedule to steal a surgeon from the hospital down the street. If you as an anesthesiologist decided to move to the hospital down the street, you would never get the same treatment. You would be told by the administration who owns the contract and would have to kiss their ass the get a job working for then on their terms.

I guess that's the difference between a premier anesthesia group and the rest.

 

[Disciple]

Do you think a surgeon's or internists practice doesn't exist at the whim of an administrator......

Have you heard of "block time"...."privileges"...etc....it's all the same thing.

What about surgeons who do most of their cases in an ASC in which they have partnership?

 

[militarymd]

What about surgeons who do most of their cases in an ASC in which they have partnership?

In any town where there is more than one anesthesia group...covering different hospitals

read my orignial post about the specific environment I'm referring to.

 

[hoboken]

read my orignial post about the specific environment I'm referring to.

So, Mil where does this environment exist where you can build an anesthesia practice that will not be taken away from you the minute some AMC liar walks into town with a bag of cash for the local hospital administrator.

 

[UTSouthwestern]

Dallas is a very unusual market. There is one big player who most people refuse to work for and the rest are cowboys chasing a surgeons from hospital to hospital.

Have no clue what you are talking about. There is no big player in this market. 15 groups are loosely associated with each other for tax and billing purposes. There is another big group of essentially independent practitioners sharing a common billing and scheduling office and tax ID number. Then there are a dozen groups like mine that are independent groups that have developed their surgeon relationships over years.

We have exclusive contracts, shares, etc. but as Mil said, it something we earned with our reputation and our skills. Are there shortsighted hospitals that don't factor this in when they dole out contracts for anesthesia services? Yes there are, even here in Dallas, but what they have found out is that their surgeons are more than willing to transplant their practices to the facility across town or across the street to practice with the people they see as having better skills and better availability.

 

[militarymd]

UT beat me to it....places where there are more than one place to operate.

 

[deleted87051]

1) safety....that is a given...but if you are competing with unsafe groups...you will win hands down
2) bedside manners
3) perioperative course....pain control, nausea control, etc.
4) service to surgeons....minimal cancellations, minimal delays, minmal lab tests.
5) availability...to both surgeons and to the hospiatl.


You do a bad job...the surgeons take their patients somewhere else....

Do anesthesia groups build practices? You can answer that for yourself.

You forgot # 6+7.

6) Sign lowball contracts with local IPAs to get control over patients. Invade local hospital with competing anesthesia group. When the hospital goes to surgeon request system and ALL the surgeons continue to request the existing group, complain to the IPA administrators. IPA puts the screws to the surgeons saying if they continue to request the competing group, they will pay the difference in anesthesia fees, deducted from their own fees.

#7) Hire slick, professional JD, MBA wheeler-dealer to negotiate with health plans for you. We learned our lesson.

If you have the contract, it doesn't matter how many wet taps/failed spinals/pneumocephalus you get. Doesn't matter if your average epidural takes 30 mins. 2 of the OBs did move their practices but that's it. Around here the surgeons do not decide where patients have their surgery, the health plans do.

 

[militarymd]

different environments require different methods of building practices.

 

[TheSandMan]

You forgot # 6+7.

6) Sign lowball contracts with local IPAs to get control over patients. Invade local hospital with competing anesthesia group. When the hospital goes to surgeon request system and ALL the surgeons continue to request the existing group, complain to the IPA administrators. IPA puts the screws to the surgeons saying if they continue to request the competing group, they will pay the difference in anesthesia fees, deducted from their own fees.

#7) Hire slick, professional JD, MBA wheeler-dealer to negotiate with health plans for you. We learned our lesson.

If you have the contract, it doesn't matter how many wet taps/failed spinals/pneumocephalus you get. Doesn't matter if your average epidural takes 30 mins. 2 of the OBs did move their practices but that's it. Around here the surgeons do not decide where patients have their surgery, the health plans do.

nimbus, what is an ipa?

 

[deleted87051]

nimbus, what is an ipa?

They are independent practice associations. They are groups of independent physician practices who affiliate to negotiate with big payors such as Aetna and Blue Cross. They work in a particular geographic area and are often affiliated with a specific hospital system. They are usually run by PCPs.

An insurance company such as Aetna will pay them $x/month/patient to take care of their enrolled patients. This prespecified amount is divided among all the PCPs and specialists participating in the plan. Usually, the IPA pays specialists (surgeons, anesthesiologist, radiologists) a discounted FFS rate. But the more the PCPs pay the specialists, the less they can keep for themselves. Essentially the risk is transferred from the insurance company to the Primary care physicians of the IPA. In a given month, if there is a high utilization of specialty services, more of the fixed monthly income will have to be paid out to the specialists. Moreover, if the rates being paid out to specialists is high, less $$$ remains for the PCPs who are typically running the show.

A few examples. I am not affiliated with any of these.

http://www.stfrancisipa.com/
http://www.sccipa.com/
http://www.victorvalleyipa.com/
http://www.care1st.com/network/ipas.asp


HTH