Contract ceos

[ateria radicularis magna]

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Hello,
Does anyone know of a good resource (book preferably), that can elucidate the dark arts of controlling physicians by non-physicians?

 

[lobelsteve]

What are you talking about? Open your own practice and you are the CEO oh. You call all the shots. That’s not too hard.

 

[ateria radicularis magna]

What are you talking about? Open your own practice and you are the CEO oh. You call all the shots. That’s not too hard.

Thanks man.

 

[Status Sciaticus]

Hello,
Does anyone know of a good resource (book preferably), that can elucidate the dark arts of controlling physicians by non-physicians, such as contract ceos?
It seems there is a method to what I have encountered in my adventures in private practice.
There are obvious methods, such as obscuring the flow of money through the practice, telling the physician, “don’t bother with this...we will take care of this side of things while you focus on your passion of curing the sick, which we could never pretend to understand,”
Or by trying to force new graduates heavily burdened by debt into questionable practices.
Or by using puppet physicians as mouthpieces or guard dogs.
But there are other more subtle arts, very methodical and disturbing corporatization of the physician, a slow burn that erodes the physician’s authority and creates a corporate puppet where he once stood.
Where are these arts taught?
Word of mouth?
Business school?
There must be a physician-written guide to deciphering and dissolving these grim tentacles.
Where can I find it? I am at my wit’s end with these belly crawlers.

Thank you!! AND DON’T GIVE UP THE FIGHT!!

where HE once stood? Its 2020! Women are doctors too!
Just messing with you. There is no guidebook on this. Maybe you should write one so the rest of us can pick up on these things.

 

[PainMD23]

A few options:
1. As Steve said, open your own practice.
2. Academics or the VA
3. Get an MBA or MPH. Become a private practice CEO, admin at your hospital, or work for a giant insurance company; and clean house from the inside.

 

[ateria radicularis magna]

Here is another of their dank machinations—
Conflating their knowledge of business with a knowledge of medicine, and then trying to convince you that the number of years they have been in business somehow enables them to make pseudo medical decisions for you and your patients.

 

[DrSpine]

I believe you are looking for this - How To Discourage a Doctor

Jokes aside, the difficult part is many grads coming out are burdened with debt so have to be employed. The trick is, be employed for 2-3 years, get your experience, get your money, and then open up your own gig and be your own CEO like Dr. Lobel said. This way, you won't be some loser working to make an admin money, and you won't be stuck in that system forever. What you don't want to be is that guy who is now 45, still working in the hospital system or for some guy, stuck, and miserable. Currently you won't even be called a Doctor, you're called a Provider.

 

[joshmir]

I think that the OP’s question may not yet be fully answered

Perhaps OP wants to know Where he can find such Insights so that he can continue working as a physician and not be victimized by these “dark arts”...maybe he has no intention of working as a CEO

Maybe the best way to find what you were looking for would be to hire a consultant who has experience with advising hospital CEOs and multi specialty group admin on how to do what you were describing

 

[ateria radicularis magna]

.

 

[Asclepius186]

A few options:
1. As Steve said, open your own practice.
2. Academics or the VA
3. Get an MBA or MPH. Become a private practice CEO, admin at your hospital, or work for a giant insurance company; and clean house from the inside.

interesting #2 including the VA. Pain at the VA seems like a pretty lame gig to me in terms of clinical ability, procedures, and red tape. But I have no experience with doing pain at a VA. Is it a decent gig? Better than an employed pawn for some big hospital or Non partnership private practice?

 

[AdminPatient]

Hello,
Does anyone know of a good resource (book preferably), that can elucidate the dark arts of controlling physicians by non-physicians, such as contract ceos?
It seems there is a method to what I have encountered in my adventures in private practice.
There are obvious methods, such as obscuring the flow of money through the practice, telling the physician, “don’t bother with this...we will take care of this side of things while you focus on your passion of curing the sick, which we could never pretend to understand,”
Or by trying to force new graduates heavily burdened by debt into questionable practices.
Or by using puppet physicians as mouthpieces or guard dogs.
But there are other more subtle arts, very methodical and disturbing corporatization of the physician, a slow burn that erodes the physician’s authority and creates a corporate puppet where he once stood.
Where are these arts taught?
Word of mouth?
Business school?
There must be a physician-written guide to deciphering and dissolving these grim tentacles.
Where can I find it? I am at my wit’s end with these belly crawlers.

Thank you!! AND DON’T GIVE UP THE
FIGHT!!

You paint a pretty grim picture here. I am a “contract ceo” and do not spend my day counting money thinking of how to screw our doctors. There are plenty of other physician employment alternatives in our market so having a market competitive compensation package with incentives that align the health system objectives with physicians is the ultimate goal. There’s not a gold standard book that explains it all. A lot is based on experience, an organization’s risk tolerance, Stark/regulatory guidelines, and third party benchmarks

if you have a specific question I would be happy to address. I can’t compare my job to yours, but we too are pulled in different directions:
A commercial reasonableness “pull” to pay like physicians for like work that’s competitive within the market but doesn’t generate a huge subsidy for the health system

Some physicians wanting special arrangements/a higher guarantee/Wrvu rate/bonus structure than their peers in their own practice at similar productivity levels which causes all sorts of internal equity downstream problems when these arrangements are broadcasttheir special “deal” that was mutually agreed to be confidential

Stringent compensation guidelines from risk and compliance, often at the national level of parent organizations: no salary guarantee longer than 2 years, compensation per wrvu may not exceed the 60th percentile, no guarantees in excess of the 75th percentile, no compensation tied to volume or value of referrals, no quality metric compensation that can be tied anywhere near to rationing care

A legal analysis of every contract demonstrating ones productivity supports ones cash compensation. Board approval from any physician earning in excess of the 90th percentile with periodic updates to the board on how every highly compensated physician is performing relative to the initial justification/projections

Practice acquisitions/valuations are also a whole different ball of wax with different guidelines and standards

I understand this type of role isn’t always popular with physicians but I try to be fully transparent to doctors about what we can pay and why. I explain the benchmarks we are bound to and constraints. If they have a bonafide offer from a competitor we sit down and talk about what we can do economically or operationally to retain a physician. We sometimes waive non competes depending on circumstances. If a physician is especially disenfranchised with an element of the organization, We sometimes add pay for them to help become part of the solution (eg leading a physician burnout work team, or developing a physician led opioid prescribing work group).
At the end of the day, not every physician I interact with is happy with their contract but they at least understand the principles around compensation and why things are structured the way they are.

like I said, if there’s something specific I can help explain more, I’d be happy to

 

[AdminPatient]

You paint a pretty grim picture here. I am a “contract ceo” and do not spend my day counting money thinking of how to screw our doctors. There are plenty of other physician employment alternatives in our market so having a market competitive compensation package with incentives that align the health system objectives with physicians is the ultimate goal. There’s not a gold standard book that explains it all. A lot is based on experience, an organization’s risk tolerance, Stark/regulatory guidelines, and third party benchmarks

if you have a specific question I would be happy to address. I can’t compare my job to yours, but we too are pulled in different directions:
A commercial reasonableness “pull” to pay like physicians for like work that’s competitive within the market but doesn’t generate a huge subsidy for the health system

Some physicians wanting special arrangements/a higher guarantee/Wrvu rate/bonus structure than their peers in their own practice at similar productivity levels which causes all sorts of internal equity downstream problems when these arrangements are broadcasttheir special “deal” that was mutually agreed to be confidential

Stringent compensation guidelines from risk and compliance, often at the national level of parent organizations: no salary guarantee longer than 2 years, compensation per wrvu may not exceed the 60th percentile, no guarantees in excess of the 75th percentile, no compensation tied to volume or value of referrals, no quality metric compensation that can be tied anywhere near to rationing care

A legal analysis of every contract demonstrating ones productivity supports ones cash compensation. Board approval from any physician earning in excess of the 90th percentile with periodic updates to the board on how every highly compensated physician is performing relative to the initial justification/projections

Practice acquisitions/valuations are also a whole different ball of wax with different guidelines and standards

I understand this type of role isn’t always popular with physicians but I try to be fully transparent to doctors about what we can pay and why. I explain the benchmarks we are bound to and constraints. If they have a bonafide offer from a competitor we sit down and talk about what we can do economically or operationally to retain a physician. We sometimes waive non competes depending on circumstances. If a physician is especially disenfranchised with an element of the organization, We sometimes add pay for them to help become part of the solution (eg leading a physician burnout work team, or developing a physician led opioid prescribing work group).
At the end of the day, not every physician I interact with is happy with their contract but they at least understand the principles around compensation and why things are structured the way they are.

like I said, if there’s something specific I can help explain more, I’d be happy to

Also, a few resources that may help you learn about some of the constraints

-Follow Sullivan Cotter on LinkedIn or periodically review their website. They are similar to MGMA but focus exclusively on compensation related matters and are constantly issuing surveys and position papers and best practices sharing (eg how are organizations handling comp during Covid, what impact do the upcoming CMS proposed changes have on physician comp, how has the pain compensation median comp changed year over year)

-if you want to learn more about regulatory constraints, the law firm Hall Render is the market leader. Follow (LinkedIn) Joe Wolfe, their healthcare practice leader and holds a bunch of useful webinars

-mgma sometimes has good content but a lot of it is at the National level so may not resonate in your market

Forgive all the typos, last week I just had my second fusion in two months (my hardware moved). I had been working with my pain doctor dutifully but had dropfoot on the stairs while holding my newborn and knew it was time for the big procedure (I caught him but could have been very bad).

I sincerely believe pain medicine is the most thankless specialty in medicine

I’d be happy to discuss how we pay our pain doctors if that would be helpful or answer any evil contract CEO questions, or pointers if you have an upcoming contract renewal and wonder if you are getting a square deal

 

[ateria radicularis magna]

Hey, thanks for your reply.
1. If you could separate healthcare ceo’s into 3 categories, how would you divide them?
2. Is it normal for a ceo of a specialty (vascular surgery vein centers por ejemplo), to jump into a ceo role in another specialty (ortho tal vez)?
3. What are the most common reasons for arguments between investment/ceo/admin and physicians besides pay structure and physician autonomy?
4. What do you think physicians need to understand that they do not understand?

Thanks again for your thoughts. I hope that you recover quickly.