Hca/fps buyout

[Mordak]

Although we haven't been officially contacted, it seems as though there are strong interests by fps/hca to continue to expand their network. We anticipate them to not renew our contract sooner rather than later.

I am wondering if anyone has any negotiation experience with these folks. My understanding is, they prefer to only negotiate 1 on 1 with pathologists for the purposes of "rehiring."

Any experience? Hca sucks, for sure, and I'd probably exit if they said take it or leave it. I'm just curious to see how much people have squeezed them for?

Thx.

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[cmz]

They will expand into your territory. We saw them coming and bolted. I know the service is going to suffer and patient care will definitely be compromised. However, they won't care unless something catastrophic happens. It is what it is.

Regarding how they approach the pathologists... they do prefer to divide and conquer. You might have some leverage if you're in a remote area where it is hard to recruit pathologists. Good luck.

 

[Napoleon1801]

Although we haven't been officially contacted, it seems as though there are strong interests by fps/hca to continue to expand their network. We anticipate them to not renew our contract sooner rather than later.

I am wondering if anyone has any negotiation experience with these folks. My understanding is, they prefer to only negotiate 1 on 1 with pathologists for the purposes of "rehiring."

Any experience? Hca sucks, for sure, and I'd probably exit if they said take it or leave it. I'm just curious to see how much people have squeezed them for?

Thx.

I would bet money they will try to negotiate one-on-one, keep who they can, and then recruit to fill in any gaps. If your practice is solid, you might try be able to approach them as a group and get a better deal. It's difficult to recruit competent people right now, so you might have an edge in that respect.

 

[deleted314957]

If they can, they will say take it or leave it. Your very best bet
( and I hope you have garnered their support over the years) is to have the “ rain makers” on the medical staff insist that you be retained AND rewarded or they may need to rethink their allegiances. It worked for me and others in analogous circumstances.

 

[Mordak]

If they can, they will say take it or leave it. Your very best bet
( and I hope you have garnered their support over the years) is to have the “ rain makers” on the medical staff insist that you be retained AND rewarded or they may need to rethink their allegiances. It worked for me and others in analogous circumstances.

Many thanks for the insights. I shall see what happens. Recruitment will be a bear for years, I think that this is the rate limiting step for them. My assumption is that, they could perhaps slowly incorporate more and more of their own staff to review cases. I do know fps core facilities are all digitized now, so maybe they think they can build a centralized scanner. The problem is, IT infrastructure and the general lack of lab staff already make this an uphill battle. Siphoning off volume to other locations? I could see that possibly be a strategy too, but I just can't see them saying take or leave it to a very large quantity of pathologists all at once and it not resulting in anything less than a dumpster fire.

 

[Alteran]

I'm pretty sure at a talk somewhere I saw the head pathologist of HCA speak not too long ago and stated it was his goal that patients have the same pathology health care experience irrespective of HCA facility they go to. I'll leave that up to the reader to decide exactly what that means.

Your only saving grace is that while there is no shortage of pathologists, competent pathologists are not that easy to find these days. From the people that I know personally HCA has hired, they have low standards. But if they're struggling to fill spots, that means there are actually pathologists out there that are even beneath their standards. Think about that for a minute or two.

 

[deleted314957]

I'm pretty sure at a talk somewhere I saw the head pathologist of HCA speak not too long ago and stated it was his goal that patients have the same pathology health care experience irrespective of HCA facility they go to. I'll leave that up to the reader to decide exactly what that means.

Your only saving grace is that while there is no shortage of pathologists, competent pathologists are not that easy to find these days. From the people that I know personally HCA has hired, they have low standards. But if they're struggling to fill spots, that means there are actually pathologists out there that are even beneath their standards. Think about that for a minute or two.

“low standards “ is being generous. And, I have seen nothing but trouble from physicians who become health care executives/administrators of some type. I actually had one have the temerity to tell me, verbatim, that his job was to “fist f*** doctors”. And he said it with a smile. Be very wary of such “ physicians “ in your journey.

 

[coroner]

I've interviewed with HCA in FL (did not take offer). During the interview I talked with pathologists in your situation i.e. they were a private group contracted with the hospital, HCA took over the hospital, busted up the group, some stayed, some bolted or retired.

From what they told me, as well as the offer that HCA gave me, I think you don't have much bargaining power. They might have some staffing shortages, workflow issues where a known presence such as yourself would be ideal for them to retain, but I don't think it will move the needle that much. It may not be as cut & dry as "take it or leave it"; but, the administrator you negotiate with will probably say something more along the lines of: "We have a standard pay scale for all physicians determined by specialty, experience, and RVU's. And, all of our pathologists are within range of this salary structure which is coming from corporate HQ and I can't deviate much from that."

None of us are special snowflakes, no matter if you graduated at the top of your med school and scored in the 99th percentile of your exams. We are all replaceable cogs in the corporate wheel that is healthcare. He who has the gold wins; and, that is the venture capital funded behemoth in this situation, quality or patient care be damned...

 

[caffeinegirl]

None of us are special snowflakes, no matter if you graduated at the top of your med school and scored in the 99th percentile of your exams. We are all replaceable cogs in the corporate wheel that is healthcare. He who has the gold wins; and, that is the venture capital funded behemoth in this situation, quality or patient care be damned...

+1,0000 This is absolutely the truth.

 

[Mordak]

+1,0000 This is absolutely the truth.

I don't disagree with these sentiments. I was just trying to see if there had been any successful mitigation strategy. Looks like the answer is that there is no leverage. Thank you all for the feedback!

 

[Drifter76]

But if they're struggling to fill spots, that means there are actually pathologists out there that are even beneath their standards. Think about that for a minute or two.

Alternatively, it could also mean that they are such an undesirable employer, that even bottom of the barrel pathologists don’t want to work there.

 

[Alteran]

I don't disagree with these sentiments. I was just trying to see if there had been any successful mitigation strategy. Looks like the answer is that there is no leverage. Thank you all for the feedback!

If you have any outreach volume that is not native to the hospital you're at (i.e. surgical center(s), GI docs, urologists, derm, etc.) but merely processing it there, and its of sufficient volume that you can survive off of it, I would move it out of the hospital ASAP. Either build your own lab or work out a deal with another lab to have it done there. That way you have a lifeline with established clientele still under your control. The dirty secret is that most physicians are loathe to switch pathologists they've worked with and feel comfortable with - even if they're mediocre at best. Barring this, I'm not sure what you can do that would have a meaningful impact.

 

[caffeinegirl]

If you have any outreach volume that is not native to the hospital you're at (i.e. surgical center(s), GI docs, urologists, derm, etc.) but merely processing it there, and its of sufficient volume that you can survive off of it, I would move it out of the hospital ASAP. Either build your own lab or work out a deal with another lab to have it done there. That way you have a lifeline with established clientele still under your control. The dirty secret is that most physicians are loathe to switch pathologists they've worked with and feel comfortable with - even if they're mediocre at best. Barring this, I'm not sure what you can do that would have a meaningful impact.

I've been there and done that - and it's not pretty. Most pathologists are not business-savvy and it brings out the worst in people. And, many times the takeover includes preferred insurance contracts, so building a new lab to keep certain clients is not sustainable in the long run.

 

[deleted314957]

As Alteran alluded, your best bet is a very vociferous and supportive medical staff.

 

[Dave CX]

I've been there and done that - and it's not pretty. Most pathologists are not business-savvy and it brings out the worst in people. And, many times the takeover includes preferred insurance contracts, so building a new lab to keep certain clients is not sustainable in the long run.

You can to TC/PC in their offices.

 

[Alteran]

I've been there and done that - and it's not pretty. Most pathologists are not business-savvy and it brings out the worst in people. And, many times the takeover includes preferred insurance contracts, so building a new lab to keep certain clients is not sustainable in the long run.

I 100% agree with you having also done this. Pathologists generally have no clue how to run a business and manage personnel, let alone market and grow one. I have also seen how competing visions/interests in pathologist owned laboratories can negatively impact the operation of the lab.

You can to TC/PC in their offices.

I also agree. While the maximum potential reward is to own your own lab, you merely just have to control the referral of the work to a laboratory that you provide the PC for. Contracting with another non-hospital lab to do the TC would be just fine. If you're in a state that allows client billing, you could do that too.

As Alteran alluded, your best bet is a very vociferous and supportive medical staff.

And yes, this is your best option. But Mike, you are of a different medical era when there was more comradery amongst community physicians. My senior partners did this a time or two in their heyday. However, its effect has been lost as more and more physicians fall under giant multidisciplinary groups that are hospital owned and just simply no longer care or even take notice.

 

[Dave CX]

I 100% agree with you having also done this. Pathologists generally have no clue how to run a business and manage personnel, let alone market and grow one. I have also seen how competing visions/interests in pathologist owned laboratories can negatively impact the operation of the lab.


I also agree. While the maximum potential reward is to own your own lab, you merely just have to control the referral of the work to a laboratory that you provide the PC for. Contracting with another non-hospital lab to do the TC would be just fine. If you're in a state that allows client billing, you could do that too.


And yes, this is your best option. But Mike, you are of a different medical era when there was more comradery amongst community physicians. My senior partners did this a time or two in their heyday. However, its effect has been lost as more and more physicians fall under giant multidisciplinary groups that are hospital owned and just simply no longer care or even take notice.

Actually if you are doing the work in their office, it is not client billing. So this can be done in any state

 

[deleted314957]

I 100% agree with you having also done this. Pathologists generally have no clue how to run a business and manage personnel, let alone market and grow one. I have also seen how competing visions/interests in pathologist owned laboratories can negatively impact the operation of the lab.


I also agree. While the maximum potential reward is to own your own lab, you merely just have to control the referral of the work to a laboratory that you provide the PC for. Contracting with another non-hospital lab to do the TC would be just fine. If you're in a state that allows client billing, you could do that too.


And yes, this is your best option. But Mike, you are of a different medical era when there was more comradery amongst community physicians. My senior partners did this a time or two in their heyday. However, its effect has been lost as more and more physicians fall under giant multidisciplinary groups that are hospital owned and just simply no longer care or even take notice.

Sadly, I think you are right. Very different times. Even “professional courtesy “ is now illegal &/or considered some type of fraud and abuse.

DaveCX has a good position, i believe, for today’s world. The further you can get your ass away from hospitals, the better.
I thoroughly enjoyed my time at the scope. Favorite time of the day. The business, admin, personnel, etc side of the job
( of which I had too darned much) was always a mental effort that delivered no satisfaction.

 

[WEBB PINKERTON]

Virtually everything is going to be owned by hospitals or venture capitalists. I can't believe anyone is talking about starting a lab. Those days are gone.

 

[cmz]

You can to TC/PC in their offices.

This is the **** that needs to stop.

 

[WEBB PINKERTON]

Sadly, I think you are right. Very different times. Even “professional courtesy “ is now illegal &/or considered some type of fraud and abuse.

DaveCX has a good position, i believe, for today’s world. The further you can get your ass away from hospitals, the better.
I thoroughly enjoyed my time at the scope. Favorite time of the day. The business, admin, personnel, etc side of the job
( of which I had too darned much) was always a mental effort that delivered no satisfaction.

His position will disappear really fast when Mitt Romney types buy up the place and send all the GI work to the mothership who is providing pathology services for all the offices they have purchased. In-office labs have a bleak future. I have been watching this play out big time with the derms in my neck of the woods. All that talk earlier in this thread about trying to getting our colleagues to "go to bat" for the pathologist had me rolling my eyes. Most don't care.

 

[KeratinPearls]

Virtually everything is going to be owned by hospitals or venture capitalists. I can't believe anyone is talking about starting a lab. Those days are gone.

Yup and if you have an pathology account with an clinician group that gets bought out by a larger organization, you are at risk of losing that account. They will take your business.

 

[Drifter76]

They will expand into your territory. We saw them coming and bolted. I know the service is going to suffer and patient care will definitely be compromised. However, they won't care unless something catastrophic happens. It is what it is.

Regarding how they approach the pathologists... they do prefer to divide and conquer. You might have some leverage if you're in a remote area where it is hard to recruit pathologists. Good luck.

They absolutely will try to divide and conquer. I joined a group that had an HCA contract that represented over 80% of their revenue, and they lost the contract to HCA/FPS right after I started. FPS negotiated with us individually and got about half of us to stay and work for them. The rest, including me, walked and they replaced us with low quality foreign grads. I heard that it didn’t go very well after I left, the clinicians are still pretty unhappy with the quality of the pathology (several years later), and there’s been continued high turnover of pathologists. For close to a year, they were without a heme person and they were flying pathologists in from one of their other regions to cover heme. But those problems apparently haven’t been bad enough to make them reverse course on their model.
I am aware of one instance where a group fought off FPS and kept their contract (at least for the time being). HCA bought their main hospital system and tried to shove the FPS model down their throats, announced that they’d terminate their contract. The group stood together and said hell no. When it became apparent that FPS would have to replace every single pathologist, they backed down and gave the group a new 4 or 5 year contract. HCA represented a lower percentage of their total revenue (less than 50%) compared to my old group, which helped. The group decided they could survive without HCA if they had to and they’d just make significantly less.

 

[cmz]

His position will disappear really fast when Mitt Romney types buy up the place and send all the GI work to the mothership who is providing pathology services for all the offices they have purchased. In-office labs have a bleak future. I have been watching this play out big time with the derms in my neck of the woods. All that talk earlier in this thread about trying to getting our colleagues to "go to bat" for the pathologist had me rolling my eyes. Most don't care.

If you have a good reputation, most docs will go to bat for you. However, administration will shut them the **** down. The only time administration comes back to you with open arms is when they need a favor.

And yes, a lot of VC groups are gobbling up practices one at a time. The volume is slowly going to dry up. Some places will feel it sooner than others.

 

[Dave CX]

Yup and if you have an pathology account with an clinician group that gets bought out by a larger organization, you are at risk of losing that account. They will take your business.

A TC/PC lab isn't really a lab per se, although it requires a clia certificate and policy manual. Otherwise its just a microscope, desk and somewhere to file slides.

 

[Dave CX]

His position will disappear really fast when Mitt Romney types buy up the place and send all the GI work to the mothership who is providing pathology services for all the offices they have purchased. In-office labs have a bleak future. I have been watching this play out big time with the derms in my neck of the woods. All that talk earlier in this thread about trying to getting our colleagues to "go to bat" for the pathologist had me rolling my eyes. Most don't care.

If that happens (possible), I will work for the mother ship.

 

[deleted314957]

His position will disappear really fast when Mitt Romney types buy up the place and send all the GI work to the mothership who is providing pathology services for all the offices they have purchased. In-office labs have a bleak future. I have been watching this play out big time with the derms in my neck of the woods. All that talk earlier in this thread about trying to getting our colleagues to "go to bat" for the pathologist had me rolling my eyes. Most don't care.

Very sad. Time was, that was NOT the case. Must suck to be in practice today.

 

[WEBB PINKERTON]

If that happens (possible), I will work for the mother ship.

Better be prepared to move. The derm work at the in-office labs here went from the hills of kentucky up to wisconsin. No thanks. Never know where the mothership will be.