How Big is Too Big to Fail

[IVO2Monitor]

Just wondering if anyone has advice on hospital group contract negotiations. New president of the hospital we haven't dealt with previously. Definitely has looked at an AMC, but our books and work load really support our stipend. We bill efficiently, have some of lowest paid CRNAs in country that deserve a raise, OR ran by hospital inefficiently due to surgeons being able to shop the city, work in 75% for hours and around 70% for Units billed, but paid at 20%. Team based 4:1, some 3:1 supervision. We are on hospital committees and bend over backwards to help out around OR and making surgeons happy.

If you can't tell I think we do a great job.

Could an AMC really replace 15 MDs, 50 CRNAs all with non competes that we could enforce as we have other business besides main hospital without our approval? Seems too expensive for AMC to just locum out or transfer employees.

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[Planktonmd]

I wish I could tell you are safe... but you are not.
The CEO only sees one thing: The stipend he is paying you, and he will continue to try to find a cheaper solution.
Sooner or later an AMC will show up and offer to take over your practice and maybe something else like the ER without any stipend.
They will offer you all jobs but if you want these jobs they will want you to drop the non compete you have on the CRNAs.
If you decide to walk they will replace you, it would be bumpy but not impossible.

 

[aneftp]

AMC can come in an offer a "bundled " package you can't compete with.

Take zero anesthesia subsidy

But in return offer to take the ER and Rads contract.

How can you compete with that? Cause they figure they can make up the subsidy lost from anesthesia with rads and ER. And their billing is even more efficient since adding another contract doesn't cost them 6-7% billing fees you are paying.

 

[nimbus]

If you decide to walk they will replace you, it would be bumpy but not impossible.

This is basically true 100% of the time.

 

[Noyac]

1. Increase the profile of your group with active meetings with the CEO and representation in committees
2. Estimate the value of your initiatives in reducing cost, increasing quality or improving satisfaction among patients, colleagues and staff. This could be critical!
3. Create new initiatives to improve safety and quality such as blood transfusion protocols, acute pain protocols, etc. Get help from consultants to estimate cost savings and create surveys to save prove your value.
4. Expand into new areas such as office based practice

 

[criticalelement]

Do what any self respecting entity would do.

Hire a private investigator to tail the CEO. Follow him to the no-tell/motel. Pay the motel owner off to be able to bug the room. Take photos.

Present your facts to the hospital CEO that you followed and blackmail him. TEll him if he messes with your livelihood you are going to the press about his affair with a man and after you go to the press you are going to his wife about it.

voila.. Your contract will be renewed.

 

[IVO2Monitor]

Thanks for all the replies. In our favor is that other hospitals in town have lost surgeons after going with AMCs and have since bagged those groups. It did help our surgical volume. We do have work at surgery centers. Also, our hospital fired team health in the ed. As always, we could certainly do more with protocols and safety, but I'd say we are pretty involved already. I really think we give them value and help them save money... It's probably true though that we do a terrible job at showing that value to the hospital both from a PR and money standpoint. We spend so much time doing clinical work, most of the group just doesn't get it that quality initiatives also have to be shown to those it doesn't matter to in a way that matters to them.