In order for private practices to thrive in the current health care climate, they must maintain a standard of excellence in both patient care and financial matters. Those who fall short of either mark often bail out of having control over their own business and shelter themselves under the umbrella of a hospital based practice.
Basically there are two types of physicians who opt to align themselves with a hospital model. The first brand of physicians who choose to abandon the idea of private practice are those who have not and can not understand or involve themselves in the business of medicine. Since physicians never receive training in running a successful practice, there is a trial and error period involved in creating a structure that succeeds. Some doctors will try their best and still fail, while others refuse to believe that they have any other responsibility than to practice medicine. Either way, you will usually find these doctors functioning in a disorganized office that is always on the brink of one catastrophe or another and bail out is sometimes their only means of survival.
The other physicians who need the hospital model are those egomaniacs that have expanded their original model to include either offices or equipment that they can not afford or maintain. They find themselves in a situation where overhead continues to accumulate, without the patient volume to offset these expenses.
Initially, the idea of a hospital based practice may seem like the greatest invention since sliced bread and indeed physicians who refuse or cannot grasp what it takes to make a successful private practice may find their salvation here. What could be better, they wonder, than to lose all financial responsibilities, bill and salary paying, and maintenance for the office and equipment? Ahh!, to just come in each day, collect a salary and go home with a clear head. Wonderful, right? Well, before we pay homage to the gods of hospital employ, we should be aware of the many pitfalls that can plague this arrangement and make us realize that it may not be the nirvana that we hoped for.
First and foremost are the staff problems. While some hospitals will negotiate with physicians and allow them to bring their former staff members with them as part of their deal, many hospitals will require that the new take-over practice use their employees. Many hospitals are now using their R.N. staff as part of their practice management team. This is a great idea if you need blood draws or IV placement, not so much a lot if you need staff that is familiar with verification and authorizations, front desk staffing, and billing protocols. Many R.N. have never run a private practice before and have no prior understanding of the nuts and bolts of everyday practice life and all that it entails. Without a team mentality for success, you may find yourself short of your financial goals at the end of each quarter and eventually find that you cannot meet the expectations of your contract.
As hospital employees, your staff is paid by the managing organization and they may have little to zero interest in making the success of your practice their number one goal. You may have some input into employee evaluations and raises, but in most cases the employee is protected by the hospital job description that was agreed upon at their time of hire and asking them to perform additional tasks or even to change protocols or procedures is akin to expecting them to perform open heart surgery during their lunch hour. You are just another nameless, faceless physician to these workers and if you could not motivate staff in your own practice, then you can forget about motivating employees who have no direct connection to you at all. In most hospitals, employees have constant access to human resources and administration if their little world is interrupted in any way, and you may come to find out that unless an employee is in violation of the most serious of crimes, you will be gone before they are!
You will now find yourself in a situation where you have to submit written requests for any and all equipment that is needed to run your daily operations successfully. Should these requests be granted, you will be placed on the list of all other requests and can expect to wait, sometimes for weeks for a new printer, fax, or telephone. When these finally do arrive, you can hope and pray that they first work and that they are compatible with your other equipment. Wait times can be endless.....
Your billing may now be outsourced and reports may go directly and exclusively to the hospital controllers office. If the billing department is located somewhere off campus, you will never be able to see EOB's and other insurance correspondence and will rely on nameless and faceless personnel to make your financial decisions. You may never find out if there are a particular set of problems that are preventing the optimization of your financial goals and again you may never meet or exceed your contracted goals. You could find yourself making the same amount of money year after year, without knowing why your goals are not being met. And if you did not understand the business of medicine before, you will now find yourself in the deepest and darkest of corners.
Patients may be billed and even harassed for charges that you may have waived or made some time concessions for without your knowledge or input. What you will get are the patient complaints and exits that can result from a billing staff that does not act in your best interest. The hospital may not accept all plans that you were formally par with and more patients will exit because of this problem as well. You may be expected to perform a number of charity procedures and see these patients for private visits as well and this can have an important impact on the number of profitable visits during a financial quarter.
You can also forget about referring to physicians that are not part of the hospital staff. You will be judged and evaluated upon your constant referral to hospital staff and they can be a tough task master. Some hospitals may even expect that you obtain their approval prior to vacation and sick time and you may be expected on call whenever other members of the staff are away. Your life is no longer your own and unfortunately this is exactly what you bargained for.
Finally, there may come a day when someone realizes that the hospital based practice is just another referrals for money scheme. Eventually, these practices will only be allowed in areas where the affiliated hospital is the only game in town, so if won't matter where the patient is admitted, since no other options exist. In most urban areas, this is far from the case and your patients, surprisingly enough, may not always want to be admitted to your employer hospital. Then - What ?
Basically there are two types of physicians who opt to align themselves with a hospital model. The first brand of physicians who choose to abandon the idea of private practice are those who have not and can not understand or involve themselves in the business of medicine. Since physicians never receive training in running a successful practice, there is a trial and error period involved in creating a structure that succeeds. Some doctors will try their best and still fail, while others refuse to believe that they have any other responsibility than to practice medicine. Either way, you will usually find these doctors functioning in a disorganized office that is always on the brink of one catastrophe or another and bail out is sometimes their only means of survival.
The other physicians who need the hospital model are those egomaniacs that have expanded their original model to include either offices or equipment that they can not afford or maintain. They find themselves in a situation where overhead continues to accumulate, without the patient volume to offset these expenses.
Initially, the idea of a hospital based practice may seem like the greatest invention since sliced bread and indeed physicians who refuse or cannot grasp what it takes to make a successful private practice may find their salvation here. What could be better, they wonder, than to lose all financial responsibilities, bill and salary paying, and maintenance for the office and equipment? Ahh!, to just come in each day, collect a salary and go home with a clear head. Wonderful, right? Well, before we pay homage to the gods of hospital employ, we should be aware of the many pitfalls that can plague this arrangement and make us realize that it may not be the nirvana that we hoped for.
First and foremost are the staff problems. While some hospitals will negotiate with physicians and allow them to bring their former staff members with them as part of their deal, many hospitals will require that the new take-over practice use their employees. Many hospitals are now using their R.N. staff as part of their practice management team. This is a great idea if you need blood draws or IV placement, not so much a lot if you need staff that is familiar with verification and authorizations, front desk staffing, and billing protocols. Many R.N. have never run a private practice before and have no prior understanding of the nuts and bolts of everyday practice life and all that it entails. Without a team mentality for success, you may find yourself short of your financial goals at the end of each quarter and eventually find that you cannot meet the expectations of your contract.
As hospital employees, your staff is paid by the managing organization and they may have little to zero interest in making the success of your practice their number one goal. You may have some input into employee evaluations and raises, but in most cases the employee is protected by the hospital job description that was agreed upon at their time of hire and asking them to perform additional tasks or even to change protocols or procedures is akin to expecting them to perform open heart surgery during their lunch hour. You are just another nameless, faceless physician to these workers and if you could not motivate staff in your own practice, then you can forget about motivating employees who have no direct connection to you at all. In most hospitals, employees have constant access to human resources and administration if their little world is interrupted in any way, and you may come to find out that unless an employee is in violation of the most serious of crimes, you will be gone before they are!
You will now find yourself in a situation where you have to submit written requests for any and all equipment that is needed to run your daily operations successfully. Should these requests be granted, you will be placed on the list of all other requests and can expect to wait, sometimes for weeks for a new printer, fax, or telephone. When these finally do arrive, you can hope and pray that they first work and that they are compatible with your other equipment. Wait times can be endless.....
Your billing may now be outsourced and reports may go directly and exclusively to the hospital controllers office. If the billing department is located somewhere off campus, you will never be able to see EOB's and other insurance correspondence and will rely on nameless and faceless personnel to make your financial decisions. You may never find out if there are a particular set of problems that are preventing the optimization of your financial goals and again you may never meet or exceed your contracted goals. You could find yourself making the same amount of money year after year, without knowing why your goals are not being met. And if you did not understand the business of medicine before, you will now find yourself in the deepest and darkest of corners.
Patients may be billed and even harassed for charges that you may have waived or made some time concessions for without your knowledge or input. What you will get are the patient complaints and exits that can result from a billing staff that does not act in your best interest. The hospital may not accept all plans that you were formally par with and more patients will exit because of this problem as well. You may be expected to perform a number of charity procedures and see these patients for private visits as well and this can have an important impact on the number of profitable visits during a financial quarter.
You can also forget about referring to physicians that are not part of the hospital staff. You will be judged and evaluated upon your constant referral to hospital staff and they can be a tough task master. Some hospitals may even expect that you obtain their approval prior to vacation and sick time and you may be expected on call whenever other members of the staff are away. Your life is no longer your own and unfortunately this is exactly what you bargained for.
Finally, there may come a day when someone realizes that the hospital based practice is just another referrals for money scheme. Eventually, these practices will only be allowed in areas where the affiliated hospital is the only game in town, so if won't matter where the patient is admitted, since no other options exist. In most urban areas, this is far from the case and your patients, surprisingly enough, may not always want to be admitted to your employer hospital. Then - What ?
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