"Psst, I've got a deal for you.  Want to work harder, but for the same money?"

 

If I asked you that, you'd look at me as if I were nuts.
 
But, chances are, if you're a physician in a hospital-based group, your group has jumped to accept that same deal, perhaps even more than once. 
 
A classic example is the situation in which a hospital seeks to expand its O.B. service line from the current level of a handful of deliveries each week, even though its market is such that the expectant mothers are likely to be heavily from the Medicaid population.  The hospital "asks" (you can read this as "demands") its anesthesia group to provide 24/7 in-house coverage in order to attract obstetricians to use the facility.  The group is now faced, at a minimum, with having one of its physicians stay overnight in the hospital, when he or she might be doing only a few cases a week and generating very few dollars. 
 
Yet groups often agree to these demands due to the mistaken belief that voluntarily providing more services will endear the group to the hospital's administration. 
 
Although I counsel that hospital-based groups need to create unique experiences for their referral sources, patients and hospitals (see my article on creating an experience monopoly
http://www.advisorylawgroup.com/experiencemonopoly.html), they should not take on new coverage obligations without a concomitant financial reward.  If sufficient reward does not come from patient services, it must come from the hospital. 

 

Failing to obtain a quid pro quo leads to two unfavorable results:
 
1.  The group works harder for the same money, destroying morale and making it harder to recruit and retain.