ADVISORY e-ALERT     October 31, 2011 
Advisory Law Group, a Professional Corporation  


The tides come in and out, ties get wider then narrower, then wider again, and society cycles round and round from an emphasis on, and worship of, rugged individualism, to an emphasis on, and lauding of, community and cooperation. I call this the "Me - We CycleTM."


me-we image    

Currently, society is heavily affected by "we" think, from notions of shared sacrifice, to paying your fair share, to "giving back."


Physicians are told that the future of healthcare is not in rugged individualism but, rather, in the "it takes a village" world.


Of course, not everyone in a society buys into the current stage of the Me - We Cycle and that's why trends eventually moderate and return toward the antipode. However, there are some who, while holding a view closer to the other extreme, understand that they can benefit from co-opting the current zeitgeist.


Thus, the move by hospitals to take advantage of "we" think.


As the current wave of collectivism shapes trends in healthcare, hospitals seek to ride the wave to further their own "me" interests: Witness the completely hospital-centric notions of Accountable Care Organizations, healthcare collaboration, and physician alignment.


Physician groups that want to survive the crush of the Me-We Cycle's current collectivist position need to focus attention both internally and externally.


Internally, you must take steps to ensure that your group is cohesive. Hospitals often use dissension within a group as both an excuse and a pathway to extend their tentacles of control.


Take, for example, an office practice group consisting of three physicians, one owner and two employees, with offices located adjacent to a hospital. The owner physician has held a medical directorship at the hospital for some time. One of the employed physicians becomes unhappy with his subordinate role, notwithstanding his subordinate skills, management style, and personality. Instead of striking out on his own, he approaches the hospital CEO who convinces the physician that it would be too expensive to start his own practice, but that if he could get the other employed doctor to join him, the hospital would "sponsor" their new practice via an existing controlled medical group. For all practical purposes, the hospital gained control of that practice and jettisoned its relationship with the original practice and its physician owner.


Among other essential steps, bringing cohesion to your group involves governance, ownership, and management issues, and it also involves weaving legal protections throughout your group's agreements. These are not individual efforts, they require careful strategy and woven execution.


Externally, you must take steps to stop or hinder the hospital's efforts to gain advantage through "collaboration." Seek alliances with similarly situated groups, explore ways of using the hospital's existing medical staff bylaws and political support within the medical staff to preserve physician control. To the extent that hospital efforts to "align" physicians are underway, use that process to argue for physician control of the resulting entities and arrangements. If your relationship with the hospital involves a contractual arrangement, build in restrictions and protective provisions, such as prohibitions on solicitation and fees for outplacement to the hospital.


Eventually, the Me-We Cycle will shift back the other way, but that may take decades. If you'd like to wait it out then you don't need to take action other than to learn the words "may I have my paycheck, please?"


If that's not the future you have envisioned for yourself, contact me today, and we'll get started.


Medical Staffs Gone Wild   


View Episode 34 of the Wisdom. Applied Videocast 





Two guys are arguing about whether it's permissible to smoke and pray at the same time, so they decide they'll ask their priest.
The first asks whether it's permissible to smoke while praying, to which the response was, no - that would be a sacrilege.
The second asks whether it's permissible to pray while smoking, to which the response was, absolutely - there is no time at which it is inappropriate to pray.
Of course, this demonstrates the power of a question and how it's phrased.
This being the long windup to the 2012 election, we're also familiar with the power of the question in connection with political polling. If two polls are statistically valid, how do they generate wildly different results?
If you're street-wise, you'd suspect that the targeted subjects could have been picked to guaranty a skew. For example, polling in an area that is heavily populated with those likely to vote for X Party who are predisposed to a certain viewpoint -- that demonstrates a related negotiating phenomenon, the frame or context in which a question is asked.
But more commonly, the form of the polling question influenced the response: "Are you in favor of inexpensive nuclear power, generated without producing carbon emissions?" vs. "After the failure of reactors in Japan to contain radiation, are you in favor of nuclear power?"
This lesson is particularly applicable to medical groups, both in connection with negotiations with a hospital and in connection with many exchanges, written or verbal, involving items in contention.
"We'd like to discuss a 12% increase in our stipend in order to provide this proposed new package of services." vs. "No other hospital in the County provides this proposed new package of services, which gives Hospital Y a huge advantage in attracting such-and-such cases. The return on investment would be tremendous and the Hospital will be recognized as a leader in treatment; we'd need just a 12% increase in our stipend to get this in place."
You've got everything to gain; you'll ask the right question, won't you?

How Scenario Surveys Strengthen Strategy, published in the September 2011 issue of Pain Medicine News and in the October 2011 issue of Anesthesiology News.

Scenarios Can Shape Group Strategy, published on on August 24, 2011. 


To read other recent articles, click here 



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Not Much is Fair About Fair Market Value



The fair market valuation process is often unfair, blind to value and generally ignores the true market.   

And, that's not the worst part.


Now learn about its negative impact on physician compensation, group stipends and the ability to do real world deals.


When: Nov 14, 2011

Time: 4:00 PM Pacific Time

Length: 45 minutes

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Upcoming Presentations
Mark will be giving a webinar presentation, How to Protect Your Practice: Radiology Contracting in the Era of Competitiveness, on November 2, 2011, at the Virtual Conference.  Registration complimentary via the lecture site.

Mark will be presenting a Grand Rounds lecture at USC's Keck School of Medicine's Department of Anesthesiology on November 4, 2011.  The two topics are: The Future Of Your Anesthesia Practice and How Anesthesia Groups Are Organized.  

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Warning Sign
In This Issue
Physicians: Action Required to Thrive In Today's "WE" Society
Videocast: Medical Staffs Gone Wild
All Things Personal
Recently Published Articles
The e-Alert Archive
Upcoming Presentations
2011 Anesthesia and Radiology Business Updates Now Available
The Wisdom. Applied. Blog
Q & A Video Series
The Immediate Leader Experience
Mentor Program


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Whether you're an anesthesiologist, a radiologist or another hospital based or office based physician, there's tremendous value waiting for you in your complimentary copy of Advisory Law Group's 2011 Anesthesia Business Update and 2011 Radiology Business Updates.

Click on the images below to access the download page.   
2011 Anesthesia Business Update   

2011 ALG Radiology Business Update

Follow this link to Mark's blog, Wisdom. Applied.


Overhear Mark's responses to medical group strategy and business questions.
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Q & A video page.    


You're a physician who wants to form a medical group and, among other things, subcontract with or employ other physicians, enter into exclusive contacts, obtain significant stipend support money, create related entities to increase protection and the like. And you want to come up to speed on all of this immediately.

Or, you're the new leader of an existing group with complex practice and business operations -- you need to understand how to master the group's organizational, operational and leadership issues -- and you need to be brought up to speed immediately.


After having regularly dealt for many years with physicians in both of these contexts, we've designed a process to deliver immediate results: The Immediate Leader Experience™.


The Immediate Leader Experience™ takes place over a weekend in Santa Barbara, California and includes two nights accommodation at the Four Seasons Santa Barbara Biltmore Hotel. 


In two short days, you'll be entirely up to speed, totally prepared and confident.  You'll be armed with tools and sample documents.


Due to the nature of this program, admission is upon interview only -- there is extremely limited availability.


For further information on The Immediate Leader Experience™ follow this link.   
For information on Mark's mentor program, click on the following link:  The Advisor Program.