Bigger Isn’t Better; Better Is Better

Breaking The Paradigm of Quantity: An Obstacle for Physician Leadership Certainly one of my favorite Jackie Mason jokes goes similar to this. Any customer enters an outlet whose register front side window proclaims: “WE SELL Not Only BELOW RETAIL. WE SELL BELOW COST!”. He skeptically approaches the store’s proprietor and asks, “How can you have the ability to earn money selling below cost?” “Simple” answers the proprietor, “We recover it with volume!”

When I tell this joke to Hospital CEO’s or CMO’s they laugh until I suggest which they could be doing a similar thing making use of their medical staff strategy: much bigger is better. The greater the medical staff and also the much bigger their referring volume the higher the hospital’s important thing. The much bigger the magnitude of a physician’s practice the higher the standard of the doctor. “He/she should be a great doctor, take a look at the dimensions of his/her practice and exactly how many patients he/she refers!”.

This unfortunate strategy has lead to a stampede of practice acquisition, joint ventures, and “institute models” that have, for a lot of, succeeded in bigger referral patterns for hospitals. Unfortunately, number of these larger systems are in fact better. In reality, the purchase of heterogeneous physician groups with all the accompanying variation in practice styles, work ethic, quality and culture have made put further strains for the search for medicine’s ultimate goal: consistent, measurable, efficient and excellent outcomes.

You could debate that this plan didn’t produce a great deal of sense even when it was embraced within the bygone days of fee for service. It made even less sense when DRG’s were introduced and will prove fatal once bundling of all services and ACO’s (capitation on steroids) take hold. Organizations which will succeed are those that invest now in developing excellent physician leaders: those that may influence, model and hold others accountable for consistent, measurable, efficient and excellent outcome. This can often require trimming rather than enhancing the volume of physicians with admitting privileges.

The winners here will probably be those systems that recognize bigger isn’t better: better is way better.

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