Insights from Ludi

Working with all sizes of hospitals and their physician partners at Ludi^TM, I see a lot of interesting things. Once, I met a Chief Medical Officer that carried around his physician agreements in a folder that had an orange stain on it. The stain was reminiscent of cheese puffs, but who am I to judge?

It’s a dance we all do. Too many issues, so little time, and a bit of numbness takes over in all of our lives. If you are at the helm of a large healthcare system, ignoring issues can see like the only way to survive. Let’s just say that strategic placement of a business issue towards the BACK of the priority list continues to be en vogue. We all in know life and business, what you ignore, sidestep, rationalize, bury, underestimate….will bite you.

I worked for a large non-for-profit system “papering” physician employment, loans, and other physician alignment strategies. I regarded compliance as a necessary evil.

It’s actually smart to conduct your organization’s business within in the bounds of federal regulations. The Department of Justice (DOJ) hasn’t taken 2018 off and when they hit an organization, the fine tends to go big. And, now it’s even personal – healthcare executives are being given prison time. As one Ludi™ client has stated, “Orange is not my color.”

Health systems are expanding and continue to acquire new facilities. This type of growth requires examination of all the legacy physician “deals” that are in place. Yet, at Ludi^TM, we often hear that examination of physician administrative contracts that include medical directorships, co-management, and shared or on call agreements are often put on the back burner for health system teams. We get it, management of physician contracts is messy, and teams do not get overly excited about having to deal with this process. Teams are short on time and people, so this is the bucket that gets pushed down the priority list or even completely ignored.

LEAN, Sixth Sigma – man, we have all heard it, trained on it, and implemented it. This type of efficiency mantra is the bedrock of how to stay profitable; hospitals continue to have more and more pressure to cut any type of fluff from their budgets, to deliver quality care, and be able to grow services to meet the needs of the communities they serve.

How would your medical staff rate your health system as a partner? Have you asked? Are you wincing just thinking about it? Physicians are your most important partner as a health system to create the best possible teams for healthcare service to a local community and beyond. This is a relationship that has to be tended to daily. What are the data points to watch and measure for your physician relationships?

This is funny. (Well, if you are giant hospital nerd focused on broken processes, it’s funny.) Do you know what you are spending on your hospital administrative agreements with your physician partners? You have to know where they are located to start the count. You need to know your “official count” of partnerships (co management, call, employed, medical directorships to name a few.)

Do you know how many administrative physician agreementsyou have? Do you know what group took call last night? Do you know who you are paying on auto-pay, how much, and why? How much do you spend annually on medical directorships? Are you chasing approvers to sign time logs on Friday Happy Hour so you don’t further antagonize your very important physician partner?

Who’s on first to quote Abbot and Costello…..hospital and health systems are notorious for having silos. We are witnesses to health systems acquiring other hospitals which continues to increase the silo effect and more layers of disconnect. With physician agreements, the complexity is intense and a gap for hospital operations.

Physicians have not traditionally entered the workplace to lead or run businesses; they want to care for people, heal their communities, and make a good living. With all the complications in healthcare, regulations, how to care for patients and remain profitable, physicians are being tapped daily for “extracurricular” management work.