Know your data. Hard data are far more effective than anecdotes when trying to convince the hospital of your practice’s value. Trumpet your successes, but remember that same executive will probably hear from 10 others in the same week that spending huge sums of money on their product or service will dramatically improve the hospital’s bottom line. If you’re trying to convince the hospital that every dollar spent to support your practice will provide an attractive return on investment, you need hard data to prove it.
It would be best if you could independently collect this data. But in most cases, you will have to rely on data the hospital has collected. It’s worthwhile to insist on routine reports (e.g., monthly, or no less than quarterly) from the hospital summarizing your group’s performance on quality and financial metrics (CMS core measures, patient satisfaction, cost per case). This data will be critical to you when you negotiate financial support from the hospital.
You should also have data about other hospitalist practices, such as results from the 2005-06 “SHM Survey of Hospitalist Productivity and Compensation” and other sources I discussed in a recent column (July 2007, p. 73). And if you’re able to get reliable data about other practices in your local marketplace (i.e., something more significant than just what you heard through the grapevine), be sure to share that information as well.
Agree to conditions carefully. Don’t agree to do things you would be unhappy doing just because it might help get more financial support from the hospital. Executives know it is bad business to pay people more money to get them to keep doing something they don’t want to do. Such an agreement usually leads to the hospitalists asking for more money each year to continue providing the service—and the quality of the service is often sub par if it’s something the hospitalists really don’t want to do (even if paid well to do it).
Stay focused on hospital performance—even in areas not specifically governed by your contractual relationship. Many or most hospitals that employ hospitalists assume all the financial risk for the practice. That is, the hospital agrees to make up the difference between collected professional fee revenue and the cost of operating the practice.
If the doctors underdocument and downcode, or are not compulsive about ensuring that their charges get to the billing agent, fee collections will suffer—and the hospital will end up having to pay more to support the practice.
If you are in such a situation, you should ensure that you’re helping to support optimal documentation, coding, billing, and collection practices—even if it won’t increase your paycheck but simply saves the hospital money. This will increase your chance of getting the hospital to increase financial support of your practice.
Remember your financial support isn’t a one-time negotiation; it is part of an ongoing relationship. In some negotiations, such as buying a car from a stranger, it seems reasonable to use any leverage most favorable for you. After all, you’re unlikely to ever interact with that person again. A hospitalist practice might compel the hospital to provide more support by threatening to quit suddenly. Yet it is usually a bad idea to do this because it can severely damage the long-term relationship.
Further, if you make it clear you’re going to quit unless you get more money, the hospital is in a tough spot. While the hospital may not want to lose you, any executive will realize that by making such a threat you probably aren’t committed to staying long even if you do get more financial support. TH