Several times recently I have given one version or another of the same essential talk: Doc, here is what you have to do if you want to stay independent.
I was asked to give the talk at a specialty society meeting, but was given a really short time slot, which meant that I had to get very directly to the point, something that my wife might say is not always a strong suit for me.
So I called my friend in southern California who has been doing managed care for longer than the current generation of policy wonks have been alive. What do I say, I asked her, to a group of docs who are still pretty new to this whole ‘physicians bearing risk’ idea? I thought I might get something about the importance of physician leadership or stakeholder alignment, or in keeping with the new buzz some points about big data and analytics.
But this is what happens when you’ve been in the trenches for years…you cut through the baloney and get to the real issue.
‘There are only four things that matter,’ she said without hesitating. ‘Bed days, ER visits, total cost of surgery, and medications. That is it. Everything else is noise. If independent physicians want to play in the new world, they have to figure out how to impact those four things. Anything else is just B.S.’
She might live in southern California, but she is a diehard Steelers fan, so dirty fingernails type answers is what you get.
There you go. That is what matters.
If you want to play, it is first and foremost about bending the $3 trillion cost curve. It is not about getting a 2% increase on your RBRVS rate from your commercial payer. It is about using your leverage as physicians to bend the bigger cost curve. If you can do that, you’ll make good money. If you can’t, you are a target for someone else who is trying to do just that.
It is hard, but don’t make it overly complex. Attack one or more of those four things or go home.