Guest guest Posted December 27, 2004 Report Share Posted December 27, 2004 Tim's tale of how the established practice folks just don't get our concept is one I've heard and experienced before. I was a well established employed doc with good ties to the powers that be. I tried for more than a year to have them support me in a practice environment that would give them almost zero risk and all gain ( " you get all referrals, everything that comes my way is a loan that I'll pay back " ). The sticking point was control. We both wanted it. Their non-negotiables ( " we dictate which contracts you take, you must be on IDX with a T1line to support it, we do the billing at 8%, and you get the remainder of what you earn after our cut " ) were unacceptable to me. I realized that we were on two different continents. Communicating across the gulf was not possible. They couldn't perceive the landscape of this new territory. This came to me after reading Clayton Christiansen's book " The Innovator's Dilemma. " He points out that smart and reasonable managers in the company cannot perceive the value in a truly innovative approach. That's why I get so nervous when folks look to the consulting industry or to hospitals to help them craft the practices of their dreams. I just don't believe that they will ever be able to dream as big as you guys. I suspect that the best thing that could have happened to Tim is that the board turned down the affiliation proposals. It certainly has been the case for me. Gordon At 07:32 PM 12/26/2004, you wrote: They got you on the cheap. There is an important point here. Much of what an administrator promises you must get in writing or do not depend on it. It is great that your practice has taken off. Moonlighting in the ER gets much respect from the nursing staff if you do it well and be a great referral source. The other local physicians will feel the competition. bh > Greetings, > > When I started planning my practice, I approached the local hospital for > financial assistance. The local CEO was very receptive and promised $120k. > The board of the mother hospital in a nearby city was not as receptive to > the new ideas however. For two reasons; Gordon's ideas are new and > different, and they wouldn't have control over me as a non- employee. > > I convinced the local CEO that I could do it for $50k, and he promised to > get the funding. Once again the board vetoed this. To make a long story > shorter, I ended up getting an exam table, a sphynomanometer, and a utility > cart from hospital storage, and some free advertisement. I did go back once > to the local CEO and ask again for assistance, but was told that since I had > already begun my practice, the hospital could not offer any financial > assistance. > > The approached I used. I called the local CEO and set up an initial meeting > to see if their was any interest in helping a new physician join the > community. After that initial discussion, I had a second meeting with the > CEO with a full-fledged business plan, using projections based on > information from the hospital's CFO. > > We (I say we because my wife is an integral component of the practice) > opened up with a $12k christmas gift from my mother-in-law, and working > seven 24 hour shifts a month in an ED. We opened in February of this year > 2004. At this point we have repaid the $12k loan from ourselves and I am no > longer working the ED. We have over 500 registered patients and bring in > about $3k a week gross. In fact the growth of the practice caused the local > hospital to instruct the nursing staff (with whom I am the preferred > referral, and from whom I get a great number of new patients) to refer > patients on a strict call schedule basis in order to " protect " their > employeed physicians. Needless to say, this really only fueled the flames. > The medical director of the local ED (who was my boss in the ED 4 years ago) > was noted to tell the nursing staff this order and then to say, " the list is > here in this drawer, you are supposed to use it to refer patients, but > whatever you say when you discharge the patient is between you and the > patient " . > > At my one year anniversay, I plan to go back to the CEO and hopefully be > able to convince the board that my practice is of benefit to them as well as > the community. This, not for myself, but to try to get more practices in > the area like ours (the folks on this list). > > Sincerely, > TAS > > Hospital Help > > > > > > > > Has anyone approached their local hospital with a request for > > financial help in starting and growing your practice. If so, how did > > you go about it and how was it received? > > > > Mark Newberry > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 27, 2004 Report Share Posted December 27, 2004 not to mention the noncompete clauses > > > Billing is a big issue for these hospital systems. They want you to do > it their way. Their way does not work for a small practice. The > hospital systems quite frankly can not run a small office, this is land > of the doctor, not the hospital. This is your domain so remain in > control. > Contracts are another issue. They will force you to sign contracts > that just do not make sense to the doctor > bh > >> > > Greetings, >> > > >> > > When I started planning my practice, I approached the local >> >hospital for >> > > financial assistance. The local CEO was very receptive and >> >promised $120k. >> > > The board of the mother hospital in a nearby city was not as >> >receptive to >> > > the new ideas however. For two reasons; Gordon's ideas are > new and >> > > different, and they wouldn't have control over me as a non- >> >employee. >> > > >> > > I convinced the local CEO that I could do it for $50k, and he >> >promised to >> > > get the funding. Once again the board vetoed this. To make a >> >long story >> > > shorter, I ended up getting an exam table, a sphynomanometer, > and >> >a utility >> > > cart from hospital storage, and some free advertisement. I > did go >> >back once >> > > to the local CEO and ask again for assistance, but was told > that >> >since I had >> > > already begun my practice, the hospital could not offer any >> >financial >> > > assistance. >> > > >> > > The approached I used. I called the local CEO and set up an >> >initial meeting >> > > to see if their was any interest in helping a new physician > join >> >the >> > > community. After that initial discussion, I had a second > meeting >> >with the >> > > CEO with a full-fledged business plan, using projections based > on >> > > information from the hospital's CFO. >> > > >> > > We (I say we because my wife is an integral component of the >> >practice) >> > > opened up with a $12k christmas gift from my mother-in-law, and >> >working >> > > seven 24 hour shifts a month in an ED. We opened in February > of >> >this year >> > > 2004. At this point we have repaid the $12k loan from > ourselves >> >and I am no >> > > longer working the ED. We have over 500 registered patients > and >> >bring in >> > > about $3k a week gross. In fact the growth of the practice > caused >> >the local >> > > hospital to instruct the nursing staff (with whom I am the >> >preferred >> > > referral, and from whom I get a great number of new patients) > to >> >refer >> > > patients on a strict call schedule basis in order to " protect " >> >their >> > > employeed physicians. Needless to say, this really only fueled >> >the flames. >> > > The medical director of the local ED (who was my boss in the > ED 4 >> >years ago) >> > > was noted to tell the nursing staff this order and then to >> >say, " the list is >> > > here in this drawer, you are supposed to use it to refer > patients, >> >but >> > > whatever you say when you discharge the patient is between you > and >> >the >> > > patient " . >> > > >> > > At my one year anniversay, I plan to go back to the CEO and >> >hopefully be >> > > able to convince the board that my practice is of benefit to > them >> >as well as >> > > the community. This, not for myself, but to try to get more >> >practices in >> > > the area like ours (the folks on this list). >> > > >> > > Sincerely, >> > > TAS >> > > >> > > Hospital Help >> > > >> > > >> > > > >> > > > >> > > > Has anyone approached their local hospital with a request for >> financial help in starting and growing your practice. If so, >> >how did >> > > > you go about it and how was it received? >> > > > >> > > > Mark Newberry >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > >> > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 4, 2005 Report Share Posted January 4, 2005 This was exactly how my income guarantee was structured. Rakesh C. Patel MD Gilbert, Arizona --- " Graham, M.D. " wrote: > Sorry I'm late on responding to this issue... > > Just wanted to throw my Hospital story out there as a bit of " hope " > for > those that may be considering it. > > I have a contract that with a local hospital that gurantees me a NET > income of $120,000 over a one year period. According to the Stark > law, > and this is blatant in the contract, in no way is this money based on > performance, referrals, admissions, etc. > > All of this money is then forgiven over the next 2 years as long as I > stay > within so many miles of the hospital. > > They have nothing to do with my billing, staffing, ED call (which is > optional) or anything else...all I do is submit my profit & loss > statement > every month and they cut me a check for $10,000 or whatever $10,000 > minus > my net income for the month is to gurantee I make $10k total for the > month. > > Now, this gurantee is not a penny more and not a penny less...I can't > go > moonlighting or even work as a pizza delivery boy...I guess I can, > but it > just means more work because at the end of the year, there is a > reconciliation of your W-2s to make sure you didn't make more than > $120k > total for the year. > > The only control they have, I guess is the ability to audit my > records if > they think I'm up to some foul play. There are a number of hospitals > in > my area that are willing to do this or something like this. > > It's not suprising really when you consider the average physician > brings > narly 1.2 million dollars of revenue yearly to a hospital just by > being in > the area (admissions, lab work, etc.) > > I trained a the hospital down the road, but their board of directors > did > not feel the community demonstrated a need for more family doctors in > the > area! (which IS a Stark law requirement). I laugh at them because > St. > Pete grew by 30,000 people in just the last 3 years! > > I give all my patients the choice of which hospital or lab they want > to go > to. So far, everything has been great and I've been able to do > exactly > what I've wanted. > > Hope that helps! > - > > > > > not to mention the noncompete clauses > > > >> > >> > >> Billing is a big issue for these hospital systems. They want you > to > >> do it their way. Their way does not work for a small practice. > The > >> hospital systems quite frankly can not run a small office, this is > >> land of the doctor, not the hospital. This is your domain so > remain > >> in control. > >> Contracts are another issue. They will force you to sign > contracts > >> that just do not make sense to the doctor > >> bh > >> > >>> > > Greetings, > >>> > > > >>> > > When I started planning my practice, I approached the local > >>> >hospital for > >>> > > financial assistance. The local CEO was very receptive and > >>> >promised $120k. > >>> > > The board of the mother hospital in a nearby city was not as > >>> >receptive to > >>> > > the new ideas however. For two reasons; Gordon's ideas are > >> new and > >>> > > different, and they wouldn't have control over me as a non- > >>> >employee. > >>> > > > >>> > > I convinced the local CEO that I could do it for $50k, and he > >>> >promised to > >>> > > get the funding. Once again the board vetoed this. To make > a > >>> >long story > >>> > > shorter, I ended up getting an exam table, a sphynomanometer, > >> and > >>> >a utility > >>> > > cart from hospital storage, and some free advertisement. I > >> did go > >>> >back once > >>> > > to the local CEO and ask again for assistance, but was told > >> that > >>> >since I had > >>> > > already begun my practice, the hospital could not offer any > >>> >financial > >>> > > assistance. > >>> > > > >>> > > The approached I used. I called the local CEO and set up an > >>> >initial meeting > >>> > > to see if their was any interest in helping a new physician > >> join > >>> >the > >>> > > community. After that initial discussion, I had a second > >> meeting > >>> >with the > >>> > > CEO with a full-fledged business plan, using projections > based > >> on > >>> > > information from the hospital's CFO. > >>> > > > >>> > > We (I say we because my wife is an integral component of the > >>> >practice) > >>> > > opened up with a $12k christmas gift from my mother-in-law, > and > >>> >working > >>> > > seven 24 hour shifts a month in an ED. We opened in February > >> of > >>> >this year > >>> > > 2004. At this point we have repaid the $12k loan from > === message truncated === Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 4, 2005 Report Share Posted January 4, 2005 I also had a similar structure in my last office in Texas. I was hoping for something similar in Ohio, but the local hospital basically wanted more control, and prefers bringing in physician employees. This was not an option in Texas as it is against state law for anyone other than another physician to employ a physician in that state. TAS Re: Re: Hospital Help > > This was exactly how my income guarantee was structured. > > Rakesh C. Patel MD > Gilbert, Arizona > > --- " Graham, M.D. " wrote: > > > Sorry I'm late on responding to this issue... > > > > Just wanted to throw my Hospital story out there as a bit of " hope " > > for > > those that may be considering it. > > > > I have a contract that with a local hospital that gurantees me a NET > > income of $120,000 over a one year period. According to the Stark > > law, > > and this is blatant in the contract, in no way is this money based on > > performance, referrals, admissions, etc. > > > > All of this money is then forgiven over the next 2 years as long as I > > stay > > within so many miles of the hospital. > > > > They have nothing to do with my billing, staffing, ED call (which is > > optional) or anything else...all I do is submit my profit & loss > > statement > > every month and they cut me a check for $10,000 or whatever $10,000 > > minus > > my net income for the month is to gurantee I make $10k total for the > > month. > > > > Now, this gurantee is not a penny more and not a penny less...I can't > > go > > moonlighting or even work as a pizza delivery boy...I guess I can, > > but it > > just means more work because at the end of the year, there is a > > reconciliation of your W-2s to make sure you didn't make more than > > $120k > > total for the year. > > > > The only control they have, I guess is the ability to audit my > > records if > > they think I'm up to some foul play. There are a number of hospitals > > in > > my area that are willing to do this or something like this. > > > > It's not suprising really when you consider the average physician > > brings > > narly 1.2 million dollars of revenue yearly to a hospital just by > > being in > > the area (admissions, lab work, etc.) > > > > I trained a the hospital down the road, but their board of directors > > did > > not feel the community demonstrated a need for more family doctors in > > the > > area! (which IS a Stark law requirement). I laugh at them because > > St. > > Pete grew by 30,000 people in just the last 3 years! > > > > I give all my patients the choice of which hospital or lab they want > > to go > > to. So far, everything has been great and I've been able to do > > exactly > > what I've wanted. > > > > Hope that helps! > > - > > > > > > > > not to mention the noncompete clauses > > > > > >> > > >> > > >> Billing is a big issue for these hospital systems. They want you > > to > > >> do it their way. Their way does not work for a small practice. > > The > > >> hospital systems quite frankly can not run a small office, this is > > >> land of the doctor, not the hospital. This is your domain so > > remain > > >> in control. > > >> Contracts are another issue. They will force you to sign > > contracts > > >> that just do not make sense to the doctor > > >> bh > > >> > > >>> > > Greetings, > > >>> > > > > >>> > > When I started planning my practice, I approached the local > > >>> >hospital for > > >>> > > financial assistance. The local CEO was very receptive and > > >>> >promised $120k. > > >>> > > The board of the mother hospital in a nearby city was not as > > >>> >receptive to > > >>> > > the new ideas however. For two reasons; Gordon's ideas are > > >> new and > > >>> > > different, and they wouldn't have control over me as a non- > > >>> >employee. > > >>> > > > > >>> > > I convinced the local CEO that I could do it for $50k, and he > > >>> >promised to > > >>> > > get the funding. Once again the board vetoed this. To make > > a > > >>> >long story > > >>> > > shorter, I ended up getting an exam table, a sphynomanometer, > > >> and > > >>> >a utility > > >>> > > cart from hospital storage, and some free advertisement. I > > >> did go > > >>> >back once > > >>> > > to the local CEO and ask again for assistance, but was told > > >> that > > >>> >since I had > > >>> > > already begun my practice, the hospital could not offer any > > >>> >financial > > >>> > > assistance. > > >>> > > > > >>> > > The approached I used. I called the local CEO and set up an > > >>> >initial meeting > > >>> > > to see if their was any interest in helping a new physician > > >> join > > >>> >the > > >>> > > community. After that initial discussion, I had a second > > >> meeting > > >>> >with the > > >>> > > CEO with a full-fledged business plan, using projections > > based > > >> on > > >>> > > information from the hospital's CFO. > > >>> > > > > >>> > > We (I say we because my wife is an integral component of the > > >>> >practice) > > >>> > > opened up with a $12k christmas gift from my mother-in-law, > > and > > >>> >working > > >>> > > seven 24 hour shifts a month in an ED. We opened in February > > >> of > > >>> >this year > > >>> > > 2004. At this point we have repaid the $12k loan from > > > === message truncated === > > > > Quote Link to comment Share on other sites More sharing options...
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