Practice Management: How Cardiothoracic Surgeons Can Excel in an Employment Model Environment

After patient care, professional satisfaction and financial security are significant concerns for STS members. This was clearly evident by the standing-room-only attendance at the 2017 Practice Management Summit, held during the STS 53rd Annual Meeting this past January. In this issue of STS News, Dr. Paul Levy shares some of the most important lessons from the Summit.
–Frank L. Fazzalari, MD, MBA, Chair, Workforce on Practice Management

Paul S. Levy, MD, MBA, Chief of Surgical Services, Northeast Arkansas Baptist Hospital & Clinic, Jonesboro

STS News, Spring 2017 -- Proposed changes in health care finance and delivery have stimulated renewed interest in securing our specialty’s place in this new order. At the 2017 Practice Management Summit, several experts shared how cardiothoracic surgeons can best function in this evolving environment.

The first speaker was Aaron Robinson, CEO of Community Hospitals at Health First in Melbourne, Florida. He discussed how physician-hospital partnerships and cost transparency will be important moving forward. “As we dig into more and more research on patient choice and the evolving space that it’s in, patients are defining quality along the components of service and cost,” he said. “Cost is certainly more important than we think.”

Several talks dealt specifically with contract negotiation. Health care consultant Michael N. Heaton explained best practices, how fair market value is determined and utilized, and how to strengthen and leverage one’s professional position. The importance of competent representation during a contract negotiation became very evident.

Michael G. Moront, MD, of ProMedica Toledo Hospital in Ohio, provided a surgeon’s perspective of why using a professional medical contract consultant is so important. When his practice first entered an employment contract with a local hospital, they did not consult with an advisor. Years later, they realized that the work Relative Value Unit compensation model had many downsides, such as internal competition and increasing unpaid administrative work. The group retained a consultant who helped them shift to a salary model, which has been successful for both the surgeons and the hospital.

Health care attorney Mark Kopson, JD discussed important aspects of employment contract negotiation, such as verbal promises, fraud and abuse, and fair market practice valuations. “If it’s important enough to make a difference in whether or not you accept the position, it ought to be in black and white,” he said. “Please, please, please do not accept the fact that we have standard contracts and they can’t be changed—because they can if they want you."

"Do not accept the fact that we have standard contracts and they can’t be changed—because they can if they want you."

Mark Kopson, JD

Steven V. Manoukian, MD, who is the Cardiovascular Service Line Leader for Health Corporation of America, highlighted the value of the service line structure. He pointed to the importance of defined expectations for stakeholders (both administrators and physicians) and data-driven health care delivery.

Richard I. Whyte, MD, Chair of the STS Standards and Ethics Committee, discussed potential ethical conflicts that employed physicians may face. He emphasized the importance of always staying focused upon our “true north”—the patient.

Alan M. Speir, MD, Chair of the STS Council on Health Policy and Relationships, explained how the Medicare Access and CHIP Reauthorization Act may affect cardiothoracic surgeons, including the concept of “risk-sharing” and a bundled payment pilot for coronary artery bypass grafting surgery.

In the final presentation, Steven F. Bolling, MD, of the University of Michigan Health System, spoke about the logistics of taking an innovative idea to market. He warned that significant financial investment may be required—but that good ideas are worth the effort.

If you would like to experience the full Practice Management Summit, it is included in STS 53rd Annual Meeting Online.