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    Kenneth T. Hertz
    Kenneth T. Hertz, FACMPE

    The old cha cha standard talked about living in “two different worlds.” The reality is that when you bring on physicians in an employment model, professional services agreement (PSA) or other alignment structure, you are moving physicians from one world to another. And in most cases, their new world is very different from the old one as they move from:

    • Owner to employee
    • Involvement in every decision to limited involvement in a limited number of decisions
    • Absolute control to limited control, if any
    • Financial transparency to financial murkiness

    They’re two different worlds for sure.

    In order for any of these models to succeed, there must be trust between the employer and the employee. For the employees (the physicians), one of the factors impacting the development of trust is transparency – transparency and clarity.

    If you want a successful relationship with your physicians – if you want to develop the kind of relationship with the physicians that engenders trust and confidence – transparency is a must. Here are five suggestions to create an environment of transparency and trust:

    1. In the beginning: From the first discussions with the practice it’s important that a consistent message be delivered by a consistent team of individuals. Be timely in response to questions, open with information, and honest with the vision, goals and objectives.

    2. Compensation: This is a sensitive issue. Talk honestly about performance expectations, the compensation model, the rationale behind it and what you see for the future. You can’t predict, but you can discuss planning assumptions and goals.

    3. Governance: I’ve worked with too many organizations that have offered participation in governance through a group governance model, only to crawfish when the time actually comes for participation and decision making. Physicians must be engaged in their future. If the governance model is window dressing, I suggest you change it. It won’t work, and it likely will backfire.

    4. Financial performance and productivity: If you’re going to expect physicians to play a role in expense control and the practice’s financial performance, you must have an understandable financial reporting system in place – one that communicates clearly to physicians and practice administrators and presents information in a timely and accurate manner. Distill the information. Provide guidance and explanation for review. Hide nothing. The same is true for performance. Paying the physicians based on productivity requires that you have a practice management system in place that is supported by an effective process and captures charges in a timely manner, reports accurately and thoroughly, and whose bugs have been worked out before the contract begins – not during.

    5. Compulsive two-way communication: Communication must go both ways: Physicians to administration, administration to physicians. One of the great risks in communications is the mistake of thinking that it actually happened. Provide feedback and inquire as to how things are going. Follow up. Loop back. Do what you say you will do.

      Sure, none of these are earth shattering. They are simple, basic and absolutely necessary. Failure to act on these and make them priorities sends a strong message to physicians. And in the end, it’s not a positive one.

    These are not difficult. We tend to make them difficult, but they are not. Make them happen. Transparency will equal trust.

    MGMA is working with several clients to develop customized educational offerings for physicians in medical groups, hospitals and health networks that address all of the issues outlined here. Learn more about how the MGMA Health Care Consulting Group can help you.

    Kenneth T. Hertz

    Written By

    Kenneth T. Hertz, FACMPE

    Kenneth T. Hertz, FACMPE, has held numerous leadership positions in small and large healthcare organizations in primary care, multispecialty care and large integrated systems. 

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