Most independent practices treat the Merit-based Incentive Payment System (MIPS) as a clinical-quality program with a billing-side tax. That framing misreads the decision. MIPS participation is mostly an operational question: whether the practice has the data infrastructure, EHR capability, and…
Most independent practices treat the Merit-based Incentive Payment System (MIPS) as a clinical-quality program with a billing-side tax. That framing misreads the decision. MIPS participation is mostly an operational question: whether the practice has the data infrastructure, EHR capability, and vendor support to clear the performance threshold, and whether the dollar exposure of skipping is worse than the cost of compliance. The clinical score follows the operational setup, not the …
The best person at your front desk gives two weeks' notice on a Tuesday. It's nothing dramatic, just a better commute and a job that pays a little more. Everyone wishes her well, and the seat gets filled inside a…
The best person at your front desk gives two weeks’ notice on a Tuesday. It’s nothing dramatic, just a better commute and a job that pays a little more. Everyone wishes her well, and the seat gets filled inside a month.
What doesn’t get filled shows up in pieces over the following weeks. A patient lands in a slot that’s been blocked off for a year, because he gets anxious and …
I never sought out leadership. It found me. We met when I clumsily stumbled into it as a junior faculty. Razor-focused on patient care and teaching, I stared at my clinical leader with bewilderment when she asked me if I…
I never sought out leadership. It found me. We met when I clumsily stumbled into it as a junior faculty. Razor-focused on patient care and teaching, I stared at my clinical leader with bewilderment when she asked me if I had thought about becoming an associate program director. While I questioned whether I had the experience or qualifications, I took on the role, and found deep fulfillment and joy in …
Physicians are exiting medicine faster than the sector can replace them. We've been facing burnout, workforce shortages, growing administrative burdens, and other mounting pressures. Physicians are 82 percent more likely to burn out than workers in other occupations, and for…
Physicians are exiting medicine faster than the sector can replace them. We’ve been facing burnout, workforce shortages, growing administrative burdens, and other mounting pressures. Physicians are 82 percent more likely to burn out than workers in other occupations, and for many years, traditional practice models have offered few alternatives. As a result, there is a deepening sustainability crisis occurring in medicine.
As a practicing anesthesiologist for more than 30 years, …
The email arrived on a Tuesday afternoon. It thanked everyone for their dedication, praised the organization's proud history, and announced that the hospital had been acquired. There would be new leadership, new opportunities, and a town hall meeting the following…
The email arrived on a Tuesday afternoon. It thanked everyone for their dedication, praised the organization’s proud history, and announced that the hospital had been acquired. There would be new leadership, new opportunities, and a town hall meeting the following week. Clinical operations would continue as usual.
There was one thing missing. No one had asked the physicians.
For generations, doctors assumed that if the ownership of a hospital or medical practice …
Ask a physician what the biggest business risk to their practice is, and most will land somewhere familiar. A lawsuit. A bad payer contract. A denial spike that guts a quarter's revenue. It is none of those. For a solo…
Ask a physician what the biggest business risk to their practice is, and most will land somewhere familiar. A lawsuit. A bad payer contract. A denial spike that guts a quarter’s revenue.
It is none of those. For a solo or independent physician, the single biggest risk to the practice is the physician’s own unavailability. Not the clinical kind anyone insures against. The plain fact of not being there to run …
I have previously written that "not all physicians are nice." Some physicians (a tiny minority) in private practice hold out the promise of partnership, paying physicians below-market wages until they get to the golden ring. Then, they terminate these physicians…
I have previously written that “not all physicians are nice.” Some physicians (a tiny minority) in private practice hold out the promise of partnership, paying physicians below-market wages until they get to the golden ring. Then, they terminate these physicians before they are made partners. As I noted then:
I have been representing physicians for over forty years, and the vast majority of the people I work with are genuinely …
Most independent practices renew payer contracts the same way they sign them: the renewal letter arrives, the practice manager forwards it to the physician owner, and either someone signs it or no one does. The contracts that escape renegotiation for…
Most independent practices renew payer contracts the same way they sign them: the renewal letter arrives, the practice manager forwards it to the physician owner, and either someone signs it or no one does. The contracts that escape renegotiation for three or four cycles are the ones quietly anchoring 20 to 35 percent of commercial volume at fee schedules that lag the practice’s best contract by 15 to 25 percent.
I did not encounter Norman Schwarzkopf's leadership doctrine until long after I had already been living it. When I finally read his words about sweat, preparation, and the courage to act despite uncertainty, I felt an immediate jolt of recognition.…
I did not encounter Norman Schwarzkopf’s leadership doctrine until long after I had already been living it. When I finally read his words about sweat, preparation, and the courage to act despite uncertainty, I felt an immediate jolt of recognition. It wasn’t admiration. It was recognition. I realized I had been following the same principles instinctively throughout my medical and institutional life, especially in the moments when leadership and command …
A patient came to me worried she was going to lose twenty-five pounds in the next month. Even on tirzepatide, what would make her think that? She'd only lost five pounds in the first two months. She said the marketing…
A patient came to me worried she was going to lose twenty-five pounds in the next month.
Even on tirzepatide, what would make her think that? She’d only lost five pounds in the first two months.
She said the marketing that brought her in had promised her thirty pounds in three months.
So I explained the truth: the body does not save up its losses and then spend them in a lump sum. …
Hospitals would never rely on the idea that "we know good care when we see it" to control infections. Yet when choosing leaders, many still rely on the vague belief that "we know leadership potential when we see it." Medicine…
Hospitals would never rely on the idea that “we know good care when we see it” to control infections. Yet when choosing leaders, many still rely on the vague belief that “we know leadership potential when we see it.”
Medicine reviews nearly every process that affects patient care. But choosing leaders often happens privately, through conversations, informal nominations, search committees, and personal opinions about “fit.” This process is rarely reviewed as …
It was two in the morning and I was starting a heparin drip on a patient whose clot was not going to wait for daylight. I typed the order, the electronic health record (EHR) flagged the weight-based dose, and minutes…
It was two in the morning and I was starting a heparin drip on a patient whose clot was not going to wait for daylight. I typed the order, the electronic health record (EHR) flagged the weight-based dose, and minutes later a nurse hung the bag and programmed the smart infusion pump at the bedside. The pump beeped, the number climbed, and I moved on to the next patient without …
Historically, followers have been positioned as subordinate actors, defined more by compliance than by contribution. In contrast, leadership roles are associated with an assumption of power, which may be formal, positional, and at times authoritative. This dichotomy is misleading. Many…
Historically, followers have been positioned as subordinate actors, defined more by compliance than by contribution. In contrast, leadership roles are associated with an assumption of power, which may be formal, positional, and at times authoritative. This dichotomy is misleading. Many individuals in formal leadership roles experience constraints in their ability to effect change, as authority alone does not reliably translate into influence. Conversely, we all know individuals who are “not …
Most operational decisions in an independent medical or dental practice are made under time pressure with incomplete information. Hiring a practice management consultant is the decision practice owners turn to when they recognize that the operational gap exceeds their capacity…
Most operational decisions in an independent medical or dental practice are made under time pressure with incomplete information. Hiring a practice management consultant is the decision practice owners turn to when they recognize that the operational gap exceeds their capacity to close. The mistake is not the decision to bring in outside help. The mistake is signing an engagement contract before disclosing what success looks like and verifying that the …
I enjoy building LEGO projects with my grandchildren, because it is possible to sit with a grandchild for several uninterrupted hours, unlike video games or watching them scroll on cell phones. Our last project was a LEGO Technic set, which…
I enjoy building LEGO projects with my grandchildren, because it is possible to sit with a grandchild for several uninterrupted hours, unlike video games or watching them scroll on cell phones. Our last project was a LEGO Technic set, which lets the child learn about engineering principles like cams, levers, and fulcrums. This project was estimated to take 7 to 8 hours to complete. We made the mistake of misplacing …
Clinicians are treated as invincible, so when their own mental health suffers, many stay silent. Namit Choksi, a physician entrepreneur and health care executive, joins to explain how credentialing forms and a culture that treats wellbeing as a perk push…
Clinicians are treated as invincible, so when their own mental health suffers, many stay silent. Namit Choksi, a physician entrepreneur and health care executive, joins to explain how credentialing forms and a culture that treats wellbeing as a perk push doctors to hide depression, anxiety, and substance use until they reach …
The best investment I ever made didn't start with a pitch deck. It started with a nurse spending two hours on a task that should have taken ten minutes. I was rounding as a hospitalist, and I noticed, again, the…
The best investment I ever made didn’t start with a pitch deck. It started with a nurse spending two hours on a task that should have taken ten minutes.
I was rounding as a hospitalist, and I noticed, again, the amount of time clinical staff spent on manual equipment checks, compliance logs, and inventory reconciliation. It was the kind of operational friction that becomes invisible when you see it every day. …
Most independent practices treat HIPAA as a documentation exercise. The policy binder sits on a shelf, the privacy notice is posted, the staff training certificate is in the file, and the assumption is that the practice is covered. Enforcement patterns…
Most independent practices treat HIPAA as a documentation exercise. The policy binder sits on a shelf, the privacy notice is posted, the staff training certificate is in the file, and the assumption is that the practice is covered. Enforcement patterns over the last several years suggest a different exposure model. The settlements that reach small practices are rarely about the policies that were missing on paper. They are about the …
Today, many physicians will be considering applying for employment at a hospital or clinic. You might be one of those. Finding your next employer is the most important decision you have made since you entered medical school, because selecting the…
Today, many physicians will be considering applying for employment at a hospital or clinic. You might be one of those. Finding your next employer is the most important decision you have made since you entered medical school, because selecting the wrong one may end your career as a doctor. And even if a bad employer choice does not end your career, you may have a difficult experience in re-starting your …
Doctors spend over a decade training and then quietly leave a fortune on the table when they handle their own money. In this episode, economics professor Hernan Moscoso Boedo explains why high income and years of schooling do not make…
Doctors spend over a decade training and then quietly leave a fortune on the table when they handle their own money. In this episode, economics professor Hernan Moscoso Boedo explains why high income and years of schooling do not make physicians good investors. He compares the way doctors avoid the stock market to the way some people distrust vaccines, not …
