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NEGOTIATING INSTITUTIONAL SUPPORT for ACADEMIC DEPARTMENTS

NEGOTIATING INSTITUTIONAL SUPPORT for ACADEMIC DEPARTMENTS. Robert E. Johnstone, MD West Virginia University. WHY NEGOTIATE SUPPORT?. Because clinical revenues no longer cover costs Collections per RVU stagnant in many practices, and schedules less efficient People cost more

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NEGOTIATING INSTITUTIONAL SUPPORT for ACADEMIC DEPARTMENTS

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  1. NEGOTIATING INSTITUTIONAL SUPPORTfor ACADEMIC DEPARTMENTS Robert E. Johnstone, MD West Virginia University

  2. WHY NEGOTIATE SUPPORT? Because clinical revenues no longer cover costs Collections per RVU stagnant in many practices, and schedules less efficient People cost more Hospitals need the services that anesthesiologists provide

  3. ANESTHESIOLOGIST: REVENUES vs COSTS 2 ex laps of 3.5 h, 47 wk/yr, 17% NCT, 2:1 ratio with residents, 50% Medicare ($17) & 50% commercial ($34), less 15% Dean/taxes: $225,420 SAAC/04 Assoc Prof salary+fringe: $320,190 Support Needed: $94,770

  4. MOST ANESTHESIOLOGY DEPARTMENTS RECEIVE HOSPITAL SUPPORT Scott/Blough (2001) – 88 of 153 practices received stipends. Med Director, Trauma coverage ASA/Tarrance survey (2002) – 111 of 327 subsidize anesthesia clinical practices SAAC (2004) - $5.4m/49 faculty $109,756 support per faculty member

  5. INSTITUTIONAL SUPPORT INCREASING YEARSUP/FTE 2000 $34,319 2002 $59,906 2003 $85,607 2004 $109,756 K Tremper, Anesth Analg 2004;99:1185

  6. HOSPITAL SUPPORT: Examples Medical director stipends Manage operating rooms Recruitment/sign-on bonuses Trauma or obstetric coverage Off-site services, e.g. endoscopy, PAU Uncompensated care Incentives to achieve hospital goals Acute pain services Employ CRNA’s, support staff

  7. NEGOTIATIONS: TRADITIONAL The facts What’s fair Defer to Dean Please Try to see it my way

  8. VALUES-BASED LEADERSHIP • Rooted in moral values and respect • Machiavelli outmoded • Encourage self-evaluation • Must believe in values to change - 1996

  9. STEWARDSHIP • Replace leadership with stewardship • Workplace where everyone owns and thinks • Reform organizations • Service and larger community commitments • 1996

  10. BATTLEFIELD LEADERSHIP • Solid teamwork, single-minded pursuit of goals, commitment to excellence • Focused team building • Who’s your enemy? Ally? -2003

  11. COMPETITIVE ADVANTAGE • Warrior ways for today’s business environment • New competitors and difficult challenges are constant threats • Times demand activist, information-intensive, predatory CEO’s - 2004

  12. NEGOTIATING HELP • Multiple types and strategies of negotiations • Know goals and BATNA • Know your hot button • Buy time to think • Don’t argue – step to side • Don’t reject – reframe • Let them know consequences -Wooten/Lockhart, 2002 Pract Manag Syllabus

  13. HOSPITAL STIPEND NEGOTIATIONS • Explain the challenges and market • Can hospital do more to improve the situation? • How much assistance? • Comply with antikickback/Stark II – allow FMV compensation arrangements • Pay for salaries, coverage, or services • May face consultants and RFP - J Semo, Pract Manag Syllabus 2004

  14. NEGOTIATING • Game of life • Detach yourself so you care, but not that much • Never take no for a final answer • Don’t underestimate your options or capacity to make things happen • Style supersedes substance -2003

  15. SUPPORT Remember other sources: Medical school, foundation, industry, alumni Expense decrease often as good as revenue increase, and easier to negotiate ASA Practice Management Conference, Anesthesia Administrators Assembly, consultants for information and help

  16. Money is better than poverty, if only for financial reasons.Woody Allen

  17. You can get much further with a kind word and a gunthan you can with a kind word alone.Al Capone

  18. Whoever said money can’t buy happinessdidn’t know where to shopGertrude Stein

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