By Chuck Falci
A wise man once said, “change is the only constant.” Nowhere is this more evident than the world of healthcare, especially when considering the trend of group consolidations, the ever-present reimbursement challenges from payors, and the CMS quality initiatives riding the crest of the most recent wave. These external changes often make groups reactive, and with no ability to predict or prepare for them. But, there is a more predictable and significant change occurring within physician groups over the next five years. This change will challenge the status quo. It will prompt a cultural change in radiology group practices. And, there is no avoiding it.
Does anyone Like Change?
With change, the future becomes less certain. People are forced to realize that their sense of control was mostly an illusion. Well-known author Gustavo Razzetti best described it when he said, “we fear the unknown because we can’t anticipate the outcome.” Often people prefer predictability because, at a minimum, change makes them uncomfortable. When things change, it’s hard to predict what will happen next…which means leadership must rise to the challenge. Brent Gleeson, a Navy SEAL and bestselling author, believes that “it is up to leadership to drive the change,” especially when dealing with culture change. If the external factors of group consolidations, payor negotiations, and CMS regulations seem challenging to a group’s leadership team, then it will truly be tested – and must step up – when the waves of culture change ripple through the practice.
A Generational Shift
The aforementioned “culture change” refers to a generational shift that began a few years ago. Many of today’s practices are comprised of three different generations working side by side and possessing different ideas, approaches, and work ethics: 1) Baby boomers, 2) Generation Xers, and 3) Millennials.
So, what does this shift mean for radiology practices? It likely means that different ideas about issues at the core of the practice, such as scheduling, work ethic, communication, and decision making will change. Because Millennials have motivators, priorities, and goals that are different from previous generations, the way the practice currently thinks and operates will shift, resulting in a culture change that will transform the radiology groups of tomorrow.
Leadership is the Answer
Answering the question behind the uncertainty is leadership, which is essential to navigating the waters of change. Practice leaders who understand the values, motivators and ideas that are ingrained among the different generations can create a cohesive group of highly effective radiologists. It starts with understanding why each generation thinks and behaves the way they do, based on historical and societal differences. Steven Covey summed up this ideal nicely in “The Seven Habits of Highly Effective People” when he said, “seek first to understand, then to be understood.”
Understanding what makes each generation “tick” is a study in and of itself, and once a group’s radiologists begin to understand one another, they can more effectively hone in on each other’s unique and individual talents. For instance, Baby Boomers and Gen X’ers may discover that Millennials are adept in all forms of communication, in addition to their familiarity with technology, or that they may need and desire more coaching and feedback about from Baby Boomers who possess a vast wealth of medical experience. Millennials, on the other hand, may find ways to contribute to the practice that haven’t been discovered previously. These differences can be leveraged to strengthen the group instead of fracture it.
Governance Guides Change
If leadership is needed to navigate change, then governance is the compass used to guide it. By the simplest definition governance is the collection of corporate documents that was established to preserve the life of the entity while also protecting the rights of its owners, including the “Shareholders Agreement” and the “Company By-Laws.” These are the foundational documents that dictate how the practice will be run.
Many groups may be unfamiliar with these documents, only unearthing and cracking open the dusty pages when there is a disagreement amongst the shareholders or dissension in the ranks. Like a fire extinguisher, these documents are to be used “in case of emergency – break glass!” Often, these documents are unchanged from the time of the organization’s founding.
A Good Foundation
Practices cannot overestimate the value of having current, relevant and effective corporate documents as the foundation of the group and its culture. Remember, over the next five years the Baby Boomers will all but vanish from the workforce, and with them goes the “corporate memory” of what transpired in the practice when the original corporate documents were written. Before a tenet is dismissed as outdated, it’s a good idea to understand why it was included in the first place. Other compelling reasons to review and revise the corporate documents include:
If practices consider the possibility that the documents could be more than 25-years old, then the need to review them is understood.
Another strong argument for taking the time to review and update by-laws in particular, is to see if voting rules need to be amended. The group’s opinion on which issues require a simple majority vote versus a super majority vote may need to be revisited. Consider the following decisions that will be dictated by the contents of the documents:
Leadership should also consider whether on-line voting is valid or if a meeting is required, and whether each shareholder can designate a proxy who may vote on their behalf in their absence. Just to name a few.
The process of reviewing corporate documents is both tedious and time consuming. Practice managers and administrators are ideally suited to go through the pages and separate the key elements from the legal boilerplate, placing key elements and issues on the agenda, to be discussed and debated over the course of several meetings. Having full group participation and consensus is also essential to achieving the best outcome. Often too, a reference guide that details all the issues to be decided and the vote required to approve a course of action can be very helpful for moving things along.
Critical to this process and worth the investment, is retaining an attorney who is well versed in medical practices and their Governance. A sound legal team can counsel a practice about what is advisable, what is enforceable, and what is to be avoided. In some cases, practice managers can serve as liaison between the attorney and the group to control costs. In other instances, the group may want to hear directly from the attorney on matters of more importance. Whatever the case, groups should keep in mind that there is no one more adept than the author if the need to legally enforce the tenets of a document should come about. Finally, new physicians should be given access to the documents so they can better understand how things are done, and ways that the documents could be improved upon in years to come.
Again, these changes can only begin with current leaders, who have the power to transform the radiology groups of tomorrow, today.
Chuck Falci is a senior practice manager with Zotec Partners, the leader in radiology revenue cycle and practice management nationwide.
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