Guest guest Posted July 30, 2012 Report Share Posted July 30, 2012 If they are willing to foot the bill, let them! Just have an attorney read the fine print in any contracts. You want to make sure that it's clear what your expectations are of the hospital. We moved here under the help of our hospital. We had a guaranteed salary, and the brunt of it is that we shouldn't have been taking that guaranteed salary because we ended up owing the hospital a bunch of $$ and are still paying it off - with 5 more payments to go. I would NOT take a salary guarantee from the get-go. Tell them how many patients you expect to see each day maximum, and stick to it! It can work; it just takes time. The benefit will be that you will get the reimbursement from a larger group, right? So reimbursement would be better than if you were solo on your own. Interesting concept, and it could work......as long as you are careful! Good luck, Pratt OK, so if any of you remember any of my previous posts, I have seen the light, want to be IMP. I have a sticky contract holding me hostage due to student loan obligation. I can terminate with six months notice but I have too much debt to foot the bill currently to make the leap (on the hook for $125K give or take in addition to what my start up would be). I have approached management and have expressed my concerns repeatedly with biweekly meetings for going on 7 or 8 months now. I finally said I've had it and I plan on leaving (gave notice without a date, no formal written notice yet as I wanted to see how they would handle my student loans, which they still haven't answered me on). The CEO says to me that I haven't told him what my issues are and given him an opportunity to fix it (HA! Were you not listening the last 8 months?!?) I proceeded to provide him with 15+ articles (much of them written by you fine folks) as obviously what I have said verbally hasn't registered detailing exactly what I want. I have had it repeatedly told to me in varying ways that I will not survive without them, I don't know what I would be getting into, and I haven't considered the ramifications therefore, I should just stay put. (Despite the fact that I have been extensively reading this listserve, joined IMPcenter.org and have listed to the calls, read the articles, consulted with some of you personally by email, have consulted a lawyer, and accountant, and a business advisor and have met personally with the IMP closest to me geographically--and I am coming to camp ). I might be young and inexperienced, but I am not naive or stupid--I know it will be hard but at least I would be off the hamster wheel and be happy (right? lol) and feel like I have purpose again. Here's the thing--they want the opportunity to try to make an IMP practice work within our employed group. I would be separated out (or so I would demand) but still under the hospital as a separate clinic. Is anyone out there doing this currently? Does anyone think it can work? I obviously have my reservations. I kind of feel like they are humoring me so they can later try to say " I told you so " . What should I look out for? Thoughts? Thanks!Crystal in TN -- Pratt Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2012 Report Share Posted July 30, 2012 My hospital (Eisenhower Medical Center in Rancho Mirage) started a subsidized pseudo-imp practice about 2 years ago to try and recruit primary care docs into the area and at least for the time being the practice is holding together - the docs that work for the hospital only see 10-12 patients per day and the hospital is able to bill more because of "facility charges" and such. I am not sure of physician salaries but I think they are quite competitive. They also have a "boutique" style option where they charge an annual fee for additional personal service. However, it remains to be seen how long this situation will last. I think the contracts were written for 2 year terms so many doctors are in the process of renegotiating as we speak. There have already been a number of doctors that have left the hospital so it is not a perfect system. I have not been tempted to join because I am doing great in my independent IMP practice. Also, my hospital does not have a good track record in terms of valuing physicians or making a commitment to physician's professional development. They also have a history of dropping support for pet programs all of a sudden once the original idea has lost luster or they move on to the "next big thing" (or the donors who are subsidizing the program cut back on their giving). I hope to make it to IMP camp this year if possible - I have been very busy with the practice and I also have been giving a lot of lectures and traveling around a bunch lately. Good luck! Just keep in mind that in the current medical marketplace, hospitals have a very different agenda than primary care physicians (almost 180-degree opposite goals in many cases). ER and specialty coverage, keeping beds filled (but only for as long as utilization review deems appropriate!), care of uninsured and medically-indigent patients, admitting for surgical specialists (even when not appropriate), complying with regulations and JCAHO requirements, and keeping VIP or politically-connected patients happy - these are the primary goals of hospital administrators. Very often I feel all the hospital really wants is my medical license and malpractice liability coverage so they can fill holes in their medical services or administrative programs - they don't necessarily value or develop any loyalty to individual physicians. , MD Palm Desert, California OK, so if any of you remember any of my previous posts, I have seen the light, want to be IMP. I have a sticky contract holding me hostage due to student loan obligation. I can terminate with six months notice but I have too much debt to foot the bill currently to make the leap (on the hook for $125K give or take in addition to what my start up would be). I have approached management and have expressed my concerns repeatedly with biweekly meetings for going on 7 or 8 months now. I finally said I've had it and I plan on leaving (gave notice without a date, no formal written notice yet as I wanted to see how they would handle my student loans, which they still haven't answered me on). The CEO says to me that I haven't told him what my issues are and given him an opportunity to fix it (HA! Were you not listening the last 8 months?!?) I proceeded to provide him with 15+ articles (much of them written by you fine folks) as obviously what I have said verbally hasn't registered detailing exactly what I want. I have had it repeatedly told to me in varying ways that I will not survive without them, I don't know what I would be getting into, and I haven't considered the ramifications therefore, I should just stay put. (Despite the fact that I have been extensively reading this listserve, joined IMPcenter.org and have listed to the calls, read the articles, consulted with some of you personally by email, have consulted a lawyer, and accountant, and a business advisor and have met personally with the IMP closest to me geographically--and I am coming to camp ). I might be young and inexperienced, but I am not naive or stupid--I know it will be hard but at least I would be off the hamster wheel and be happy (right? lol) and feel like I have purpose again.Here's the thing--they want the opportunity to try to make an IMP practice work within our employed group. I would be separated out (or so I would demand) but still under the hospital as a separate clinic. Is anyone out there doing this currently? Does anyone think it can work? I obviously have my reservations. I kind of feel like they are humoring me so they can later try to say "I told you so". What should I look out for? Thoughts?Thanks!Crystal in TN -- Pratt Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2012 Report Share Posted July 30, 2012 The hallmarks of " IMP " are practice redesign with low overhead and superb access so as to allow longer more robust visits that can attend to patients needs/patietn centered carehow easily can you negotiate overhead- who owns what percent of paper towels/ nurse/ time / room /space etc? I f you can know that and cover your costs then do you want to be paid just for what you see OR expect a salary?Who pays for your nurse? receptionist? What are the mechanics of how it coud work? Who wil cover for you? What is the advantage to the hospital to do this with you?The folks in Washington State Group Health divested themselves of the hospital piece and made longer vvisits and little consistent teamlets I think and reduced er use /increased continuity and improved various metrics they measured. It is a big conversation for an employe r to have and if you are the only one doing this how can that work? Someone near here was told lots of verbal support to try this- couldnot work it out... The whole culture of the palce has to change, but let us know! My hospital (Eisenhower Medical Center in Rancho Mirage) started a subsidized pseudo-imp practice about 2 years ago to try and recruit primary care docs into the area and at least for the time being the practice is holding together - the docs that work for the hospital only see 10-12 patients per day and the hospital is able to bill more because of " facility charges " and such. I am not sure of physician salaries but I think they are quite competitive. They also have a " boutique " style option where they charge an annual fee for additional personal service. However, it remains to be seen how long this situation will last. I think the contracts were written for 2 year terms so many doctors are in the process of renegotiating as we speak. There have already been a number of doctors that have left the hospital so it is not a perfect system. I have not been tempted to join because I am doing great in my independent IMP practice. Also, my hospital does not have a good track record in terms of valuing physicians or making a commitment to physician's professional development. They also have a history of dropping support for pet programs all of a sudden once the original idea has lost luster or they move on to the " next big thing " (or the donors who are subsidizing the program cut back on their giving). I hope to make it to IMP camp this year if possible - I have been very busy with the practice and I also have been giving a lot of lectures and traveling around a bunch lately. Good luck! Just keep in mind that in the current medical marketplace, hospitals have a very different agenda than primary care physicians (almost 180-degree opposite goals in many cases). ER and specialty coverage, keeping beds filled (but only for as long as utilization review deems appropriate!), care of uninsured and medically-indigent patients, admitting for surgical specialists (even when not appropriate), complying with regulations and JCAHO requirements, and keeping VIP or politically-connected patients happy - these are the primary goals of hospital administrators. Very often I feel all the hospital really wants is my medical license and malpractice liability coverage so they can fill holes in their medical services or administrative programs - they don't necessarily value or develop any loyalty to individual physicians. , MD Palm Desert, California OK, so if any of you remember any of my previous posts, I have seen the light, want to be IMP. I have a sticky contract holding me hostage due to student loan obligation. I can terminate with six months notice but I have too much debt to foot the bill currently to make the leap (on the hook for $125K give or take in addition to what my start up would be). I have approached management and have expressed my concerns repeatedly with biweekly meetings for going on 7 or 8 months now. I finally said I've had it and I plan on leaving (gave notice without a date, no formal written notice yet as I wanted to see how they would handle my student loans, which they still haven't answered me on). The CEO says to me that I haven't told him what my issues are and given him an opportunity to fix it (HA! Were you not listening the last 8 months?!?) I proceeded to provide him with 15+ articles (much of them written by you fine folks) as obviously what I have said verbally hasn't registered detailing exactly what I want. I have had it repeatedly told to me in varying ways that I will not survive without them, I don't know what I would be getting into, and I haven't considered the ramifications therefore, I should just stay put. (Despite the fact that I have been extensively reading this listserve, joined IMPcenter.org and have listed to the calls, read the articles, consulted with some of you personally by email, have consulted a lawyer, and accountant, and a business advisor and have met personally with the IMP closest to me geographically--and I am coming to camp ). I might be young and inexperienced, but I am not naive or stupid--I know it will be hard but at least I would be off the hamster wheel and be happy (right? lol) and feel like I have purpose again. Here's the thing--they want the opportunity to try to make an IMP practice work within our employed group. I would be separated out (or so I would demand) but still under the hospital as a separate clinic. Is anyone out there doing this currently? Does anyone think it can work? I obviously have my reservations. I kind of feel like they are humoring me so they can later try to say " I told you so " . What should I look out for? Thoughts? Thanks!Crystal in TN -- Pratt -- MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2012 Report Share Posted July 30, 2012 Crystal,It all depends on the terms. Are you clear on that at all? What would be different from what you are doing now? What they would want from you in order to give you the loan payback and the salary? (I assume that is what you want at this point or you'd be out of there already.) It certainly wouldn't be starting an IMP from scratch with you having total control, but most don't quite anyway (there are somewhere because of some reason, few really choose where to go completely based on best IMP possibilities). Do your patients think you are an awesome doc? Is there any money in the community that some people would pay a fee (annual, monthly, whatever) to have accessibility and time with this awesome doc? If so, that could be a proposal you present. A membership model within a larger system. But in any case, whatever you work out for the next year or two, make sure that you have the legal option to go on your own (with your patients if you want) after that time. All the best, Sharon Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com The hallmarks of " IMP " are practice redesign with low overhead and superb access so as to allow longer more robust visits that can attend to patients needs/patietn centered carehow easily can you negotiate overhead- who owns what percent of paper towels/ nurse/ time / room /space etc? I f you can know that and cover your costs then do you want to be paid just for what you see OR expect a salary?Who pays for your nurse? receptionist? What are the mechanics of how it coud work? Who wil cover for you? What is the advantage to the hospital to do this with you?The folks in Washington State Group Health divested themselves of the hospital piece and made longer vvisits and little consistent teamlets I think and reduced er use /increased continuity and improved various metrics they measured. It is a big conversation for an employe r to have and if you are the only one doing this how can that work? Someone near here was told lots of verbal support to try this- couldnot work it out... The whole culture of the palce has to change, but let us know! My hospital (Eisenhower Medical Center in Rancho Mirage) started a subsidized pseudo-imp practice about 2 years ago to try and recruit primary care docs into the area and at least for the time being the practice is holding together - the docs that work for the hospital only see 10-12 patients per day and the hospital is able to bill more because of " facility charges " and such. I am not sure of physician salaries but I think they are quite competitive. They also have a " boutique " style option where they charge an annual fee for additional personal service. However, it remains to be seen how long this situation will last. I think the contracts were written for 2 year terms so many doctors are in the process of renegotiating as we speak. There have already been a number of doctors that have left the hospital so it is not a perfect system. I have not been tempted to join because I am doing great in my independent IMP practice. Also, my hospital does not have a good track record in terms of valuing physicians or making a commitment to physician's professional development. They also have a history of dropping support for pet programs all of a sudden once the original idea has lost luster or they move on to the " next big thing " (or the donors who are subsidizing the program cut back on their giving). I hope to make it to IMP camp this year if possible - I have been very busy with the practice and I also have been giving a lot of lectures and traveling around a bunch lately. Good luck! Just keep in mind that in the current medical marketplace, hospitals have a very different agenda than primary care physicians (almost 180-degree opposite goals in many cases). ER and specialty coverage, keeping beds filled (but only for as long as utilization review deems appropriate!), care of uninsured and medically-indigent patients, admitting for surgical specialists (even when not appropriate), complying with regulations and JCAHO requirements, and keeping VIP or politically-connected patients happy - these are the primary goals of hospital administrators. Very often I feel all the hospital really wants is my medical license and malpractice liability coverage so they can fill holes in their medical services or administrative programs - they don't necessarily value or develop any loyalty to individual physicians. , MD Palm Desert, California OK, so if any of you remember any of my previous posts, I have seen the light, want to be IMP. I have a sticky contract holding me hostage due to student loan obligation. I can terminate with six months notice but I have too much debt to foot the bill currently to make the leap (on the hook for $125K give or take in addition to what my start up would be). I have approached management and have expressed my concerns repeatedly with biweekly meetings for going on 7 or 8 months now. I finally said I've had it and I plan on leaving (gave notice without a date, no formal written notice yet as I wanted to see how they would handle my student loans, which they still haven't answered me on). The CEO says to me that I haven't told him what my issues are and given him an opportunity to fix it (HA! Were you not listening the last 8 months?!?) I proceeded to provide him with 15+ articles (much of them written by you fine folks) as obviously what I have said verbally hasn't registered detailing exactly what I want. I have had it repeatedly told to me in varying ways that I will not survive without them, I don't know what I would be getting into, and I haven't considered the ramifications therefore, I should just stay put. (Despite the fact that I have been extensively reading this listserve, joined IMPcenter.org and have listed to the calls, read the articles, consulted with some of you personally by email, have consulted a lawyer, and accountant, and a business advisor and have met personally with the IMP closest to me geographically--and I am coming to camp ). I might be young and inexperienced, but I am not naive or stupid--I know it will be hard but at least I would be off the hamster wheel and be happy (right? lol) and feel like I have purpose again. Here's the thing--they want the opportunity to try to make an IMP practice work within our employed group. I would be separated out (or so I would demand) but still under the hospital as a separate clinic. Is anyone out there doing this currently? Does anyone think it can work? I obviously have my reservations. I kind of feel like they are humoring me so they can later try to say " I told you so " . What should I look out for? Thoughts? Thanks!Crystal in TN -- Pratt -- MD ph fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2012 Report Share Posted July 31, 2012 Crystal, I recently retired at age 54 after working for a hospital system for a long time so I do have some opinions. What you are describing is very difficult and I would be very circumspect as to whether it can succeed. Your best bet may be to negotiate a patient panel that you would take care of, what type of office support you would get and what type of reimbursement they are willing to offer.It might be useful to be proactive and offer them a business Plan ahead of Time.Since I have plenty of time, I would be willing to talk with you personally over the telephone or Skype if you wish. I would also use this type of question as a shout out for those who can to attend IMP camp. > > OK, so if any of you remember any of my previous posts, I have seen the light, want to be IMP. I have a sticky contract holding me hostage due to student loan obligation. I can terminate with six months notice but I have too much debt to foot the bill currently to make the leap (on the hook for $125K give or take in addition to what my start up would be). > > I have approached management and have expressed my concerns repeatedly with biweekly meetings for going on 7 or 8 months now. I finally said I've had it and I plan on leaving (gave notice without a date, no formal written notice yet as I wanted to see how they would handle my student loans, which they still haven't answered me on). The CEO says to me that I haven't told him what my issues are and given him an opportunity to fix it (HA! Were you not listening the last 8 months?!?) I proceeded to provide him with 15+ articles (much of them written by you fine folks) as obviously what I have said verbally hasn't registered detailing exactly what I want. > > I have had it repeatedly told to me in varying ways that I will not survive without them, I don't know what I would be getting into, and I haven't considered the ramifications therefore, I should just stay put. (Despite the fact that I have been extensively reading this listserve, joined IMPcenter.org and have listed to the calls, read the articles, consulted with some of you personally by email, have consulted a lawyer, and accountant, and a business advisor and have met personally with the IMP closest to me geographically--and I am coming to camp ). I might be young and inexperienced, but I am not naive or stupid--I know it will be hard but at least I would be off the hamster wheel and be happy (right? lol) and feel like I have purpose again. > > Here's the thing--they want the opportunity to try to make an IMP practice work within our employed group. I would be separated out (or so I would demand) but still under the hospital as a separate clinic. Is anyone out there doing this currently? Does anyone think it can work? I obviously have my reservations. I kind of feel like they are humoring me so they can later try to say " I told you so " . What should I look out for? Thoughts? > > Thanks! > Crystal in TN > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2012 Report Share Posted July 31, 2012 Hi Crystal, Very tough to make it work. Gordon had someone trying to do it but I don't know the end result. But if Lou is willing to help boy I would jump on that possibility cuz he knows. Good luck. To: Sent: Monday, July 30, 2012 6:10 PM Subject: Re: Hospital owned IMP? Crystal, I recently retired at age 54 after working for a hospital system for a long time so I do have some opinions. What you are describing is very difficult and I would be very circumspect as to whether it can succeed. Your best bet may be to negotiate a patient panel that you would take care of, what type of office support you would get and what type of reimbursement they are willing to offer.It might be useful to be proactive and offer them a business Plan ahead of Time.Since I have plenty of time, I would be willing to talk with you personally over the telephone or Skype if you wish. I would also use this type of question as a shout out for those who can to attend IMP camp. > > OK, so if any of you remember any of my previous posts, I have seen the light, want to be IMP. I have a sticky contract holding me hostage due to student loan obligation. I can terminate with six months notice but I have too much debt to foot the bill currently to make the leap (on the hook for $125K give or take in addition to what my start up would be). > > I have approached management and have expressed my concerns repeatedly with biweekly meetings for going on 7 or 8 months now. I finally said I've had it and I plan on leaving (gave notice without a date, no formal written notice yet as I wanted to see how they would handle my student loans, which they still haven't answered me on). The CEO says to me that I haven't told him what my issues are and given him an opportunity to fix it (HA! Were you not listening the last 8 months?!?) I proceeded to provide him with 15+ articles (much of them written by you fine folks) as obviously what I have said verbally hasn't registered detailing exactly what I want. > > I have had it repeatedly told to me in varying ways that I will not survive without them, I don't know what I would be getting into, and I haven't considered the ramifications therefore, I should just stay put. (Despite the fact that I have been extensively reading this listserve, joined IMPcenter.org and have listed to the calls, read the articles, consulted with some of you personally by email, have consulted a lawyer, and accountant, and a business advisor and have met personally with the IMP closest to me geographically--and I am coming to camp ). I might be young and inexperienced, but I am not naive or stupid--I know it will be hard but at least I would be off the hamster wheel and be happy (right? lol) and feel like I have purpose again. > > Here's the thing--they want the opportunity to try to make an IMP practice work within our employed group. I would be separated out (or so I would demand) but still under the hospital as a separate clinic. Is anyone out there doing this currently? Does anyone think it can work? I obviously have my reservations. I kind of feel like they are humoring me so they can later try to say "I told you so". What should I look out for? Thoughts? > > Thanks! > Crystal in TN > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2012 Report Share Posted July 31, 2012 The hospitals are like car dealers , sales driven organizations. They do not ( I repeat : do not) have ur best interest in their heart.Their organizations are the antithesis of an imp, their core values are not the imp ones.The operational cost they have is tremendous.I would say going to bed with hospital sooner or later you will ended up with ur heart broken .Please make sure that ur tdap status is up to date because for sure ur back will stabbed.Sorry I am not positive about this, my personal experiences made me that way.I had too many : dr Teran do u have a minute? Talks.Adolfo E. Teran,M.D. The hallmarks of "IMP" are practice redesign with low overhead and superb access so as to allow longer more robust visits that can attend to patients needs/patietn centered carehow easily can you negotiate overhead- who owns what percent of paper towels/ nurse/ time / room /space etc? I f you can know that and cover your costs then do you want to be paid just for what you see OR expect a salary?Who pays for your nurse? receptionist? What are the mechanics of how it coud work? Who wil cover for you? What is the advantage to the hospital to do this with you?The folks in Washington State Group Health divested themselves of the hospital piece and made longer vvisits and little consistent teamlets I think and reduced er use /increased continuity and improved various metrics they measured. It is a big conversation for an employe r to have and if you are the only one doing this how can that work? Someone near here was told lots of verbal support to try this- couldnot work it out... The whole culture of the palce has to change, but let us know! My hospital (Eisenhower Medical Center in Rancho Mirage) started a subsidized pseudo-imp practice about 2 years ago to try and recruit primary care docs into the area and at least for the time being the practice is holding together - the docs that work for the hospital only see 10-12 patients per day and the hospital is able to bill more because of "facility charges" and such. I am not sure of physician salaries but I think they are quite competitive. They also have a "boutique" style option where they charge an annual fee for additional personal service. However, it remains to be seen how long this situation will last. I think the contracts were written for 2 year terms so many doctors are in the process of renegotiating as we speak. There have already been a number of doctors that have left the hospital so it is not a perfect system. I have not been tempted to join because I am doing great in my independent IMP practice. Also, my hospital does not have a good track record in terms of valuing physicians or making a commitment to physician's professional development. They also have a history of dropping support for pet programs all of a sudden once the original idea has lost luster or they move on to the "next big thing" (or the donors who are subsidizing the program cut back on their giving). I hope to make it to IMP camp this year if possible - I have been very busy with the practice and I also have been giving a lot of lectures and traveling around a bunch lately. Good luck! Just keep in mind that in the current medical marketplace, hospitals have a very different agenda than primary care physicians (almost 180-degree opposite goals in many cases). ER and specialty coverage, keeping beds filled (but only for as long as utilization review deems appropriate!), care of uninsured and medically-indigent patients, admitting for surgical specialists (even when not appropriate), complying with regulations and JCAHO requirements, and keeping VIP or politically-connected patients happy - these are the primary goals of hospital administrators. Very often I feel all the hospital really wants is my medical license and malpractice liability coverage so they can fill holes in their medical services or administrative programs - they don't necessarily value or develop any loyalty to individual physicians. , MD Palm Desert, California OK, so if any of you remember any of my previous posts, I have seen the light, want to be IMP. I have a sticky contract holding me hostage due to student loan obligation. I can terminate with six months notice but I have too much debt to foot the bill currently to make the leap (on the hook for $125K give or take in addition to what my start up would be). I have approached management and have expressed my concerns repeatedly with biweekly meetings for going on 7 or 8 months now. I finally said I've had it and I plan on leaving (gave notice without a date, no formal written notice yet as I wanted to see how they would handle my student loans, which they still haven't answered me on). The CEO says to me that I haven't told him what my issues are and given him an opportunity to fix it (HA! Were you not listening the last 8 months?!?) I proceeded to provide him with 15+ articles (much of them written by you fine folks) as obviously what I have said verbally hasn't registered detailing exactly what I want. I have had it repeatedly told to me in varying ways that I will not survive without them, I don't know what I would be getting into, and I haven't considered the ramifications therefore, I should just stay put. (Despite the fact that I have been extensively reading this listserve, joined IMPcenter.org and have listed to the calls, read the articles, consulted with some of you personally by email, have consulted a lawyer, and accountant, and a business advisor and have met personally with the IMP closest to me geographically--and I am coming to camp ). I might be young and inexperienced, but I am not naive or stupid--I know it will be hard but at least I would be off the hamster wheel and be happy (right? lol) and feel like I have purpose again. Here's the thing--they want the opportunity to try to make an IMP practice work within our employed group. I would be separated out (or so I would demand) but still under the hospital as a separate clinic. Is anyone out there doing this currently? Does anyone think it can work? I obviously have my reservations. I kind of feel like they are humoring me so they can later try to say "I told you so". What should I look out for? Thoughts? Thanks!Crystal in TN -- Pratt -- MD ph fax = Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2012 Report Share Posted July 31, 2012 hospital ...... IMP IMP ........... hospital not possible... grace (ps thought this was a friday funny) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2012 Report Share Posted July 31, 2012 Having worked for 2 different hospital systems, I couldn't agree more. They are profit driven, period, even the community hospitals, if not more so. CCote To: Sent: Monday, July 30, 2012 10:48:39 PMSubject: Re: Hospital owned IMP? The hospitals are like car dealers , sales driven organizations. They do not ( I repeat : do not) have ur best interest in their heart. Their organizations are the antithesis of an imp, their core values are not the imp ones. The operational cost they have is tremendous. I would say going to bed with hospital sooner or later you will ended up with ur heart broken . Please make sure that ur tdap status is up to date because for sure ur back will stabbed. Sorry I am not positive about this, my personal experiences made me that way. I had too many : dr Teran do u have a minute? Talks.Adolfo E. Teran,M.D. The hallmarks of "IMP" are practice redesign with low overhead and superb access so as to allow longer more robust visits that can attend to patients needs/patietn centered carehow easily can you negotiate overhead- who owns what percent of paper towels/ nurse/ time / room /space etc? I f you can know that and cover your costs then do you want to be paid just for what you see OR expect a salary?Who pays for your nurse? receptionist? What are the mechanics of how it coud work? Who wil cover for you?What is the advantage to the hospital to do this with you?The folks in Washington State Group Health divested themselves of the hospital piece and made longer vvisits and little consistent teamlets I think and reduced er use /increased continuity and improved various metrics they measured. It is a big conversation for an employe r to have and if you are the only one doing this how can that work? Someone near here was told lots of verbal support to try this- couldnot work it out... The whole culture of the palce has to change, but let us know! My hospital (Eisenhower Medical Center in Rancho Mirage) started a subsidized pseudo-imp practice about 2 years ago to try and recruit primary care docs into the area and at least for the time being the practice is holding together - the docs that work for the hospital only see 10-12 patients per day and the hospital is able to bill more because of "facility charges" and such. I am not sure of physician salaries but I think they are quite competitive. They also have a "boutique" style option where they charge an annual fee for additional personal service. However, it remains to be seen how long this situation will last. I think the contracts were written for 2 year terms so many doctors are in the process of renegotiating as we speak. There have already been a number of doctors that have left the hospital so it is not a perfect system. I have not been tempted to join because I am doing great in my independent IMP practice. Also, my hospital does not have a good track record in terms of valuing physicians or making a commitment to physician's professional development. They also have a history of dropping support for pet programs all of a sudden once the original idea has lost luster or they move on to the "next big thing" (or the donors who are subsidizing the program cut back on their giving). I hope to make it to IMP camp this year if possible - I have been very busy with the practice and I also have been giving a lot of lectures and traveling around a bunch lately. Good luck! Just keep in mind that in the current medical marketplace, hospitals have a very different agenda than primary care physicians (almost 180-degree opposite goals in many cases). ER and specialty coverage, keeping beds filled (but only for as long as utilization review deems appropriate!), care of uninsured and medically-indigent patients, admitting for surgical specialists (even when not appropriate), complying with regulations and JCAHO requirements, and keeping VIP or politically-connected patients happy - these are the primary goals of hospital administrators. Very often I feel all the hospital really wants is my medical license and malpractice liability coverage so they can fill holes in their medical services or administrative programs - they don't necessarily value or develop any loyalty to individual physicians. , MD Palm Desert, California OK, so if any of you remember any of my previous posts, I have seen the light, want to be IMP. I have a sticky contract holding me hostage due to student loan obligation. I can terminate with six months notice but I have too much debt to foot the bill currently to make the leap (on the hook for $125K give or take in addition to what my start up would be). I have approached management and have expressed my concerns repeatedly with biweekly meetings for going on 7 or 8 months now. I finally said I've had it and I plan on leaving (gave notice without a date, no formal written notice yet as I wanted to see how they would handle my student loans, which they still haven't answered me on). The CEO says to me that I haven't told him what my issues are and given him an opportunity to fix it (HA! Were you not listening the last 8 months?!?) I proceeded to provide him with 15+ articles (much of them written by you fine folks) as obviously what I have said verbally hasn't registered detailing exactly what I want. I have had it repeatedly told to me in varying ways that I will not survive without them, I don't know what I would be getting into, and I haven't considered the ramifications therefore, I should just stay put. (Despite the fact that I have been extensively reading this listserve, joined IMPcenter.org and have listed to the calls, read the articles, consulted with some of you personally by email, have consulted a lawyer, and accountant, and a business advisor and have met personally with the IMP closest to me geographically--and I am coming to camp ). I might be young and inexperienced, but I am not naive or stupid--I know it will be hard but at least I would be off the hamster wheel and be happy (right? lol) and feel like I have purpose again.Here's the thing--they want the opportunity to try to make an IMP practice work within our employed group. I would be separated out (or so I would demand) but still under the hospital as a separate clinic. Is anyone out there doing this currently? Does anyone think it can work? I obviously have my reservations. I kind of feel like they are humoring me so they can later try to say "I told you so". What should I look out for? Thoughts?Thanks!Crystal in TN -- Pratt -- MD ph fax = Quote Link to comment Share on other sites More sharing options...
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