ACC: Top 10 practice integration deal breakers
New Orleans—Presenters emphasized the importance of governance in practice integration negotiations and offered tips for determining when to walk away from the conference table, during the Managing Your Practice in a Transforming Health System: Part 1 session, held Sunday at the annual meeting of the American College of Cardiology.

C. Mike Valentine, MD, of Centra, a Lynchburg, Va., practice that integrated five years ago, focused on the importance of governance. He admitted compensation often takes center stages in negotiations. However, “Governance will affect you every day.” He recommended physicians spend twice as long on governance as on compensation during negotiation as governance is a primary determinant of satisfaction.

Other key issues to consider in the negotiation process include who’s in control, short-term gain vs. long term vision and hospital vs. office culture.

Expect less control
Valentine cautioned the audience, “In an integrated system there must be some loss of control.” An integrated system incorporates a heart center board comprised of hospital executives and physicians. The board is responsible for the larger strategic plan; it sets budgets, evaluates service line success and handles outreach and manpower.

Below the board is the physician executive committee, which handles day-to-day matters such as compensation, call schedules, discipline, local operations and recruiting.

Both the board and committee need bylaws, regular office meetings, leadership retreats, strategic planning and timelines, and transparency and trust, recommended Valentine.

In fact, ignoring process and planning could set the stage for future problems. Another cause for concern, said Valentine, is an upcoming leadership gap, which is projected based on surveys of younger physicians. He recommended succession planning, leadership training, layering physician leaders and additional compensation for physicians who take on leadership roles.

On the flip side, practices also need to develop slowdown plans as physicians over the age of 55 approach retirement. Such plans can help streamline the transition and leverage the experience of senior physicians.

Valentine suggested that practices utilize a consultant to develop the integrated system.

How to gauge your deal and when to walk
Cathleen Biga, of Cardiac Management in Woodridge, Ill., testified to the challenges of negotiations and practice integration. “Negotiations are not for the faint of heart. They are very difficult. Go in with an organized approach and a small team,” she advised.

Biga also shared a few core rules for successful negotiations. She reminded the audience:
  • Silence is powerful;
  • Don’t make rash decisions; and
  • Do NOT renegotiate.

Finally, Biga concluded the session with the top 10 indicators of a bad deal:
  1. The hospital CEO is about to be fired.
  2. The hospital and practice share none of the same values or principles.
  3. Unilateral and hospital-centric decision-making.
  4. Little opportunity for shared governance.
  5. No common ground in negotiations, and negotiations are always re-starting.
  6. Always crossing over to the next line in the sand. Know and stick to your five lines in the sand.
  7. No one is willing to resume talks.
  8. It’s all about money and not about vision.
  9. Dysfunctional problem solving prevails.
  10. A lack of trust.