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Case in Point: A health system CEO faced the decision to either keep a service as provider-based (with higher reimbursement, because of facility fees) or make it office-based (with no facility fees, lower pricing, and less administrative burden). The physicians in this specialty were adamant that the service should become office-based because of patient dissatisfaction with higher copays. The executives, on the other hand, preferred a hospital-based model because a conversion to office-based would entail a loss of millions of dollars for an already struggling health system. Egos clashed and the executives and physicians reached an impasse. The CEO convened four meetings comprising the physicians and relevant health system executives. She asked the executives and physicians to not express a preformed decision. Instead, the goal of the first meeting was to collectively understand and agree to the facts; the second was to present any new information requested in the first meeting; the third was to share the different perspectives on the issue; and the fourth was to make a collaborative decision. Barriers gradually fell as the executives and physicians learned more about the issue from each other's perspective and the physicians participated in the decision-making process. The consensus? Make the service office-based with a commitment by the physicians to mitigate losses by increasing physician productivity and working with executives to reduce staffing expenses.
