In 2017, the ‘Three A’s’ No Longer Lead to Success


When I was a resident in the 1990s, I was told by many staff surgeons that success in my career would be dependent on my mastery of the “three As.” Being polite (and a bit of a suck-up), I would usually feign lack of awareness of this advice (and interest in it) so that the attending’s delicate feelings would not be hurt as he recited this well-worn trope. For anyone lucky enough to have never received this advice, the three As are: ability, availability and affability. The advice goes, “If you, as a surgeon, are competent, make yourself available to referral sources and patients, and get along with those populations well, you will be successful.” Read More

The Real Question in Value-Based Care is ‘Whose value are we talking about?’

Let us say I need to make a trip to Nashville, which is about 400 miles round trip. I can take my car, a vehicle I purchased and maintain, or I can take a flight in which case I outsource all the responsibility and indirect costs to an airline. If I take my car, I simply fill the tank with gas for about $40. If I take the flight, my ticket costs $350. Seems like a no-brainer, right? The flight seems to cost more, but the sophisticated reader will immediately recognize this is an apples-to-oranges comparison.

The Big Data Revolution Has Begun and the Guns Are Aimed at You

“Political power grows out of the barrel of a gun,”– Mao Zedong, 1927

On my first day as a “cow” (or junior) at United States Military Academy at West Point, I learned a lesson that has stayed with me my entire life and contributes to the lens through which I consider all business issues. During my time at West Point, all cadets were required to take SS307, “Introduction to International Relations.” As I was a pre-med math/science guy, I walked into the first day of this class having no idea what we would be learning, much less expecting to learn anything that would become part of my intellectual bedrock. I was dead wrong in the first 15 minutes of that class.

If You Have the Medicare Blues, Read This Before Doing Anything Rash

I remember repeatedly memorizing the Krebs cycle in both college and medical school, and hating it intensely. I did not know much, but I knew I was not interested in any job where knowledge of the Krebs cycle was important, and so I never seriously “learned” it. I would simply “spec and dump” it for the test, which ensured that within 24 hours I could only vaguely remember Krebs had something to do with ATP and acetyl-CoA — and that was always good enough to get me to the next level of training.  Not all cycles are so worthless for a surgeon to understand, though. The revenue cycle is equally as complicated as the Krebs cycle, but is enormously useful to understand when running a practice.

Orthopedic Business Language: The Derivation of Kappa, Part 2

In last month’s blog, we defined the equation: Opportunity = Delivery + Neglect, where “opportunity” is the total daily orthopedic value created in our local markets, “delivery” is the total daily orthopedic value delivered — what we do; take care of patients — in our local markets and “neglect” is the total daily orthopedic value left untreated in our local markets.