Mogul, mogul, mogul, drop off. It didn’t take long for the widowmaker, a black diamond trail on Snowshoe Mountain, to send me to the emergency room of Pocahontas Memorial Hospital. Snowshoe Mountain in West Virginia has some of the best snow east of the Mississippi and as a first-time snowboarder, I was eager to hit the slopes. Green, blue, black…ambulance…hospital. Not my proudest moment and the start of a lifelong battle with chronic lumbar back pain.
Over the next decade, I did just about everything wrong to heal my body - landing on a railroad tie playing beach volleyball, throwing my body around like a ragdoll playing adult rec league soccer, and finding myself in an unexpected scorpion pose after what I thought was a decent dive in the shallow end at the neighborhood pool. I’m convinced that these life events inspired the popular iPhone game, “Kick the Buddy.”
About 15 years after my snowboarding accident, I decided to do something about my back. At the time, I was a Director of Operations for a large ASC company in Southern California and had access to some of the best neurosurgeons in the United States. An MRI revealed the source of all this back and leg pain were ruptures at L4/L5 and L5/S1.
“Reduce impact sports, lose a little weight, and focus on your core,” the doctor said. “Let’s start with some basics and if that doesn’t work, we’ll get you in therapy as a next step.” I remember my doctor taking a very conservative approach to what I thought was a slam dunk lumbar decompression.
Fast forward to 2018, different neurosurgeon…same conservative approach. “I’m fine to schedule an epidural steroid injection to see if we can relieve the pain, but I’d like to keep you out of the OR for as long as you can make it,” he said. “Surgery should be our last option.”
What gives? Here are two prominent neurosurgeons who are doing everything they can to keep me out of surgery. As someone who has been around surgery for most of my career, this was my first experience as a potential surgical patient. For me, this reinforced the notion that quality providers do everything they can to protect their patients through conservative care pathways.
These two surgeons became more than just partners in a surgery center. I was welcomed into their homes, met their families, played with their dogs, and became good friends. They invited me to meet their partners, practice administrators, and teams. As I built these trusted relationships, I was asked to provide objective business guidance around the group’s growth strategies and critical decisions. Over the years, what I learned about most specialist groups, not just these two, is that conservative care applies to patients only - not so much business.
I became a constant sounding board for business advice: “Should we buy that building?” “What do you think about medical tourism?” “I just hired a new provider. How can I get them contracted?” I can count on one hand the number of times a physician or group asked about an up-front collections policy, surgical scheduling workflows, ways to improve employee retention, or optimizing purchases for the various clinic locations.
While it might not be as sexy as a sponsorship at a major sporting event, getting those luxury Italian pastelli embroidered scrubs, or investing in the latest, greatest patient app, managing the fundamental basics of practice operations is dollar-for-dollar a better investment of time and money that creates sustaining power for specialist groups.
Focus on the core, practice conservative care of your business, and when it’s time to buy that shiny medical office building over fifteen miles away, I’ll be ready for surgery.
Basheer Alismail is the founder of Monument Health Advisors, a small to mid-size specialist group advisory company.
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