Saying 'No' to Your Surgeons
Here are three scenarios where you may have to do what many managers dread: say 'no' to the very surgeons who bring cases to your facility.

Capital equipment
When doctors ask for equipment, I ask them to present supporting information that would help our board when considering the request. Specifically, I need data on the number of cases being sent elsewhere because our facility doesn't have the equipment. I need to know the payer mix for the cases, so we can determine if our reimbursements will make the equipment affordable. I ask for actual historical data, not opinions. Lastly, I ask for contact names of various vendors who could bring in the equipment on a trial basis.

Physicians often tend to think in evidence-based terms, so you are speaking their language by asking for this sort of data. Sometimes they will defer the requests themselves if it's apparent that the numbers don't add up.

At our facility, the physician, if an owner, may present the request directly to the board. If the physician is not an owner, the administrator presents the information. I find it helpful, however, to ask the physician to help present the request in person, even if I coordinate the effort. Physicians tend to relate well to other physicians regarding budgetary considerations, and they may react better to a decision not to fund equipment if another physician is involved.

Contact Ann Geier at 'ageier@mindspring.com').