The Politics of Greed

It has been said that all we need to focus on, in the daily battle for market share in the rough-and-tumble world of outpatient imaging, is a practice’s unique value proposition. Indeed, I am perhaps the most vocal proponent of increasing the level of professionalism of today’s sales/marketing staff in the outpatient imaging center, equipping them with branding principles that effectively separate the center or practice from its competition, differentiating its offerings from those of the vast landscape of competitors offering similar services, and maintaining a positive attitude about the practice’s value. What is difficult to control, however (and extremely difficult to train salespeople to penetrate), is the political referral that clearly falls within the category of an expected quid pro quo: I will send you my scans if you give me something in return. Although only a minority engage in such practices, the outpatient imaging climate is affected—as are other businesses—by the attraction of risky and questionable financial incentives that permeate most, if not all, markets across the country. Some of these deals are in very gray areas, while some are blatantly illegal. Unfortunately, our profession is polluted, just as others are, by the dark attraction of greed, and stamping it out requires perseverance and deft maneuvering. How, then, does one compete with greed? How does one compete with other providers who are willing to buy their referrals? The bottom line is that we work within a profession that is incredibly lucrative. The payors know it. The regulators know it. The referring physicians know it, too. Frankly, a lot of the referrers feel that the wealth should be spread around a bit, and they want their piece of the steady flow of dollars generated by the high-tech scanning business. This attraction has created a subculture among the referring-physician community that wants, expects, and has become clear about its demand for some kind of kickback in exchange for valuable referrals. Worse, it seems that, in every market, there are medical imaging practices more than willing to accommodate such requests. Both sides in this mess are driven by the payoff, seem not to be overly concerned about the prospect of getting caught (and going to jail), and are willing to roll the dice in a game of hide and seek with the authorities (who, although overwhelmed and understaffed, are nonetheless out to eliminate fraud and abuse in the health care system). The only thing that I can figure out is that—like those who are willing to gamble on staying under the radar of the IRS by cheating on their tax returns—these referrers and providers doing dirty deals are leading a very risky existence. It sounds distasteful, and it is. I am a champion of the fact that we operate businesses, and that practices should adhere to the same basic formulas by which other businesses are governed. Having said this, it is important to draw a significant distinction between the business of health care and the myriad other businesses whose sole function is to maximize the wealth of the organization. The good news is that these types of questionable practices are clearly activities of the minority and are anomalies in an otherwise clean and fair exchange of referrals and provision of services. Theoretically, we should remind ourselves, our staff, and our customers that our enterprise is somehow more important than the average business, and certainly more important than one in which deals are the way to build volume. I believe that we operate within an incredibly noble profession, and that we are challenged, daily, to sustain the legacy that we have been handed by those who built the profession to this point. Nevertheless, money is a constant companion in our quest for diagnostic perfection and our mission to save lives through accurate diagnoses and disease management. We cannot deny that medical imaging is an attractive business, and that it appears more so to those who do not have a complete understanding of the intricacies and nuances of running a busy practice or imaging center. Back to the fundamental question: How do you compete with this greed? You don’t. Greed is as old as civilization itself, and money—as a manifestation of this one of the seven deadly sins—has been changing behavior and sinking people for centuries. What ethical and honest businesses need to do is rise above the temptation, knowing that those operating sleazy businesses are really in the minority and that they stand a very good chance of being caught and punished; they are not likely to be happy with themselves and their lives, and are not respected members of the medical community. You need to be able to look at yourself in the mirror each day and know that you are helping people, running a clean and effective operation, and inspiring your staff and teammates to achieve success through your leadership. Your ethics, values, and character will win in the long term. This is good business as well. Never apologize for your success or for making a good living at your chosen craft. You have earned it, and our society is based on the hard work and commitment of entrepreneurs in all kinds of professions, including medical imaging. Don’t be distracted by those who seem to be getting away with illegal behavior. You really would not want to trade places with them, so leave them to their own devices. The journey is what is important, not the destination. Make your journey satisfying by operating according to the values that a better vision of society has taught us. When your children ask you how it is that you have achieved your success, be proud of the fact that you did it the hard way—one hard-earned referral at a time