Proactive steps boost your position in negotiations with hospitals

Like many groups, we feel like we are always in the midst of negotiations with our hospital. During each renegotiation, it seems that the hospital starts by describing our deficiencies. Often, the barrage would start before the negotiations commenced. Missed cases were brought up, as were issues related to personnel conflicts. Irregularities in report turnaround might be mentioned, and unhappy clinicians seemed to suddenly surface.

In the past we were fairly defensive and spent much time in the discussions trying to parry these assaults. As a result, we were always negotiating from a position of weakness. While there may well be areas where we can improve, in many cases, we were responding to anecdotes that were neither representative of the body of our work nor indicative of our contribution to the hospital.

So how did we turn this equation to work in our favor? There are several aspects to consider. Here are some lessons we’ve learned:

• First, try to make the relationship more equal. Ask the hospital to take responsibility for the problems-or parts of the problems-that it owns. For example, when turnaround time (TAT) comes up, encourage the hospital to look at the entire picture. They will likely find deficiencies in their own side as well as yours. For service issues, ask them to help facilitate ancillary staff communication and availability. Always remember that there are two sides to every story. Look into all issues the hospital presents to you. Instead of seeking to place blame, focus on finding out what happened, when and how. Then work to solve both sides. Do this constructively, not confrontationally.

• Second, be your own advocate. You do this in several ways. Are there clinicians out there who love your work? Ask them to put in a good word for you. Better yet, have a preprinted letter they can sign to indicate their satisfaction with your work. Between negotiations, work at tracking and improving measurable outcomes. Hospital administrators love metrics, so you can use them to your advantage. Work to show improvement in TAT, for example, and then be sure to have those data on hand when you meet with the hospital.

• Third, always be on the lookout for things you can do unilaterally but that will benefit both parties. Keep those in your back pocket to bring up at the right time during talks. A recent example for us was setting up to do online reads from a small, outlying hospital our main hospital had recently acquired. We paid for the IT cost to create the online linkup. During negotiations we pointed out that we made this effort and others like it on behalf of the hospital, even though doing so was not in our best interest financially. Our goal, we explained, was to nurture a healthy relationship with the hospital.

• Fourth, work to improve your quality and emphasize your successes. The prime directive in our group is to go above and beyond standard methods for improving quality. Make sure you have a quantifiable quality assurance (QA) program (all hospital-based radiology departments need this for accreditation). Make the data available and embrace efforts to improve. Conduct regular QA meetings of the radiologists. Develop a brief summary of your various QA efforts and share it with the hospital. You may also create a modality-based education program for the techs that meets regularly to help improve the quality of the hospital techs’ work thru education.

• Finally, whenever possible take opportunities to get face-time with hospital administrators, both in professional situations and other events, such as hospital-associated fundraisers or recreational activities. Negotiations might not always be friendly, but it is always better to be friendly with the person with whom you are negotiating.


Dr. Woodcock is medical director for MRI at St. Joseph’s Hospital in Atlanta. He is also a member of the executive board of Atlanta Radiology Consultants and is the practice’s executive officer for finance. He may be reached at rjwatlrad@gmail.com.