Subject: February 2020 Issue of Wisdom. Applied. Newsletter

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February 29, 2020
Physician Practice Consolidator Gets Owned

It’s not quite rest in peace for physician practice consolidator Hygea Holdings Corp. It’s more like rest in pieces.

Back in the salad days of June 2016, Hygea, described itself as:

“ . . . a diversified healthcare holding company led by a team of nationally recognized industry leaders with backgrounds in insurance, finance, medicine, law and technology. The company owns physician practices, ancillary medical services, such as pharmacy, physical therapy, and diagnostics, as well as a 2,500-doctor independent physician association (IPA). Hygea prides itself as ‘the physician’s choice’ in group healthcare, as evidenced by the number of acquired physicians who then choose to invest in the firm.”

But today, well, on February 19, 2020, to be exact, it’s pretty clear that the meal’s now over.

That’s the date that Hygea put itself and more than 30 affiliates into bankruptcy.

Bleeding out at the rate of around $327,000 a week, with assets of less than $10,000,000 and liabilities of, according to press reports, approximately $200,000,000, its Chapter 11 filing indicates that the company’s plan is to turn over all of the equity to its major secured lender.

Yes, in bankruptcy, other investors, such as the “number of acquired physicians who then [chose] to invest in the firm” can get wiped out. If all goes according to plan, the secured lender will simply take the “keys” to Hygea, much like some “We Finance Anyone!” auto lender repossesses a 2016 Hyundai.

Sure, hindsight is always 20/20 but sometimes the “smartest people in the room” can’t manage their way out of a paper bag. For example, here are some of the stupid business mistakes revealed in the declaration of Hygea’s President and CEO:

They purchased physician practices that had minimal net profit.
They failed to integrate underperforming practices into their operation so as to make them profitable.
As a result, they became burdened with supporting a number of losing operations, that even with performance improvements will never be profitable.

The Lessons For You

The takeaways in the Hygea debacle lie on two sides of the same coin.

If you’re a buyer of medical practices, or of any other business, don’t overpay. “Everyone else” may be paying 20 billion times EBITDA, but you don’t need to be that stupid. Buying lots of businesses with no profit just creates a big business with no profit that can't pay it's debts and that goes into bankruptcy.

If you’re the seller, understand that your practice or business probably isn’t worth anywhere close to what you think it is. Pull out cash along the life of your operation and seek ways to profit from multiple transactions so that you’re not dependent on one sale to make a killing.

Sure, someone may come along (the so-called “greater fool”) and actually pay you 20 billion times EBITDA. If that’s the case, take cash or at least as much of it as you can get, even if it’s over time. It might be exciting to fancy yourself a “player” holding a big chunk of stock in a company with plans to go national . . . no, go global . . . no, go galactic, that is, until your shares are wiped out in a debt for equity swap restructure.

Perhaps, in Hygea’s case, the “smartest guys in the room” weren’t so smart.

Or perhaps there was just no room, for error, that is.
Wisdom. Applied. 135 - You Can Hold The Mayo, But Mayo Can’t Hold Onto Hospital

The tides of healthcare ebb and flow like the width of men’s ties and the political affiliation of Michael Bloomberg.
All Things Personal
The waiter delivered great service.

As I got up from the table, I saw him coming my way and, in addition to the large tip I had left, said "thank you."

The response? Yes, it was the increasingly common "no problem." (On the upside, it wasn't its underachiever cousin, "no worries.”)

I'm not going to launch into a rant about polite conversation, but, just to make sure, the proper response was "you’re welcome” or even, under some circumstances, "my pleasure." Those phrases are the colloquial English language equivalent of “thank, you, too.”

Here's my point and how it ties in to your business success.

In your interactions with referral sources and those others who are important to the future of your practice or business, are you expressing gratitude for the relationship?

I'm not talking about "gratitude" in some new age, inner peace sort of way. Rather, are you letting those people know how much you value them? Or, are you signaling that what they’re doing for you is more akin to “no problem”?

If it’s the latter, then don’t be surprised if their thoughts about the relationship decay to match mine of the waiter — he was an ungrateful jerk.

Podcast Compilation Greatest Hits - Strategy Edition 1.0

We've curated our most popular podcasts on strategy into our first compilation album.

Sit back, enjoy, and think about your future.

Listen here.




Come listen to Mark speak in sunny
Las Vegas on June 5, 2020, at The Advanced Institute for Anesthesia Billing and Practice Management 



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We all hear, and most of us say, that the pace of change in healthcare is quickening. That means that the pace of required decision-making is increasing, too. Unless, that is, you want to take the “default” route. That’s the one is which you let someone else make the decisions that impact you; you’re just along for the ride. Of course, playing a bit part in scripting your own future isn’t the smart route to stardom. But despite your own best intentions, perhaps it’s your medical group’s governance structure that’s holding you back. In fact, it’s very likely that the problem is systemic. The Medical Group Governance Matrix introduces a simple four-quadrant diagnostic tool to help you find out. It then shows you how to use that tool to build your better, more profitable future. Get your free copy here.
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1. Download a copy of The Success Prescription. My book, The Success Prescription provides you with a framework for thinking about your success. Download a copy of The Success Prescription here.

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3. Book me to speak to your group or organization. I’ve spoken at dozens of medical group, healthcare organization, university-sponsored, and private events on many topics such as The Impending Death of Hospitals, the strategic use of OIG Advisory Opinions, medical group governance, and succeeding at negotiations. For more information about a custom presentation for you, drop us a line

4. If You’re Not Yet a Client, Engage Me to Represent You. If you’re interested in increasing your profit and managing your risk of loss, email me to connect directly.

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