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| Dear Friend,
Food for thought.
There’s no doubt that society is becoming more communal. “Giving back” has become so prevalent a saying that it’s near cliché. And even McDonald’s is pushing a quote from its uber-successful “founder”, Ray Kroc, that “none of us is as good as all of us”. If you want to know what I think about Kroc’s own belief in such drivel, check out what he did to the actual founders, the McDonald’s brothers; “all of us” didn’t include them.
Guys like Ray and public “servants” who tell us that “it takes a village” want to be the mayor of it. No shock as I’m wise enough to know that these trends hit society every so many decades and that as much as I might rail against it, trying to stop it would be like trying to push back against the ocean’s tide. As Franz Kafka said, “in the struggle between yourself and the world, back the world.”
This certainly explains the push toward hospital-centric healthcare, because hospitals are viewed as communal institutions. But this certainly doesn’t explain why nonphysicians should be running hospitals.
If the philosophical underpinning of Stark and other prohibitions on “self-referral” as well as of the federal anti-kickback statute and its state counterparts is the belief that money is evil and that it is wrong to profit from referrals, then why create exceptions to permit hospitals to profit in this new world of aligned care?
Why should hospitals be run by non-physicians? If a committee at Community Memorial of My Local Town controlling its wholly-owned medical group is going to make a decision on rationing care to me, I want that committee to at least be made up of physicians, not of two physicians and five bean counting MBAs.
It will be decades until society swings back away from “it takes a village” to “it takes a strong individual” and the price we’ll pay in the interim will eventually be rationing, death counseling, and other warm and fuzzy attributes of a so-called communal society. Heck, this makes its opposite, the so-called “greed” of rugged individualists, seem timid in comparison.
But as long as we’re on this communal swing, there remains the opportunity to dress the argument in communal clothes while advocating that those actually trained in delivering medical care should be the ones overseeing it.
Prohibiting for-profit hospitals and even nonprofit hospitals run other than by physician control from participating in Medicare, Medicaid or any other federally managed or financed health care programs wouldn’t be any more discriminatory than prohibiting new physician-owned hospitals from participating in Medicare, as is the case under current law.
After all, the purpose of this suggested new approach would be improving patient care, delivering it in a more effective and efficient manner, all while reducing costs.
Who could argue against that? |
| | | Business Life in the Time of Coronavirus Mini-Series
The coronavirus crisis caused a short term economic crisis for many medical groups. Our mini-series shows you the way out. Plus, many of the concepts discussed are applicable during both good times and bad.
[If you haven't already seen them, follow this link to watch our entire series.] |
| | Watch Tuesday's video here, or just keep reading below for a revised, more polished transcript:
If you’re a physician you probably think that your competition is another doctor in town or maybe a doctor across town, someone who’s employed by the hospital, or working for a hospital-based medical group.
But there are entirely different types of competitors out there.
For example, physicians and other providers housed in pharmacies. CVS has rebranded itself CVS Healthcare, but if you look at the pharmacy industry, you’ll see that there are as many independent pharmacies if you add up all the stores as there are branches of the big pharmacy chains. Those pharmacies and especially those pharmacists there have a much tighter relationship (far tighter) with patients than do any chain store.
If CVS can bring in physician assistants and even physicians to treat “their patients” what do you think is going to go on if independent pharmacies realize that this is an entirely new way for them to expand their business and relationship with their patients, patients that now come from multiple medical practices?
On the other hand, if you’re a pharmacist, especially at an independent pharmacy, there is a significant opportunity here to expand your practice in a way far beyond ever imagined.
So both for physicians who are savvy and making business arrangements with pharmacists, and vice versa, there is a huge amount of opportunity in the midst of what others see as disruption of their businesses and practices.
There’s no question that there’s going to be disruption, the question is are you going to be a disruptor or are you going to be a disruptee.
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| | How to Deploy the Secret Sauce of Opportunistic Strategy
Webinar On Demand
They say that COVID-19 has changed the world, creating the "new normal." Many of your colleagues and many hospital administrators are running scared.
Others, leaders like you, know that crisis means opportunity.
Let me provide you with the strategic tools and insights that you need in order to seize opportunities, whether they’re in the context of your current business relationships, the expansion of your business activities, or the creation of new ventures.
You will learn:
•Defense as a defective default: It’s necessary, but not sufficient.
•Exploiting weakness: Drop the guilt and identify opportunity.
•Flat line negotiation is fatal: Understand its myths and limitations.
•Negotiation reality: Learn to identify and deploy on multiple planes to affect the outcome.
•Maneuver: Harness the power of maneuver, both in overall strategy and in specific negotiation strategy.
Others see a crisis and freeze in fear. Learn how to see the opportunities and obtain the tools to increase your odds of obtaining them.
The price to attend is $479. The cost of not attending is astronomical. |
| | | Wednesday - What Every Physician Needs to Know About a California Anesthesia Group’s Bankruptcy - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
With the tip of the hat to T.S. Eliot, the world for Community Regional Anesthesia Medical Group (CRAMG) ended on June 16, 2021, not with a bang but a whimper.
That’s when the Fresno, California group of approximately 40 physicians and close to 40 CRNAs, filed Chapter 11 bankruptcy after more than 20 years of providing services to Community Medical Centers’ three hospital campuses.
The bankruptcy filing followed the loss of the group’s exclusive contract. Additionally, according to CRAMG, large legal expenses defending a wage and hour suit brought by CRNAs also contributed to the decision to file bankruptcy.
Among other debts, CRAMG’s bankruptcy Petition indicates that $5.1 million is owed by it to Community Medical Centers.
The Business Journal reports that CRAMG “anticipated that it would renew a contract with Community Medical Centers before [Community Medical Centers] allowed the agreement to lapse.”
Anticipated?
But oddly, the same newspaper also reports that Community Medical Centers issued a request for proposal in advance of the expiration of CRAMG’s exclusive contract and that CRAMG did not provide a response.
Whatever the actual facts, the sad story provides some valuable takeaways for every physician, especially those who’re medical group leaders:
- Contractual relationships such as exclusive contracts come to an end, even those that have been renewed time and again over the course of many decades.
- If that’s the only relationship you or your group has, then the reason for your business’s existence will be mooted.
- A contract with a single system to provide services at multiple facilities does not spread your risk. In fact, it might increase your fragility.
- Don’t believe that relationships between medical groups and hospitals are based on love. “What have you done for me lately?” is the pertinent question. Demonstrate that.
- Although the basis of CRAMG’s $5.1 million debt to the hospital system is unclear, other groups have self-inflicted similar wounds, sometimes fatal, by making an error in structuring their hospital contracts: agreeing to a deal in which the hospital loans funds to the group as opposed to paying a coverage stipend or guarantying a unit value. Loans are not stipends.
- Surprise, they have to be paid back! (Or, you have to declare bankruptcy.)
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| | | | | Listen to the podcast here, or just keep reading for the transcript.
In case you weren't listening, UnitedHealth told you where they were going to push cases, and it wasn't to hospitals.
That's the day on which the parent company, UnitedHealth Group, announced that their goal is to ensure that more than 55% of outpatient surgeries and radiology services are delivered at a high-quality, cost-efficient site of care. If you haven't already figured it out, “cost-efficient” is a euphemism for not at a hospital but at an ASC or freestanding imaging center. Feel free to read the full report which is filled with gobbledygook about sustainability and stakeholders and other woke BS designed to get people to lay off the $22.4 billion in profit they made in 2020.
Laugh about it or cry about it, the bottom line is the same: they are cutting costs by moving all cases that can be moved out of the hospital out of the hospital. Where does that leave you? |
| | | Calibrate Your Compass
Read our exclusive RedPaper to guide you through this evolving situation.
The coronavirus crisis caused a short-term economic crisis for many medical groups. Our RedPaper shows you the way out. Plus, many of the concepts discussed are applicable during both good times and bad.
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| | Help Us Help You With Helpful Content
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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.
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| 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 Free.
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| | | | Whenever you're ready, here are 4 ways I can help you and your business:
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.
2. Be a guest on “Wisdom. Applied. Podcast.” Although most of my podcasts involve me addressing an important point for your success, I’m always looking for guests who’d like to be interviewed about their personal and professional achievements and the lessons learned. Email me if you’re interested in participating.
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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