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| Dear Friend,
You can't have one unless I control it.
There’s little question that most, if not all, medical groups should be led by practicing physicians. The problem is that too many groups create policies, either formal or informal, that actually dissuade and hinder the ability of physician leaders to lead.
Specifically, I’m talking about the fact that groups tend to put far too much emphasis on the need of physician leaders to practice medicine as opposed to spending the time required to actually lead the group.
For example, let’s imagine a group of 12 physicians generating, say, $8 million a year in gross collections. Let’s also assume that they generate that equally; in other words, they each generate $666,666.
If the group leader cut back his or her production by 20% in order to devote time to leadership, most groups would focus on the $133,333 “lost.” However, there’s a very good chance that that work would be spread over the other members of the group. Far more importantly, freeing up the ability of the leader to actually devote time to leading might make the difference in preserving the group’s relationship with the facility that if lost, would destroy the group and its $8 million a year of cash flow.
Group leaders should be given the ability to lead and they should be compensated for it. That effort is in many cases far more valuable to the group’s overall success than any direct patient care income that would otherwise result.
Don’t be penny wise and thousands-of-dollars stupid.
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| | | 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:
You’ve probably heard the expression, “justice delayed is justice denied.”
In the context of healthcare, it just might be "payment delayed is payment denied.”
A recent story in Kaiser Health News reported on a study into payment by some of the major carriers. And what do you know, to no one’s surprise, they found that some of the major carriers (particularly Anthem and UnitedHealthcare) were apparently engaged in a massive slowdown of payments. In fact, for some of these carriers, this caused more than 50% of claims to slip into the “denial” loop.
Carriers are claiming that they’ve lost information. Or that they can’t process the claims. Or that they need to speak directly with the physician.
And when the recipients (hospitals and physicians) complain, “where’s the money?” or “how come you only paid me X when I was owed X+Y?”, the carriers are reminding doctors they have the right to appeal. It's as if the cost of appealing and the time value of the money is free – which it is not. The right to appeal can be meaningless.
We can complain and scream and yell at state insurance commissioners (which is probably a good thing to do), however the takeaway here is to make sure you’re staying on top of your collections. I know it’s anecdotal, but I'm hearing from clients that they’re having more and more trouble collecting.
Stay on top of collections if you’re doing them yourself. Ensure you have enough staff and that they’re not just engaged in the “easy work” but also the follow-up.
If you’re using an outside billing service, the same advice applies. Stay on top of them. The squeaky wheel does get the grease.
Don’t just wait until you find out you can’t meet payroll and then blame it on Aetna. |
| | 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 - Cleveland Clinic Unit Pays $21.25 Million to Resolve Kickback Case - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
United States Department of Justice recently announced that Akron General Health System, which was acquired by the Cleveland Clinic Foundation at the end of 2015, will pay $21.25 million to resolve violations of the federal Anti-Kickback Statute brought to issue pursuant to a False Claims Act lawsuit.
The payment, by now owner Cleveland Clinic, resolves allegations that between August 2010 and March 2016, the hospital system paid compensation substantially in excess of fair market value to physicians in order to secure patient referrals.
As always in these types of cases, which are civil actions, the settlement does not involve any admission that the allegations were true.
Here are two takeaways for you:
- If a hospital violates the law by overpaying physicians for their services, the physicians were overpaid as a result of accepting the extra compensation. Depending on the regulatory scheme, that leaves open the question as to whether the physicians receiving the payments also violated the law. For example, anti-kickback law turns on intent, which can be inferred, but prohibitions against self-referral, such as the federal Stark Law, are strict liability statutes – no intent required.
- As indicated, the Cleveland Clinic settlement on behalf of its Akron General Health System resulted from a whistleblower action under the federal False Claims Act. Interestingly, the whistleblower was Akron General Health System’s former Director of Internal Audit, Beverly Brouse. She raised issues concerning the arrangements that the system had with certain physician groups and was subsequently terminated. Whether or not those concerns were correct or not and whether or not her termination related to her concerns have now been settled.
As I’ve written before, physicians and their medical groups need to be extremely careful not to create whistleblowers within your ranks. Take compliance concerns to heart and investigate them as part of your internal compliance program. And whatever you do, don’t retaliate against someone for raising compliance concerns; it only adds fuel to the fire and you’re the one who’s likely to get burned. |
| | | Listen to the podcast here, or just keep reading for the transcript.
If you’re a longtime reader, you know that my view is that almost all of the instances of a medical group’s organization and operation are related . . . that either they are managed in order to achieve success or they are treated silo-like (or even ignored), resulting in stagnation and failure.
In an educational setting (not a client engagement), I was asked whether a physician member of a group, a partner, could opt out of a new managed care agreement being entered into by the group. I was told that the carrier didn’t care if he did.
I found the question to be rather funny. The real question is not one of managed care contracting; after all the affected carrier consented. Rather, the real question is whether the group cares that it is slowly ceasing to be a group.
Letting each partner write his or her terms of partnership is not a long-term strategy for success, it’s a short-term strategy for failure.
Maybe your group thinks the partner’s question was funny, too. But ask yourself how many other “special deals” or “it’s just this once” you’ve let your partners cut, or, worse yet, the group has cut for them. |
| | | 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
What tailored content would you most like to see during this
time? How can we focus on solutions to your most pressing strategic concerns?
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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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