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| Dear Friend,
Where is care, exactly?
What sounds like a silly question isn’t. It, and the rapidly changing answer, have tremendous impact on healthcare and on healthcare careers and a lot of people don’t like it.
For all the talk about the patient centricity of healthcare, those invested in its delivery tend to think that the healthcare world centers around them.
We can see example of this in two recent incidents: in nurses’ push back against hospital-at-home programs and in CMS’s finalization of its 2022 hospital outpatient and ASC payment rule.
Hospitals Not Homes!
In a statement released on November 4, 2021, the National Nurses Union attacked hospital-at-home programs in general and Kaiser Permanente's program specifically.
Under Kaiser’s program, which has gained national attention, appropriate patients are released from the hospital for continuing hospital at home care rendered through a combination of telehealth monitoring and staff visits.
Other hospitals in 33 states currently have permission to bill Medicare for these arrangements.
According to the union, “Nurses are horrified by Kaiser’s attempts to redefine what constitutes a hospital and what counts as nursing care. Not only does this program endanger the imminent safety and lives of patients, it completely undermines the central role registered nurses play in the hands-on care that patients need to safely heal and recover.”
Pulling out all the stops and revealing that their efforts will eventually be to no avail, the union claims that hospital-at-home is racist. But at least the union’s honest when it states that the shift in the site of care to home will “dramatically [limit] opportunities for nurses to care for patients in a hospital setting” and that the “industry will accuse registered nurses of opposing this and similar programs because we simply want to ‘keep our jobs . . .’ [t]hat’s exactly right.”
No one is claiming that hospital-at-home will moot the need for hospitals completely. No one is saying that nurses will not play a role in hospital-at-home; just that the number of them will be fewer. Some patients will require centralized care, as in the hospital building. However, the object of a hospital is to care for patients’ wellbeing, not to care for the financial wellbeing of a hospital as a place and the number of people dependent upon it for employment.
The issue is the function, patient care, not the location in which care is delivered.
Surgery in Hospitals Not In ASCs!
Anyone who’s been reading my posts and articles (and, especially my book The Impending Death of Hospitals) knows that I’ve maintained (correctly) for close to a decade that any surgical case that can be performed outside of a hospital will eventually be perform in an ASC. Technology, level of care, level of safety, and level of both cost and charges, are all pushing the future in that direction.
Once again, the issue is the function, patient care, not the location in which care is delivered.
The test of this, as with hospital-at-home, is in the level of pushback.
On November 2, 2021, CMS released its finalized rule covering, among other things, 2022 payment for ASC services.
As you might recall, a year ago, in announcing the 2021 rule in connection with hospital outpatient and ASC services, CMS shocked the hospital world by announcing that its list of procedures that would be reimbursed only if they were performed on a hospital inpatient basis was going to be phased out over the ensuing few years. At the time, over 250 procedures (by CPT code) were immediately added to the list that would be paid for if performed in a surgery center.
However, as a result of hospital industry pushback, the Biden administration CMS has made it more expensive for patients and more profitable for hospitals by reversing the shift of nearly all of those approximately 250 procedures and by reversing its prior decision to phase out the inpatient only list.
Some takeaways:
1. You can see the pressure building in favor of hospital services outside of the hospital when it drives those completely invested in “hospital-at-hospital” nuts.
2. As Franz Kafka said, “in the struggle between yourself and the world, back the world.” The world increasingly sees patient care as a function, not as a place.
3. How’s your business model going to be impacted? |
| | | 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:
Recently, I talked to a surgeon who complained about one of his partner's preferences for a certain color surgical drapes in their ASC. The same guy I talked with said that he himself had performed operations on the mud floors of huts in the jungle.
Then I read about medical residents at UC San Diego who are claiming that the university is not negotiating in good faith, that the university doesn’t care about their well-being, because it won’t increase the residents' housing allowance. Next, they’ll say their housing allowance is a patient safety issue.
In our Santa Barbara office, we’re currently advertising a position for a new office manager. In the past, before COVID-19 and before the tremendous federal government subsidies for increased unemployment benefits, we’d have dozens of applicants within a few business days.
Now, over the last month and a half (at least) I think we’ve had two applicants, total, none of whom called back after they were contacted to schedule an interview.
Staffing shortages are hitting many facilities and medical groups across the board.
What do you do when people have a very different idea of what work is?
Do you allow them to work at home even though the job requires their physical presence?
Do you allow them to work part-time such that several people are working part-time to fill what was normally a full-time position?
How do you handle them once they actually begin working? For example, when they say they don’t feel like coming in because they have a headache?
Do you do what my inclination is – fire their ass? Or do you say sure, its kumbaya?
There’s no great answer to this, but these are substantial issues.
Is there a generational issue here? Maybe – but if so, it has nothing to do with age per se. It has to do with how children were taught about being conscientious and fulfilling their duties and also about their purpose in life.
Again, I don’t have any great wisdom here, but it is very difficult to staff when you’re not only staffing around productivity, you’re now staffing around personality and feelings.
So let’s call this a discussion. If you have a great idea for a solution to this, I’d love to hear it.
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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 - Medical Group Termites - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
Perhaps you've carefully structured your medical group's relationships with hospitals, referral sources, and other influencers. But did you pay attention to what's going on inside your practice's own house? Have you built a wonderful structure that's being eaten up from the inside out by the group member equivalents of termites and wood rot?
It's my experience, and it's becoming an increasingly regular experience, that medical groups fail more often from problems within the group as opposed to solely from competition or as a result of attacks from outside of the group itself.
These problems range from group members whose misfeasance or malfeasance bring disrepute, to group members who engage in malicious activity outside of the pure scope of medical practice, to group members who actively consort with the hospital or a competitor to destroy or co-opt your practice.
None of the protections that are normally built into relationships between groups and outside parties are aimed at protecting the group from these internal risks.
To do so requires a different series of approaches starting with screening potential group members, whether employees or owners, on personality and interpersonal attributes as well as on medical expertise. It requires carefully evaluating, and not just on an annual review type basis, the members of your group and disciplining, or if required, terminating the "termites" before they destroy your group. It requires an entirely different set of protections built into your group's internal documents, your shareholders or partnership agreements, employment agreements, and subcontracts, in order to protect against more than what even those groups who are "benchmark to best practices" consider relevant. And it requires coordination between those internal actions and the group's relationships with hospitals and other facilities.
One disgruntled or malicious physician can destroy your $50 million a year business. Preventing the problem presents one of the best returns on investment you'll ever receive. |
| | | Listen to the podcast here, or just keep reading for the transcript.
I knew that I had taken the wrong job after my first day at the firm.
More than thirty years have passed, so now I can laugh about it. But back then, I thought I was screwed.
The majority of the partners were probably geniuses, but they had little, if any human characteristics.
Perhaps they were cyborgs. I'm really not sure.
Have you made this same mistake? Either by taking a job with idiot savants or, even worse yet, by building a medical group comprised of them?
The rationalization is that are "great doctors." Or that they have CVs as thick as the phone book. But they destroy your group's relationships with "customers" of all stripes: referral sources, patients, hospitals, coworkers.
It's like a great mechanic who smokes in your car. I had one once and never went back.
My old bosses made another mistake. They pissed off clients and didn't do anything to protect their business.
Watch out who you work for. If they're jerks, plan on how to obtain the benefit they are unknowingly passing along to you.
If you're a group leader, watch out for who you hire. Take precautions that they don't destroy your practice's relationships. Have the contractual ability to discipline and terminate.
Me, I stayed long enough not to damage my resume and then began looking for a new job.
The cyborgs found out and fired me before I could give notice. I took a huge book of business with me to my new firm. To this day, I am grateful to 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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