| View this email online if it doesn't display correctly |
| |
|
|
| |
| Dear Friend,
It's apparently easier than you think to lose some fentanyl. Even more than 7 gallons of it.
Over the past several months, I've lost at least a couple of socks in the wash.
I was pretty upset until I learned that from September 2021 to January 2022, Cheshire Medical Center in Keene, NH somehow lost more than 7 gallons of fentanyl solution. I somehow doubt that checking the dryer vent will help with that problem.
Some of the diverted fentanyl, packaged in more than 583 separate bags, turned out to be attributable to a nurse, Alexandra Towle. Although investigators attribute the loss of 303 bags of fentanyl solution to her, she admitted to diverting more than 200 bags in January 2022, around 100 in December 2021, from 50 to 100 in November 2021, and approximately 12 bags in October 2021.
According to a report in the New Hampshire Union Leader, New Hampshire Board of Pharmacy documents report that Towle took the drugs “for her own use as a way of coping with the stress of working during the pandemic.” She apparently also copped to giving 12 bags to a friend.
The Union Leader reports that Towle “died unexpectedly on March 3”, but I'm not quite so sure why they described her death as unexpected.
In addition to New Hampshire authorities, the DEA is now involved in the investigation.
To add a twist, after the fentanyl theft hit the fan and the investigation began, and “improved” security measures were put into place, 11 more bags of the highly addictive and potentially deadly stuff have somehow disappeared.
Although nurse Towle was clearly the employee from hell for Cheshire Medical Center, what I'd like you to glean from this is what’s happened to the CNO, pharmacy director, and the hospital as a result.
The CNO, Amy Matthews, RN, had her license suspended pursuant to an emergency order by the New Hampshire Board of Nursing. Her job duties include managing all nursing operations, including the security, accounting, and management of controlled substances. It’s unknown as of this writing whether her license has been reinstated following a hearing.
The hospital’s pharmacy director, Melissa Siciliano, PharmD, had her license temporarily suspended, but it's reported that it's been reinstated.
And, the state’s Board of Pharmacy brought disciplinary action against Cheshire Medical Center. A hearing is slated to take place later this month and it’s possible that the hospital’s pharmacy permit will be suspended or even revoked.
I'm not writing this for purposes of warning you not to divert drugs (you know that already) or for your schadenfreude.
Instead, like CNO Amy Matthews and pharmacy director Melissa Siciliano and Cheshire Medical Center, none of whom has been implicated in any way in the theft of the fentanyl, an employee’s diversion of drugs can have tremendous blowback on you as a medical professional, or on you as a facility manager or owner, or even on you as the holder of a contract to provide hospital-based medical services, even if, in many cases, it’s not actually your job to police diversion.
When the State Board of Pharmacy or the DEA show up, you're going to have serious explaining to do, at best, and maybe even job searching and career switching to do. Let’s talk about reducing the risk before any of that happens. |
| | | 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 version:
A lot of physician groups are having trouble recruiting – no big surprise.
First, there's a relative shortage of physicians in many specialties. Second, the interest that many physicians have in "work/life balance" interferes and makes it far more difficult for many groups to recruit and, certainly, retain staff.
On the recruiting side, groups often turn very quickly to the notion of making recruits partners right away, or perhaps on a very accelerated timetable. Even that might not be the solution, because many physicians don’t want to be partners. Instead, they want flexibility in their work schedule. They don’t want to take call, or weekend work. They want a different sort of a life. The notion of becoming a partner and being "all-in" isn’t what they’re looking for.
Now, of course, I’m not saying that that’s where everyone is. Nor am I suggesting you design a program that assumes that everyone is like that.
Instead, what I think you should consider is having a sort of career buffet, one with many choices in connection with how physicians can relate to your group. For example, some might want to work as locums whom you can turn to every once in a while. Some might want to be part-time physicians on a regular schedule. Others might opt for full-time positions with no call. Some might want to be full-time with call. Some may crave a partnership track and others might never want be a partner. As long as you can find a way of scheduling those physicians, why not offer them the choice of how they want to associate with you?
You’re then flipping the issue. The question, “Do I want to work for the XYZ medical group?” becomes “How do I want to work with the XYZ medical group?” Maybe that increases the odds that the potential recruit will say, “Here’s how I’d like to work with you, if that’s possible.”
If it is possible, you’ve just made another hire.
|
| | 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 - Hospital-Based Services, Not Hot Dogs - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
You own the hot dog concession at the local major league ballpark. Because 50,000 plus potential customers come to the facility several days a week during baseball season, sales, and profits, are good, so good that you pay a hefty fee for the right to operate the hot dog stands.
Later, stadium management wants to increase their ticket sales, so they get you to agree to honor coupons distributed in the community -- in varying amounts, they give the holder a discount of up to 70% off. Sales, in terms of volume, is up, way up. But, for each of the many hot dogs eaten by the coupon holders, a large bite is taken out of your profits. So much so that after a few years of operating at a near or actual loss, there's no way that you can afford to continue operating the stands.
The stadium, realizing that baseball without hot dogs isn't baseball, decides to incentivize you to keep operating the stands. They pay you a fee to assure that you will make enough profit, as measured by an "expert" as of that day, to keep the stands running. But you've got to keep honoring the coupons -- and the stadium managers keep printing more and more coupons.
Would you keep running your hot dog stand if business slips back into the red (after all, the public needs hot dogs) or would you either negotiate additional funding from the stadium or find a new venue for your products and your services?
Of course, the stadium is a hospital and your concession stand doesn't sell hot dogs, it renders hospital-based medical group services. But, the analysis is much the same. Instead of food, you sell anesthesiology, radiology, pathology or emergency medicine services. You hold an exclusive contract, not a concession-stand agreement. But what is it that hot dog vendors know about strategy and tactics that you don't?
If you're selling medical services but collecting only peanuts (or even hot dogs) let me know. You need a better agent. |
| | | Listen to the podcast here, or just keep reading for the transcript.
Consider these possibilities:
You’re a pain specialist and the majority of your referrals come from a group of orthopedic surgeons who announce they’re now hiring a pain specialist to work as a part of their group.
Or, you have hospital privileges at only one facility and receive referrals for the care of chronic, post-operative pain. The hospital opens a new clinic directed solely at charity care and almost overnight 25% of the referred cases become no pay or at best, very low pay.
Or, your workers’ compensation focused practice includes dispensing pharmaceuticals to your patients but changes in the state’s fee schedule gut 90% of pharmaceutical sales profits.
These may or may not be real issues for your practice, but each problem (as well as many others) has impacted my clients over the years.
What changes are in store for you and your practice? As Niels Bohr, Nobel Laureate said, “Prediction is very difficult, especially about the future.” But just because it’s difficult, doesn’t excuse you from attempting to predict the possible bumps that are in store for your practice, or from protecting your profits and guarding against significant business setbacks.
This process of identifying potential events and trends, conducting what I call The Scenario Survey Process™, is a necessary part of establishing a vibrant overall strategy for your success.
Before going further it’s essential you understand the important distinction between planning and strategic thinking. Planning is a process of projection from the present. However, extrapolating future problems based on your present situation isn’t effective. This tactic presumes the facts of your present situation will remain the same.
For example, you might assume that the hospital will never close, that the payor mix cannot change overnight, or that new regs won’t instantly gut $1.2 million from this year’s bottom line, because these things are not occurring at the present time. But life isn’t that simple, and all potential future scenarios must be considered when developing your practice’s overall business strategy.
Unlike planning, strategic thinking is based on envisioning a future and then strategizing to, in essence, pull you toward its accomplishment. A strategy involves an ongoing, changing process that if done properly allows the creators to regularly revisit and alter the approach.
In essence, a scenario survey involves identifying as many possible scenarios or conceivable futures as possible. The survey is, in effect, a hunt for your own black swans, events that no matter how low their probability, have the potential for high impact.
For example, if your pain practice were centered at one facility, the odds that the facility will be physically destroyed by a natural disaster are low, but the impact of that event would be disastrous to your practice.
The purpose of The Scenario Survey™ is not to identify potential scenarios, judge the odds that they might occur and estimate the damage that would result. Because no matter how expert you are at strategizing, it's impossible to identify and value all potential risks.
Instead, the purpose of The Scenario Survey™ is to identify classes of underlying trends, issues and questions and to develop a strategy that accounts for as many possible future classes as possible.
For example, a facility's closure due to bankruptcy is a possible scenario that could belong in the same class as a facility being destroyed. The more scenarios a strategy incorporates, the more robust that strategy is and, therefore, the more likely the strategy will serve you well.
Alternatively, if a strategy survives only in one possible future, the more fragile and prone to failure it likely will be.
The Scenario Survey™ is a valuable tool in the development of strategy. Using it strengthens strategies and therefore strengthens the odds of your practice's success. |
| | | 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.
|
| | 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?
|
| | | | 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 Free.
|
| | | | 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. |
|
|
