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| Dear Friend,
There's more to controlling the outcome of a contract.
Therefore, in order to gain that control in any deal, you must be the party that presents the first draft of the document.
But you need to think deeper. Beyond controlling the terms of the deal, what else should you be using the contract to accomplish?
For example, in connection with a negotiation of an exclusive contract, what terms might create problems for you, or, alternatively, lubricate the way, in regard to future business strategy? In other words, it’s not just the terms of the hypothetical exclusive contract, items such as coverage and stipend support, that you should be setting up, it’s far, far more.
You don’t know the future, of course, in the sense of total prescience, but you do have the ability to discern potential strategies, potential futures, so to speak, with enough clarity to not purposefully foreclose them yourself when controlling the contract.
Yes, this ends up costing more up front in time, effort, and legal fees (there's the disclosure that I have a horse in the race). But paying even a factor of two or three times more now is not even a rounding error in what failing to consider what you might do in the future will cost you later. Don’t be penny-wise and ton foolish. |
| | | 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:
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, so that the color of drapes was bullshit.
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, when we advertised for an open position 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. The last time, over the span of a month and a half (at least) I think we had two applicants, total, neither 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, it's 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. |
| | 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 - Hiring the Shunned: Failure to Check Exclusion Status Drives Psychiatrist Crazy to the Tune of $310,874 - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
Some say that you’re the composite of the five people with whom you spend the most time.
I don’t know if that’s true, but employing or contracting with the wrong person, someone excluded from participation in Medicare and Medicaid, can lead to drastic penalties as one physician recently found out.
As reported by the U.S. Dept. of Justice, in late February, 2022, Alan Siegel, M.D., a psychiatrist, and his Hamden, CT practice, Geriatric & Adult Psychiatry, LLC (“GAP”) entered into a civil settlement agreement with both the U.S. Government and the State of Connecticut as the result of employing an excluded individual.
The civil settlement cost the physician and his practice $310,874.
Originally enacted in 1977 as a part of the Medicare-Medicaid Fraud and Abuse Amendments in the form of mandated exclusions and subsequently expanded over the ensuing decades to include permissive exclusions, the U.S. Department of Health and Human Services Office of inspector General (“OIG”) wields authority to exclude physicians and other individuals convicted of Medicare and Medicaid program-related crimes, as well as others who submit fraudulent or false or other types of improper claims, from participation in federal health care programs.
In addition, the effect of an OIG exclusion is that no federal health care program payment may be made for any item or service furnished by an excluded person or at the medical direction or on the prescription of an excluded person. This is the case even if the excluded person’s services are not separately billed. Submitting any such claim is a false claim.
Extremely important for physician groups, the prohibition applies even if the payment is made to a person who is not excluded: in other words, a payment to a medical group that is used in whole or in part to pay for the services of an excluded individual makes the underlying claim a false claim, even if that individual’s services are not separately billed and even if they are administrative in nature.
In the civil case settled by Dr. Siegel and GAP, the government alleged that Siegel and GAP improperly employed Eric Ressner, a physician who was convicted of conspiracy to commit healthcare fraud and excluded from all federal health care programs. Apparently, Dr. Siegel hired Ressner as GAP’s clinical director. During the time of Ressner’s employment, GAP and Siegel submitted claims to federal health care programs and, as alleged, a portion of the reimbursement that they received was used to pay Ressner’s salary and benefits. As always, remember that the allegations were settled, they were civil allegations not criminal, and that a settlement means there was no determination of liability by a court.
Lest there be any confusion, the scope of the prohibition applies very broadly. In addition to prohibiting an excluded individual from serving in an executive or leadership role, for example, as a chief executive officer, chief financial officer, general counsel, director of health information management, director of human resources, physician practice office manager, and so on, at a provider that furnishes items or services payable by federal health care programs, it also prohibits an excluded individual from providing other types of administrative and management services, such as health information technology services and support, strategic planning, billing and accounting, staff training, and human resources, unless wholly unrelated to federal health care programs.
Note that liability attached to employing or contacting with such a person applies whether the entity submitting claims to federal health care programs knows or should know of the exclusion. Translation: if you had checked the exclusion database you would know.
The bottom line is that you must carefully vet every single one of your potential employees and contractors against the OIG exclusion database ( https://exclusions.oig.hhs.gov/). Preserve the record of your check. Recheck periodically to make certain a “clean” hire is no longer so clean. |
| | | Listen to the podcast here, or just keep reading for the transcript.
Covenants not to compete. Cultivating new business opportunities.
Costs or investments?
It all depends on your business horizon.
Like the visible horizon, the apparent line that separates the earth from the sky, your business horizon is directly tied to height.
In the physical realm, the average size person sees the horizon out at approximately 2.9 miles. But climb up a bit higher than 300 feet and your horizon moves out to approximately 22 miles. At the top of Mt. Everest, your horizon moves out to 209 miles.
Metaphorically speaking, what's your group's business horizon. If you're only able to see until the end of year parceling out of all dollars remaining in the group, everything will appear as a cost. Your future is self limited.
Many of your competitors, especially the large ones, have bigger dreams, bigger goals, bigger strategies. What other groups see as costs, they see as investments propelling them forward.
The irony is that, at the outset, height of thinking has nothing to do with business size. Rather, it's thinking that determines size and success.
Change your thinking. |
| | | 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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