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| Dear Friend,
Managing risk.
If you’re like most medical groups that use an outsourced service for one or all of coding, billing, and collection, you probably focused on fees when it came to deciding with which company to contract, with the lowest bidder crowned the winner.
If you’ve got more sophisticated management than most groups, you might’ve moved to the next level of analysis which is cost versus efficacy: paying a 10th of a cent per claim is overpaying if collections are running at, say, 15% of contractually adjusted dollars.
But the real point here is that there’s far more to risk in outsourced coding, billing, and collection than the risk of collection. Let’s look at simply one other element of the equation out of many: data risk.
Data risk itself can be sliced like cold cuts: HIPAA risk, state confidentiality of medical information risk, credit card data risk, and so on.
Just because you outsource coding, billing, and collection doesn’t mean that you can outsource the risk; in fact, as to third parties the risk lies exactly where it began, with you.
So, what can you do?
Internally, your group can both adopt and implement related policies and procedures, from active HIPAA compliance to cyber security. And, you can ensure that you’re properly insured, from E&O, to D&O, to general liability, and to cyber risk.
But in light of the outsourcing issue, let’s slice this another way: What data risk obligations does your agreement with your outsourced coding, billing, and collection company impose on the service provider?
The issues are complex, from dealing with specifying exactly what insurance they must obtain, to avoiding caps on the third-party company’s liability (“our liability shall not exceed the amount of fees charged to Client within the trailing twelve months”). The object, of course, is to be able to be made whole for the liability (plus costs, etc.) imposed on/incurred by you to third parties, including the government, as a result of the outsourced vendor’s error. As in any negotiation, you don’t always get what you want. But with liability for, say, a data breach running into the many millions, make sure that you at least get what you need. |
| | | 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:
Let's talk about an issue involving telemedicine.
It revolves around an initial news story from mid-May 2022, but I guarantee you that the takeaway for you is going to be relevant whether you listen to this in a week or in 13 years.
The story I saw was in The Wall Street Journal. It involves the fact that a company called Cerebral, a telemedicine company, focused on mental health and ADHD in particular, had been subpoenaed in a government investigation into its prescribing practices.
The story also reported that a number of the nurse practitioners engaged by the company had complained that a thirty-minute patient visit wasn’t sufficient to diagnose and that there was pressure on them to prescribe controlled substances. The story also revealed lawsuits filed by Cerebral physicians alleging that the company is putting pressure on them to increase profits as opposed to deliver proper patient care.
All of this involves allegations and investigation, not charges filed against Cerebral, and no one has proven they’ve done anything wrong. So, we're not going to pick on Cerebral.
But we can use it as an example that is somewhat akin to, but not identical with, something I’ve addressed on other recordings and on the blog, and that’s the classic pain cream scam, in which physicians and sometimes other healthcare practitioners are roped, cajoled, or one might say bribed into participating in telemedicine arrangements that turn out to be prescription scams.
In the classic pain cream scam, it’s a physician who is in essence hired or paid on a per call or per patient basis, to prescribe a pain cream, generally a supposed compounded product (although the government would allege it is actually an illegally manufactured medication) to patients with whom that physician has a five to ten minute phone conversation. Patients are pulled into the arrangement by way of the participation of telemarketers.
Generally, those sorts of scams target Medicare, Tricare, and other federally funded patients and they usually end in a tremendous mess, not only for the scamsters but for the physicians as well.
The moral of the story is to be extremely careful even though you might go into one of those ventures with a very pure heart. The moral is the same if you go into your own venture as opposed to one proposed by marketing sharpies.
You need to be extremely careful about any telemedicine business that doesn’t involve telemedicine with established patients, or that doesn’t follow your state’s laws in connection with what you have to do to establish a physician-patient relationship. And you need to pay particular attention to your state's laws on what sort and what intensity of a patient visit is required before you can prescribe what it is that you prescribe.
The downside could be jail, significant fines, and medical board discipline.
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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 - Why You Have to Build a Bigger Future - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
Sessile animals, for example, sponges or coral, live their lives fixed in one place. Food comes to them.
You might think that they’ve got it made. But, in an emergency, as when their natural defenses fail them, almost none have the ability to move. It’s all over.
Many medical practices are in the same position. They’re sessile in terms of psychology and business model. Their physicians, whether one or one hundred, practice at the same location, often in the same way, for years, for decades, for careers. Instead of having twenty-five years’ experience, it’s likely that they have one to five years’ experience repeated five to twenty-five times.
Life’s good and “efficient,” a common meme in healthcare. But, like a sponge, when conditions change, they can neither change with the times nor change location, at least not until it’s too late.
Your current situation may be comfortable and even highly profitable. But time marches on and it’s not likely that your current situation will remain unaffected.
The only way that you and your medical group can survive is to constantly work on building a future that’s bigger than your current present. It’s not growth for growth’s sake, it’s growth for your own survival.
When sponges die, someone else mops up with them. I doubt that that’s your desired future. |
| | | Listen to the podcast here, or just keep reading for the transcript.
It's morning in a mall outside of a metro station in Washington, D.C. Josh, dressed in jeans, T-shirt and baseball hat, picks up his violin and begins to play. Classical music, some of the most complex and beautiful ever written for the instrument, floods the air.
Over the next three quarters of an hour, over 1,000 people pass directly by. Few notice Josh. Only a handful slow down to listen. Only 6 stop. Josh's take: $32.
But Josh isn't one of the thousands of street musicians commonly encountered in cities across the country. As reported by Gene Weingarten of the Washington Post, he's Joshua Bell, the internationally acclaimed violin virtuoso whose performances regularly sell out at over $100 a seat. The instrument he's playing: a $3.5 million Stradivarius.
As the Joshua Bell experiment demonstrates, value is not a fixed concept. It’s tremendously impacted by context.
There’s a significant advantage for you in understanding the concept of context, how it can be created and how it can be used by you to your advantage in various situations. Here are two examples.
Altering Context to Alter Value
Take for instance, the concept of patient satisfaction and how it can be altered by context. This is a direct extension of the story of the valuation of Bell’s performance.
A friend recently spoke glowingly about “the best medical care he ever had.” Why the best care? He then described an experience that began with being greeted by name at his car by a member of the doctor’s staff and went on from there in a similar high-touch manner.
Uber valet services might be out of your control, but the concept underlying this example can be deployed in a number of ways whether you’re an office-based physician, a hospital-based physician, or the administrator of a healthcare facility.
Altering Context to Alter Negotiation
The other major way for you to utilize the magical power illustrated by the Joshua Bell experiment is to proactively alter the context of the metaphorical space in which negotiation takes place.
That includes actions to alter the conceptual context in which your medical group or facility, and its goals, are perceived in order to impact your negotiating strength.
And, it includes actions to alter the context of the negotiation itself.
In a sense far larger than most people realize, business relationships and contract negotiations are types of "conversations" that take place back and forth between the parties.
Conversations don't happen in a vacuum, they take place within a context.
There's an opportunity, then, to alter the outcome by controlling the context of the negotiation “conversation.”
On a personal level, think of the situation in which you call your spouse and ask, "Where shall we go to dinner tonight, Chez Marc or La Casa Bianca?" The context is where you will be going out for dinner, not whether you will be going out or eating at home.
You have similar opportunities to control the context, or, as I refer to it, to "frame" the issues, of business negotiations. For example, discussions of money can become discussions of quality and the investment required to obtain it.
Of course, it's easy for someone to believe that they can control the context, and quite another to actually establish a frame. To achieve transformational results, framing the issues takes considerable planning and time. Additionally, the frame must be consistent with your business strategy and its implementing tactics.
Remember that every relationship and every negotiation has a context; the question is whether it will be set by you or by the other side or simply left to chance. The latter two alternatives leave you open to happenstance: In any and all events, you are going to face the music; the question is whether or not they're playing your song. |
| | | 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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