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| Dear Friend,
We’re living in a time of fast-paced change. Sure. But, I think people have been saying that since the Enlightenment. Maybe it’s the one thing that’s remained constant. But maybe it’s not. Some things have certainly remained the same.
For example, more than ten years ago, in my blog post entitled Who’s Driving Your Practice’s Bus?, published in April 2012, I wrote that for many medical practices, it appears as if no one is driving the bus; that is, no one is in charge of the group’s business. Instead, the practice operates like a runaway bus — yes, the providers are seeing patients, but where is it headed? Instead of a map with a clearly marked final destination, it’s just rolling along.
Many groups have a related problem: There isn’t a bus driver, there’s a whole committee of them. In fact, for some groups, there is a whole Greyhound bus full of them.
There is no question that the healthcare market is changing rapidly. This means that groups must have the ability to make business decisions rapidly.
Drawing on the work of the late Col. John Boyd, considered by many to be the second greatest military strategist to have lived, success requires a faster cycling through what he termed the OODA loop. In simplified form, the loop consists of observing, orienting, deciding and acting. (The OODA loop is actually much more complex with various internal feedback mechanisms). The point, however, is that the competitor who can cycle faster through the loop gains a tremendous strategic advantage over its opponent.
Additionally, the principle behind the loop, essentially one of constant iteration, is necessary in and of itself, that is, in the absence of any externally driven need to make a decision. The most successful groups, in fact the most successful businesses, continuously engage in a process of observing their performance across the board, evaluating it against problems, mismatches, and suggestions, and then synthesizing new rules, standards, and so on, which, once again, are put through the process.
Whether you take the time to study Boyd or not, it’s axiomatic that a group must be able to make decisions quickly. That requires that someone, not some committee, be in charge.
Note that I’m not saying that groups need dictators: far from it. However, group leaders must be empowered to lead – and they must actually lead. |
| | | 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:
At least something in the economy other than inflation is going up: Healthcare fraud investigations, prosecutions, and settlements.
To be complete, healthcare enforcement action by the federal government has been on the upswing for years. Looking back to data from 2017, civil settlements from whistleblower and government initiated cases plus the fines and penalties collected from criminal prosecutions brought in $2.6 billion that year.
That's a return of about four dollars and twenty cents for every dollar spent. See if you can get that in the stock market or even in real estate. And, it's a huge “follow the money” in connection with the fraud investigation "business".
So what’s the practical takeaway here, besides the fact that you wish you had a business that did so well?
Because of the huge return on investment, we can expect both the number of civil actions filed in connection with healthcare fraud and the number of criminal prosecutions to continue to rise.
Some of the types of behavior that the government challenges are within the realm of what many in healthcare would say are “normal” practices. So, one has to be extremely careful in terms of doing deals.
Compliance has become far more than “check the box,” far more than “give me a compliance plan and put the thing on the shelf”. That’s because spending hundreds of thousands of dollars to millions in connection with an investigation and a defense is the end of many healthcare businesses, except for the largest. Even that doesn't factor in the cost of civil settlement, the cost of penalties, and the cost of fines. And, how can you even put a cost on doing time?
Take that into account, both in terms of your thinking and in terms of your actual practice.
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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 - Don’t Be Surprised By the No Surprises Act Notice and Good Faith Estimate Requirements - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
Even though a federal court struck the U.S. Department of Health & Human Services’ No Surprises Act (“NSA”) regulations as pertain to the process for arbitrating disputes between payors and out-of-network providers, the law and the remaining implementing regulations remain in effect.
Although much of the attention has been placed, for good reason, on the operative billing-related restrictions imposed by the NSA, the technical notice requirements require immediate attention.
In particular, the regulations require that patients be given a notice of rights and, should they so request, a good faith estimate of charges.
For facility-based groups, the hospital or facility will almost always (but not completely) be charged with providing notice to patients and responding to requests from uninsured and self-pay patients for good faith estimates of charges. But the obligation to provide the notice and estimate does not obviate the need for all medical practices to provide required website notice, nor does it, unless you want to give up financial control, obviate the need to coordinate how the charges for your services will be estimated by the hospital or ASC.
Despite the fact that much of this can be offloaded to the facility, it’s wise for all facility-based providers (and required of all office-based providers) to include notice on the practice’s website. Although HHS has provided a form of notice, the use of which demonstrates a good faith effort to comply, it must be customized to incorporate applicable state law. Print copy notices must be made available and (in nearly all cases) posted.
Although the law has been in effect as of January 2022, the government is exercising discretion as to enforcement of the good faith estimate requirement. The better approach, though, is to address these issues ASAP. |
| | | Listen to the podcast here, or just keep reading for the 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. |
| | | 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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