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| Dear Friend,
Let's meet and confer.
That's the subject of Monday's blog post, Deal School: Meet and Confer. You can follow the link to read the post online, or just keep reading.
The term “meet and confer” has several meanings in the context of legal proceedings and contracts.
Outside of the scope of this post, the term describes a process that is often mandated in the context of lawsuits: a process by which the parties attempt to resolve the dispute without court action, for example, in connection with a filed motion.
Because our deal school series focuses on issues involved in structuring and documenting deals, this post looks at how “meet and confer” provisions might be incorporated into an agreement.
To be sure, in either the litigation or the deal context, the concept of a “meet and confer” is for the parties to try to work things out before resorting to more formal action.
In the context of a deal, a “meet and confer” is often found in provisions requiring the parties to discuss a claimed breach of the agreement before taking steps to initiate a formal dispute resolution process; for example, an agreement might require a “meet and confer” before moving to mediation, to arbitration, or to the filing of a lawsuit.
But there are other uses as well, such as mandating a “meet and confer” in an attempt to resolve an impasse that might otherwise lead to a party exercising termination rights under an agreement.
For example, in connection with an exclusive contract requiring a medical group to provide “all required services” within its specialty, for example, radiology, at a hospital, “all” might be tempered by way of a coverage matrix. And, the agreement might provide for stipend support based on that level of mandated coverage. So, what happens if the hospital later wants to expand the scope of coverage, either in terms of additional hours, days, or locations?
As an alternative to a provision that automatically increases the amount of support as the coverage matrix expands, the parties might incorporate a requirement that they “meet and confer” to adjust the amount of the stipend, with the failure to do so or the failure to come to agreement as to its amount leading to some type of quasi-for-cause termination right on behalf of the medical group.
As you might have already realized, in some situations, such as the one described involving coverage stipends, a “meet and confer” without real “meat” (the ability to trigger termination on short notice), makes the meet and confer just talk.
Additionally, other provisions are required to impose good faith participation, to ensure that the process takes place quickly and doesn’t last long, and so on, or the delay can be fatal to a party’s rights.
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| | | 2024 CMS Fee Schedule Woes Signal Need to Cut the Cord - Success in Motion
Watch the video here, or just keep reading below for a slightly polished transcript:
Let’s talk about Medicare and whether it's time to cut the cord.
CMS, Medicare’s parent organization, has announced that for 2024, the fee schedule for hospital inpatient reimbursement is going up a net 3.1% while the physician fee schedule is suffering an approximate 3.4% net cut.
Despite what the government might say, inflation is still going crazy. If you’ve been to a market recently you’ve seen inflation’s impact on prices. Staffing cost demands, in other words the cost to staff, compensation demands, are way up. In some specialties it's nearly impossible to recruit and retain because people are jumping ship as fast as somebody else says here’s another $100k.
So what’s the real message here for physician practices?
Can you continue to run faster and faster on the treadmill of treating Medicare patients if you’re making less than the year before, and when it costs you more to provide the service?
There’s an old Monty Python skit about a bank whose business model is only making change. When asked how they could ever earn a profit making change, the banker’s response was that they make it up on volume.
Well, obviously, that’s a joke. But how funny is it to think that you could ever make up for losing money on every patient, by treating more patients?
So what kind of strategy is that? It’s certainly not a strategy for success. Well not your success, at least.
Politicians and bean-counter administrators can say that they’re “saving Medicare”. But the reality is they’re going to push physicians out of participating in Medicare.
Do you want to be the last one?
Think about other strategies, other ways of shaping your practice so that you’re not caught in the death spiral – which is what Medicare is becoming.
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| | | | Wednesday - Value Based Reimbursement Is A Lie - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
I hate it when people lie to me.
I also hate it when people lie to my clients and friends.
Someone is lying to you now. That someone is the government and the pundits and the so-called healthcare journalists who tell you that checking a box is value-based something. News flash: it’s not value-based anything.
Here’s an example from an article, Physicians Must Realign Compensation with Value, published on the Physicians Practice website: "Value is quantified through tasks such as conducting patient satisfaction surveys, measuring patient outcomes for chronically ill populations like diabetes patients, and keeping patients healthy and out of the hospital, all the while holding down costs."
No, none of those have anything to do with value. The act of measuring outcomes does not yield value. If it did, you should just measure everything and payors and patients will be throwing money at you. Costs have nothing to do with value or no hospital would have ever filed for bankruptcy.
Conducting surveys and measuring things and an entity’s costs are all sell-side. They are internal to the provider. But value is a buy-side determination. It’s the customer who decides what the value is. Ford spent millions on the Edsel, yet few wanted one.
One has to decide who the customer is in the context of reimbursement. If it’s the payor, then don’t pretend that patient care is where value is measured, because it’s measured at the payor end and payors ultimately care about profits not patients. Checking the box that you gave an antibiotic is not the same as giving the antibiotic and is not the same as determining whether the antibiotic should be given in the first place.
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| | | Listen to the podcast here, or just keep reading for the transcript.
Hospital-based medical groups shouldn't simply conceptualize their practice as one business. If you're a medical group leader, you must view your practice as consisting of several independent, yet coordinated, units, each of which requires a separate focus. So, for example: - There is a group owner unit
- There is an employee/subcontractor unit
- There is a hospital unit
- There is a referral source unit
- There is a patient unit
Then within each of those units there are multiple elements of required activity. Finally, each of those elements are valuable only if they are working in coordination and within the scope of the group's master business strategy. |
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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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