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| Dear Friend,
Things are getting so bad that a hospital's turned to crowdfunding to stay afloat.
I’ve written about hospital closures, shrinking hospitals, and hospitals that became holes in the ground. I’ve even written an entire book on The Impending Death of Hospitals. But before today, I’ve never written about a hospital that turned to crowdfunding to stay afloat. According to a story on Medpage Today (see https://www.medpagetoday.com/special-reports/features/106291), 16-bed critical access hospital Bucktail Medical Center in Renovo, Pennsylvania is attempting to raise $1.5 million via GoFundMe to keep the lights on. It’s losing $150,000 each month. The Pennsylvania Department of Human Services wants repayment of $255,467 for care delivered four years ago. And, the hospital reports that a $381,941.00 Employee Retention Credit (ERC) payment is delayed indefinitely. Bucktail has been in business since 1909. It’s the sole hospital, and sole operator of an ambulance service, in the county. It also operates a nursing home. See it here: https://www.gofundme.com/f/your-community-your-hospital-your-choice-help) The hospital business is dying, one facility at a time. The story is another breadcrumb on the trail of The Impending Death of Hospitals. For physicians, it leads to the conclusion that: 1. There is no longer safety in hospital employment. 2. That contracted medical groups, especially hospital-based groups such as anesthesiologists and radiologists, can’t be dependent upon any single hospital or single hospital system relationship. 3. That there is huge opportunity in alternatives to hospitals, such as ASCs and MOCs™, physician-owned Massive Outpatient Clinics™. |
| | | Tuesday - Tough Financial Times – Stay on Top of Collections - Success in Motion
Watch the video here, or just keep reading below for a slightly polished transcript:
I hope you're having a good day and are unfazed by the news that we’re seeing a record number of auto repossessions, that interest rates are higher than they’ve been in 20 years, that a close to 100-year-old giant trucking company, the largest in the country, decided to file a straight liquidation bankruptcy, and so on.
Oh, plus consumer debt is apparently at a decades' high.
Which leads me to talk about something that I probably haven’t talked about in 20 years and that's the urgent need for medical groups to stay on top of collections.
We’re talking two kinds of collections; payor collections (because even though payors are apparently having a banner year, many are slowing down claims processing and payment) and patient collections.
Many groups, especially hospital-based groups, completely outsource these activities. While the mechanics, i.e., the process, can be outsourced, the responsibility for staying on top of collections can’t be outsourced. That’s the case whether you’re a solo physician with one staff member at the front desk who is supposed to be collecting, or whether you’re a group of hundreds of physicians plus hundreds of other professionals with completely outsourced billing and collection. Stay on top of this.
The other collection dynamic is the impact of "surprise billing" legislation and other perhaps well-intentioned patient protections that have made economic life not just difficult, but downright precarious for many groups.
I’m thinking of the bankruptcy of Envision Healthcare as well as the complete closure of American Physician Services, a large physician staffing company. You don’t want that to happen to you.
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| | Wednesday - A $15 Billion Lesson On Stipend Negotiations - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript: We’ll take your $15 billion stipend, but as to those strings you put on it, “F*^%” you”.
No, it’s not a perfect analogy to medical group–hospital negotiations, but, well, it’s close enough for government work.
TSMC, the world’s largest contract microchip maker, is balking at up to a $15 billion government stipend in connection with its construction of two new chip factories in Arizona in which TSMC will invest $40 billion.
The problem isn’t the $15 billion, it’s that the government has put some strings it, such as “tell us how you are spending it” or “if you make more than $X, give us some of the money back”.
As an aside, how you or I conceive of the wisdom of, to put the nicest moniker on it, “public --private partnerships”, is beside the point.
What is almost directly on point is how TSMC, which I doubt even needs the money, is playing its cards. Essentially, they are saying, “we know that you need us more than we need you, so we’ll just take the money, no strings attached.”
It’s true that there are distinctions between one time negotiations, what I call Transactional Contracts™, say for the purchase of some real property, and Relationship Contracts™, the negotiation of a hoped-for many decades long relationship between your medical group and some facility. But it’s not clear that TSMC’s dealings with the government aren’t hoped by both parties to be of the Relationship variety because far more than two new chip factories are needed.
Some consultants think that it pays to be reasonable when making a first offer. Those with an understanding of human nature don’t think that that advice is very, well, reasonable.
Of course, being “unreasonable” from the hardball perspective and being “unreasonable” from the perspective of wanting to be liked are two wildly different things. Note that using legal counsel wisely in negotiations allows you to maintain your need to be liked while still pushing the envelope. “It’s Weiss’s fault that we asked for $15 billion. Had we known, we’d have come in at $12 billion.” Either way, try being a bit more unreasonable.
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| | | Listen to the podcast here, or just keep reading for the transcript.
The economy is in shambles and some say we're headed into a recession.
The Medicaid population is growing and the ranks of the well-insured are declining.
As Baby Boomers age, the Medicare population is growing.
If yours is an average group, you're doing more work for less pay. Chances are, you're being asked to cut back on your income and on your expectations.
But just like with the economy in general, cutting back is one approach. Growing your group's business and increasing its income is another. And I'm not simply talking about doing more volume for less money, I'm talking about expanding its scope, creating different value and reaping its reward.
This is a wildly different approach than that advocated by most medical specialty societies, which for the most part bemoan the financial position their members have been "put" in, acting as self-reinforcing loops of low self esteem.
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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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