Subject: Practice Success

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November 3, 2023
Dear Friend,

Just how much intent is behind a letter of intent?

That's the topic of this past Monday's blog post, Deal School: Letters of Intent. You can follow the link to read the post online, or just keep reading for the rest of the story.

Let’s take a quick look at what a “letter of intent” is and isn’t. I say “quick” because a complete look at the subject would turn this post into a book.

Letters of intent, often referred to in shorthand as “LOIs”, are a usual, but neither legally required nor universal, step in an acquisition or “M&A” transaction. That said, they can be used in many other types of contracting arrangements as well.

Because they’re most often conceived of in the course of an acquisition, let’s focus on an LOI in that context, a context in which they are prepared by the buyer.

It’s easy to see an LOI as a very odd document in that most of its terms, including but not limited to those pertaining to price, timing of closing, and terms of purchase and payment, are specifically set out as nonbinding. On the other hand, provisions pertaining to what’s essentially an exclusivity period running in favor of the buyer, continuing promises of confidentiality, and choice of law provisions are specifically set out as binding.

Importantly, even if specifically agreed to be nonbinding, deal term provisions set out in an LOI take on psychological importance – they become the starting point for later negotiations, and it is always harder to negotiate against an entrenched position.

More so than the few specifically binding provisions, the generally nonbinding nature of an LOI lures many sellers into make a significant strategic mistake: They fail to advocate for positions and definitions that would best be addressed up front in the LOI even if “nonbinding”, in order to avoid putting themselves in a weakened negotiating position months ahead of the preparation of the definitive deal documents.
Tuesday - The Price of Dog Food and Your Medical Group's Survival - Success in Motion

Watch the video here, or just keep reading below for a slightly polished transcript:

What does the price of dog food have to do with the ability of your medical group to survive?

Well, the answer is more than you might think.

Earlier this week I ordered dog food for my three dogs. A 25 lb bag from Chewy (which is where I’ve been ordering this particular food for a few years) just took a 20% price increase. I found another online vendor and purchased it there.

If you’ve been to the market lately, you’ve seen similar, dramatic, price rises in things from ground beef, to chicken legs, to, probably, Ritz crackers.

So what’s that have to do with your group?

If you’ve negotiated managed care rates more than a year ago, certainly more than two years ago, you are in all probability way underwater in terms of where those rates need to be to remain viable.

Many groups hardly ever take a look at their managed care rates. Some don’t
do it for years and years until somebody remembers it’s got to be done – or perhaps when someone's in trouble for just signing what came in the mail to re-up the existing terms of an agreement. I've even witnessed an administrator who was so happy to sign renewals that she authorized rates cuts. 

For almost all groups, the cost of supplies has gone up, the cost of support staff has gone up, the cost of administrative personnel has gone up, and the cost of your own physician staff has gone up.

If you don’t stay on top of managed care agreements, if you don't negotiate their terms, and if you don’t build cost of living adjustments into agreements, you’re not only leaving money on the table, you’re potentially killing your group one ignored contract at a time.
Wednesday - When the First Class Physicians Leave the Hospital, Who’ll Be Left? - Medical Group Minute

Watch the video here, or just keep reading below for a slightly polished transcript:

I’m seeing a growing trend of dissatisfaction on the part of office practice physicians employed by, or otherwise closely aligned with, hospitals.

They're reporting a significant disparity between physicians who care/physicians with good skills/physicians who want to work, on the one hand, and the much larger majority, who have become satisfied to metaphorically punch the clock and collect a paycheck.

Those in the first class are becoming increasingly frustrated with mediocrity, meddlesome management, decreasing compensation, and the increasing overhead charged to them either directly or indirectly. What was supposed to bring more efficiency through “professional management” has revealed itself as ineptitude tied to profligate spending.

Because of the context in which I speak with these physicians (i.e., working with them to create new, independent practice structures, often in concert with the formation of new surgical and other facilities) it’s fair criticism to say that they’ve self-selected.

But so what? Isn’t that the point?
Listen to the podcast here, or just keep reading for the transcript.

I've written previously about the power of framing – of creating context – to support your group's position in negotiations. For example, framing negotiations around quality, not cost.

Or, as an example of the same argument coming from close to the polar opposite, consider the government's argument that accountable care organizations are all about quality, not cost.

Related to framing is the power of the story, from the fairy tales that your parents read to you when you were a child to the story of your group and its meaning to the hospital, to referring physicians, to patients, and even to the community at large.

A few minutes before writing this, on a whim, I googled "who discovered America?" I found the popular stories of Christopher Columbus, claims that it was actually Leif Ericson or other Vikings, and others citing Chinese explorers. Or was it the Basques? Others pooh-pooh all this and say what about the Native Americans? But even they didn't "come" from here – their ancestors came from Asia.

My point isn't who discovered America but rather that there are a number of believable stories about who discovered America. People buy in to the story they believe and discredit the others. So the underlying truth really isn't the point – no one can force you to believe; you do all the "believing" yourself in your own head.

Now, of course, it's really not that simple because while someone can't force you to believe, they can certainly create conditions that make it conducive for you to believe. That's the whole point of advertising and sales - telling a story that resonates with you so well that you develop a coherent belief.

What story are you telling about your practice? If you're not telling one, or if you're not telling it convincingly, someone else is out there telling another story about you or your group that is likely to be believed.

These are not amorphous or esoteric concepts. They have real-world application. They are as much a part of negotiating your next contract, for example, an exclusive contract with the hospital, as in the face-to-face stage of negotiation when you're sitting across the table from one another hammering out paragraph 47.

Abe Lincoln learned to write using a piece of charcoal from the fireplace. George Washington cut down the cherry tree and admitted it. What's your story?
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Books and Publications
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.
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.
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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