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| Dear Friend,
He conspired to allocate cancer care.
I was sitting in an ASC lobby with my wife waiting for her to go in for a second pain injection after the one she received the prior week had failed. My wife commented that the only other patient sitting in the lobby was a woman who had been there with her a week before for a pain injection, too. I commented, perhaps jokingly, perhaps not, that I thought I had discovered their business model.
No, impossible! No physician would do that!
Perhaps you,aren’t familiar with Dr. William Harwin, who pleaded guilty on August 23, 2023, in connection his with criminal antitrust prosecution in U.S. District Court in Fort Myers, Florida, relating to his suppression of competition by agreeing to allocate chemotherapy treatments for cancer patients to his medical group, Florida Cancer Specialists & Research Institute, and radiation treatments to a competing entity.
He’ll be sentenced at a future date.
In April 2020, Harwin’s group was charged for its role in the same criminal conspiracy and entered into a deferred prosecution agreement under which it admitted to conspiring to allocate chemotherapy and radiation treatments for cancer patients. Under the agreement, the medical group committed to pay a $100 million criminal penalty and to cooperate fully with the Justice Department’s ongoing investigation, which I’d guess is what led to Dr. Harwood’s guilty plea.
I represent physicians in transactions across the country and there are plenty of ways to make a profit and to do the right thing for patients. But don’t fool yourself into thinking that everyone does the right thing and that, just sayin’, someone’s business model might be encouraging repeat visits.
I shouldn’t need to remind you to stay on the right side of the line, but I do need to remind you to be careful with whom you deal because they might not be as careful about where that line is drawn.
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| | Wednesday - Collaboration as a Tool in Negotiation - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
In my practice, I see a tremendous amount of tension when it comes to the relationship between administration and hospital based groups. On one level, this tension results from the business relationship between them – the exclusive contracting process and especially the issues relating to stipend support.
Unlike some, rather than wish this tension did not exist, I find it rather healthy in that it creates a robust atmosphere for the negotiating process.
On another level, that of the operational relationship (perhaps better thought of as the “professional” relationship) between the hospital and the hospital-based group, I work hard with my clients to create not simply smooth, but “delighting” relationships.
However, those "collaborative" relationships are themselves a part of the negotiation process (for the renewal of the contract relationship) and can be used both passively and actively (e.g., “delight” as a weapon) to achieve the group’s and the hospital’s goals.
Over the years, hospital administrators have often manipulated the operational relationship in a quite aggressive way, setting up failure, triggering breaches, etc. My clients understand this and have tools to combat it. After all, this sort of behavior on the part of administrators simply indicates that they, too, share my long term view of what negotiation really is.
The relationship between a hospital-based group and each of the facilities at which it practices requires this long term view, something I've described as The Strategic Group Process™. Each of the touch points between your group and a facility, as well as between your group and other members of the medical staff and between your group and your patients and their families, is, in actuality, a part of the negotiation with the facility.
Harness your power to influence those relationships and transform your practice.
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| | | Listen to the podcast here, or just keep reading for the transcript.
You're undoubtedly familiar with the concept of surprise medical billing, the situation in which an out-of-network, hospital-based group, say an anesthesia group or radiology group, is working at a hospital that is in-network. Forget about freedom to contract: the law essentially pressures an out-of-network group to accept in-network, or worse, levels of payment.
Well, surprise! The concept of a surprise bill has spread. In early July 2023, the Biden administration proposed that there should be restrictions on hospital surprise billing.
But what’s a hospital surprise bill? Well, it’s something slightly different from the concept applied to physicians.
Apparently, it's the situation in which, for example, a patient, we'll call her Ms. Smith, goes to her cardiologist in January of some year for some test. The cardiologist bills Ms. Smith $300 for the test at the office. Ms. Smith comes back six months later, gets the same test, in the same office but now gets billed a few hundred dollars by the physician’s office and $1,000 by the hospital as a facility fee.
What! What facility and why a fee?
The answer lies in the fact that in the interim between Ms. Smith’s two visits, the cardiologist sold his practice to the hospital and the former medical office became a hospital outpatient clinic, i.e., part of the hospital facility. What do you know, “Suite 201” is now a “facility” and there’s now a facility fee.
Stories abound about these sorts of “surprises”. [The darkly funniest one that I heard concerned a patient who was billed a facility fee for a telehealth visit because the doctor connected to the call from a hospital.]
Before you start snickering or delighting in the schadenfreude of hospitals getting whacked with surprise billing prohibitions in the same manner as physicians, what’s sauce for the goose is not always sauce for the gander. That's because the Biden administration is not proposing a policy that would prohibit or put caps on these fees, but instead is proposing that hospitals should be required to disclose facility fees up front. I suppose that disclosure is better than no disclosure, but it’s not exactly the same "solution" imposed on supposed physician surprise medical billing. That bread's been buttered only on one side, and that side isn't yours. |
| | 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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