| View this email online if it doesn't display correctly |
|
|
|
| |
Dear Friend,
Today is Presidents Day 2019. The three-day weekend holiday designed to honor Washington and Lincoln, the federal holiday’s name remains, legally, Washington’s Birthday.
Both Washington and Lincoln were exceptional. Thrust into lives that they wanted but didn’t want, from pasts of trial and error, and failure upon failure. Self-promoters whose careers didn’t follow a smooth arithmetic progression.
Instead of waiting to be chosen, they chose themselves. They knew their value and how to compete based on it.
You’re told to wait. That there’s some pot of gold at the end of the rainbow that someone else has painted. That employment by a hospital that can terminate you on whatever number of day’s notice (none?) is safer than an alternative in which you take entrepreneurial risk.
Washington, with little more than the 1700’s version of an elementary school education, became a surveyor. His brother, who commanded a local Virginia militia died, and Washington, with no military experience, talked his way into taking over the command. In one of his first skirmishes (in the French and Indian War) he was responsible for killing an ambassador, a serious protocol breach. He was then defeated in battle and signed a surrender agreement written in French, a language he pretended to, but didn’t, understand: it contained an admission of the protocol breach. He then resigned his command when he was passed over for promotion.
He later reentered the Virginia militia and served bravely but resigned once again when he was refused a regular commission in the British army. He married a rich widow and became a planter. In 1774 he was elected to the First Continental Congress. Then, in 1775, against his wishes, he was appointed by the Second Colonial Congress as the commander of all continental forces. He guided the colonists to victory and then resigned again. He was elected the first president but did not wish to serve a second term. He was drafted into a second term but retired rather than serve a third.
There was good money in being a surveyor in the mid-1700’s. Land use was expanding and surveyors were not only in high demand, they had the ability to purchase land that was well situated for an increase in value. Why didn’t Washington keep that job? It would have been very “safe.” But Washington knew his value.
As we all know, in the end, physicians bled him to death. But that was in December 1799 and there’s been monumental progress made in medicine over the ensuing 200-plus years.
How things have changed. Today, Washington has given hospitals the keys to healthcare, and the hospital administrators who tell you that hospital employment is safe are bleeding physicians to death.
Of course, that’s only if you let them. Will you?
|
| | Tuesday - Success in Motion Video: Who'll Be The First to Be Let Go If Case Volume Drops Off? - Rebroadcast Watch Tuesday's video here, or just keep reading below for a slightly polished transcript: |
| | I want to talk with you about a transfer of a concept from retail and wholesale inventory to hospital-based medical groups.
In inventory, there are concepts known by the acronyms LIFO and FIFO. LIFO stands for "last in, first out," FIFO stands for "first in, first out."
The concepts have to do with how a company accounts for the profit on the sale of its inventory. Let’s say they have 100 widgets in stock, some of which were purchased by the company for $1 each, and others of which for $1.50 each. When a widget is sold, how do you know whether the gain or profit is measured against the wholesale price of $1 or $1.50? If the system is based on FIFO, then the first (or earliest) widget purchased (at whatever its purchase price was) is treated as the first one that was sold, and so on.
The same notion of looking at the first one in, or at the last one in, applies to hospital-based medical groups in the context of the changes that are going on in healthcare, particularly in the context of the changes in the hospital industry, with an amazing number of hospitals shrinking or closing.
How does a hospital-based group of, say, 100 physicians account for whose work is going to be cut back, or who will have to be let go, when and if a facility they serve closes or drastically scales back?
Is it by seniority, in which case it would be that the last one in is the first one to go?
Or is it by some other method, say based on specialty?
What if your group's business has shifted focus to outpatient centers? Would a last in, first out policy suit the group's business goals if the recently hired folks are better suited to outpatient practice?
There are several issues here and there’s no easy answer. But, you don’t want to have the discussion or make decisions with your back against the wall.
You need to consider these issues now, because it takes time to come to tough decisions, to gain acceptance from the group's owners, and to incorporate corresponding provisions into your group’s employment and organizational documents.
If not, you’re simply asking for a lawsuit that will be far more expensive and difficult to resolve than dealing with this up front.
|
| | | Wednesday - Medical Group Minute Video: Hospital CEO Blames (almost) His Dog For Eating His Homework . . . I Mean Profits
Watch the video here, or just keep reading below for a slightly polished transcript:
|
| In a quote qualitatively similar to “my dog ate my homework,” a hospital CEO blamed an “aggressive, direct competitor” for the downturn in his facility’s patient volume. The drop in business led to a significant financial loss, a staff layoff, and a near scrape with Chapter 11 bankruptcy.
It seems that the aggressive competitor’s “crime” was that it “funnel[s] health care dollars into other communities and away from [the hospital CEOs facility].” Literal translation: The competitor runs a more efficient business.
Wow, competition! That’s breaking news, huh?
Other than knowing that the CEO has an accountability issue, here are some takeaways for you:
1. Healthcare is a business, whether everyone likes that fact or not. Even the purest desire to deliver patient care doesn’t result in much benefit if there are no patients to care for.
2. Hospitals have spent billions “aligning” physicians to create systems that are more financially fragile. High overhead including bloated administrative costs make them more susceptible to failure and to failing big.
3. There’s competition in all aspect of business, including the hospital business and within the business of medical practice specialties. Competitors don’t give a [bleep] whether you fail, nor should they. You’re fooling yourself if you think that there’s something inherently wrong with a competitor poaching “your” business. It was never actually “yours.”
4. Is your practice or facility operated as an actual business? If not, then how can you expect it to be able to compete? Download a copy of The Medical Group Governance Matrix.
|
| | Thursday - Podcast: 4.89 Billion (Dollar) Reasons for Physicians To Love Owning Surgery Centers |
| Listen to the podcast here, or just keep reading for the transcript
Yes, 4.89 billion reasons for you, if you are a physician who owns or is thinking about owning a surgery center (“ASC”). And, yes, each of them is green. Green as in a dollar bill.
That’s the dollar amount that the Centers for Medicare and Medicaid Services (“CMS”) estimates it will be paying ASCs in 2019. That sum includes an approximately $300 million increase to ASCs, many of which are physician owned. That might include the ASC that you've been thinking of forming.
Thinking's fine, but action’s better.
In addition to those 4.89 billion reasons, there are a few other incredibly interesting bullet points to note in regard to CMS's 2019 payment rules for ASCs:
• Reimbursement to ASCs will increase, on average, by approximately 2%.
• CMS added a total of 183 new codes to the list of procedures approved for ASC payment.
• 45 "surgery-like" procedures will be added to the covered list.
• On the interventional surgery front, 12 additional cardiac catheterization procedures will be added to the ASC approved payment list.
• And, very interestingly, instead of the historically applied, more general CPI-based adjustment formula, CMS is proposing to use the same "market basket" approach it uses to adjust hospital outpatient department (“HOPD”) rates in connection with 2019 payments, forward.
As the future of surgery moves from the hospital setting to the outpatient setting, ASC's are where the action is. Hospitals, and, increasingly, HOPDs, are where the action was.
Don’t be left behind.
The time is now to consider how you can legally profit from ASC ownership.
Look at it like this: You can finally say goodbye to all those folks in suits who have their hands in your pockets.
[Note: This topic was suggested by Cecilia Kronawitter of HDA Enterprises (http://hdaenterprises.net), one of the most experienced ASC developers in the country. Cecilia can be reached at cecilia@hdaenterprises.net.]
|
| | | | 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 here.
|
| | | | 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. |
| | |
|
