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Dear Friend,
Choices. Strategies. Futures. They're more flexible that most think.
When I was a kid, I had a Gumby. (Did you have one, too?)
In common with other businesses, medical groups often assume that deals and decisions are like on–off switches, yea or nay, thumbs up or thumbs down.
The truth is that although many view the world that way, decisions and paths are far more flexible, more fluid, more customizable. They are infinitely adjustable, like Gumby.
That’s where the value is: in the nuances within the design of a deal or of a decision.
That’s how you must think. Not black or white, not yes or no, not right or left, but green, rubbery and bendable — like Gumby.
For example, many physician groups believe that they are faced with the decision to remain independent or to sell. Yet that’s a binary question: “on” or “off.”
The reality is that there’s a plethora of other choices. For example, to name but a very few: merge with another practice, hire to expand, acquire another practice outright, capture the referral sources or contracts that presently benefit another group, and so on.
And then, within each one of those routes there are multiple alternatives and multiple ways to structure the deal or effort.
Need a reminder? Go buy a Gumby and put it on your desk at work or at home. Every once in a while, pick it up and play with it. (You still remember how, right?)
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| | Tuesday - Success in Motion Video: Platform Analysis in Healthcare
Watch Tuesday's video here, or just keep reading below for a slightly polished transcript: |
| | I want to talk with you today about a concept that I call a “platform analysis.”
As you’re probably familiar, the word “platform” has several meanings in English, but they all relate to the concept of holding something up, something that supports you.
So platforms can be political platforms. They could be platforms from which people dive into a swimming pool. They could even be platforms such as YouTube or even Google.
There are also platforms in the sense that your business is attached to them. So, you know, for example, a platform like Google on which internet marketers have hitched their businesses.
In fact, several years ago there was an event that internet marketers referred to as the “Google slap.” What happened was Google changed their search algorithm, and all of a sudden those long-form sales letter sites that were selling who knows what, weight-loss supplements and muscle-building stuff, were no longer appearing high in search results, and it significantly impacted – in fact, probably destroyed – many online marketers’ businesses.
We see that same kind of concept in the news today in terms of, well, YouTube or Twitter “de-platforming” someone because of their political views.
We also see it today in other news stories. Take the story of American Airlines and Southwest Airlines, both of which invested heavily in the Boeing 737 Max only to find out that that "platform" has some significant issues, leading to the grounding of their fleets.
So what does it have to do with you?
Well, whether you’re the leader of a hospital-based group, an office-based group, or someone who runs a healthcare facility, say an ambulatory surgery center or a chain of imaging facilities, you may be dependent upon a network: It could be a platform such as a hospital with which you have a contract. It could be a system-wide exclusive contract for imaging. It could be the platform of being on the provider network of a certain large payor that’s significant in your market.
You’re subject, just as were those guys who were marketing through Google or those folks who were de-platformed by Twitter, to the same sort of de-platforming: A hospital-contracted group can lose its contract, mooting its existence. A facility or a medical group that's dependent on being in-network can be devastated by being tossed out by the payor.
How have you taken care of analyzing your risky of being de-platformed?
What steps have you taken to reduce or minimize the impact of being de-platformed?
You must seriously question how dependent you are on any one such platform relationship.
If you’re like most medical group leaders, you have dreams of a bigger and better and larger future for yourself and for your group.
But if you’ve given the authority to someone else to moot your existence, to de-platform you, whether you’ve done it on purpose by saying you’re dedicated to only one system or facility, or whether you’ve done it by accident because you haven’t spread the business out as wide as you could, then you’re giving someone else permission to turn your dreams of a bigger and better future into a nightmare.
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| | | Wednesday - Medical Group Minute Video: Why Hope and Fear Drive (Stupid) Deals
Watch the video here, or just keep reading below for a slightly polished transcript:
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| I see too many deals that are hatched from the evil twins of self-inflicted human nature: fear and hope.
Fear, because those jumping into these ill-hatched arrangements believe that if they don’t take this deal, this job, this contract, another one won’t be offered to them, at least not anytime soon. Or that the other offers won’t pay as well. Or that they’ll have to move from Columbus to Cleveland. Or that, well, you fill in the blank.
As a result, they signal weakness. They forfeit all bargaining power. They simply sign on the bottom line. They sell themselves short.
And hope, because even though they know that their deal partner is untrustworthy, that he summarily terminates contracts, that he is a megalomaniac, they fool themselves into believing that he is going to love them so much that he’ll never do it to them.
They fool themselves into entering into deals that put themselves, their futures, and their families at risk.
Drop fear. There’s always a better deal down the road. Sure you may have to wait, but waiting and choosing gives you leverage.
And realize that the people you deal with generally tell you, in words or by action, who they really are. Accept it. And then just walk away. Far away.
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| | Thursday - Podcast: Another Hospital System Settles Whistleblower Allegations That Outpatients Were “Turned Into” Inpatients |
| Listen to the podcast here, or just keep reading for the transcript
Alchemists struggled without success for centuries attempting to turn lead into gold.
Will hospitals struggle that long in their quest to turn outpatients into inpatients?
Almost a year ago, in my post, Alchemist Can’t Turn Outpatients Into Inpatients For Less Then $18.3 Million, I wrote about the settlement, by Banner Health, of False Claims Act (a/k/a “whistleblower lawsuit”) allegations that it had submitted improper charges to Medicare, billing short-stay, outpatient services that should have been performed on an outpatient basis as if they were more expensive inpatient services.
Another failed alchemist just settled similar allegations in response to another whistleblower’s claims.
This time, it was Prime Healthcare Services, Inc. (“Prime”), headquartered in Ontario, California, and Prime’s Founder and Chief Executive Officer, Dr. Prem Reddy. On February 14, 2019, the Department of Justice announced that Prime and Dr. Reddy have agreed to pay $1.25 million in settlement (without admitting any wrongdoing) that two Prime hospitals in Pennsylvania, Roxborough Memorial Hospital and Lower Bucks Hospital, knowingly submitted false claims to Medicare by admitting patients to the hospital for overnight stays who required only less costly, outpatient care. Also involved were allegations that the hospitals billed for more expensive patient diagnoses than the patients had.
If you think the $1.25 was getting off cheap, consider that this settlement follows an August 2018 settlement of $65 million by Prime and Dr. Reddy (again without admitting any wrongdoing) of another False Claims Act suit brought by a different whistleblower.
Here are the takeaways for you:
- Just as lead isn’t gold, outpatients are not inpatients.
- No matter how large and sophisticated your healthcare organization is, mistakes, whether or not intentional, abound. Some result in improper claims, not just to Medicare, but to other federal health care programs (e.g., TriCare, health services for Peace Corps volunteers, Medicaid, Indian Health Services, and on and on). All are potential reasons for False Claims Act litigation, whether brought directly by the government or by way of whistleblower lawsuits.
- Most whistleblowers are insiders such as employees of the defendant entity. For example, nurse executives, physicians, facility administrators such as chief financial officers, and so on. In the Banner case, the whistleblower was a registered nurse who had worked for Banner as its corporate director of clinical documentation. In the recent Prime settlement, it was an employee and a former employee of Roxborough Hospital.
Contact me for more information on how your facility or medical group can take action to reduce the risk of whistleblower action or to discuss how your knowledge of improper claims can lead to the filing of a whistleblower action.
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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 here.
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| | | Come listen to Mark speak in sunny Las Vegas at the Advanced Institute for Anesthesia Billing and Practice Management Conference. Celebrating its 20th year, the AIABPM conference is the recognized leader in preparing physician and nurse leaders, practice managers, coders and attorneys to secure the future of anesthesia practices https://aiabpm.com/ |
| | | | 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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