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Dear Friend,
This past Monday's post featured some thoughts on Labor Day. Read it on the blog at Laboring On [About] Labor Day or just keep reading for the full post:
[Today, I’m waxing philosophical. If you want to wax along with me, then keep on reading. If not, then please peruse my other posts instead.]
This post, an annual classic, was originally written and published on September 5, 2016, Labor Day in the U.S.
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Originally proposed by union leaders, Labor Day commemorates American workers. Just as unions have mostly outlived their usefulness to all but union leaders, Labor Day has become a day for barbecues, family gatherings, and just plain old fun.
Some claim that there is a thing called “work-life balance.” My opinion is that we have only one life (I’m not betting on reincarnation) and that work is an essential part of it. It’s a main driver in why we’re here. Work gives us a purpose in life.
I’ve often heard people say things akin to “I have four years left,” in reference to the time until they “retire.” I shake my head in wonder, both because it seems to me as if they’re talking about a prison sentence (i.e., four years until parole) and because it seems as if they believe that work is getting in the way of some idealistic “life” that hasn’t yet begun.
I’m certainly not advocating that you work, work, work and have no fun, for what is life without fun. I believe that we should approach work and non-work as building blocks for your day. You not only have to work smarter (do the right thing) but there’s no getting around the fact that you also have to work harder.
I can almost guaranty that your competitors are not just sitting around the pool today, they’re also doing some thinking about how they can snatch away your opportunities. Even if I’m wrong and they’re all floating around on inner tubes, it’s even more of a reason for you to outwork them into the ground.
I took some time off this morning. Now I’m about to get back to work preparing for a meeting. After all, it’s Labor Day.
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| | Tuesday - Success in Motion Video: Solving the Physician Retirement CrisisWatch Tuesday's video here, or just keep reading below for a slightly polished transcript: |
| | Thanks for joining me today, because together we're going to solve the physician retirement crisis.
You haven't heard about the crisis?
Well, obviously as the baby boomer generation is getting older, there are more and more physicians using the “R” word – in my estimation, the “R” word is worse than the “F” word. The “R” word – retirement – is basically a signal to God, to the universe, however you want to put it, to take the parts back.
I can’t tell you how many physicians I’ve known who’ve retired only to die shortly thereafter. Just like other clients who sold their businesses, lost purpose, and then, well, dropped dead.
I know that many disagree with me. They think retirement is some sort of goal. They’ve fallen for the notion of the “golden years”, blah blah blah, and so they are letting their colleagues, and their medical groups, know that they are going to be retiring soon.
Now, certainly, I understand that if a physician is losing his or her skills, if they’re in a specialty that requires very small motor movements – placing needles, for example, or using a scalpel – and their hands are beginning to shake, well that’s another story.
But that’s not what I’m talking about. I’m talking about the choice that physicians make to retire. Why are they making that choice to retire? Is it that they actually want to stop working, which is the assumption. Or is it actually something else? What underlies the “why”?
For many, it’s that they want to slow down. They don’t want the same level of intensity. But if that’s really the underlying “why,” perhaps the assumption made by the group, that someone is either in or out, can change.
Why would it change? Certainly, some medical groups function like accounting firms, where the older partners are pushed out because, if you look at the numbers, it makes sense to push them out . . . there’s more money left for the younger partners.
But is that really the case if, for a medical group, what’s walking out the door is the relationship with the hospital CEO, what’s walking out the door is the twenty years of experience as the group’s president? Is it really a savings to have that person leave? Or is it actually something that’s going to cost you money?
On paper the first year or the second year after the "retiree" gone, it certainly looks like you saved money because their compensation is no longer a drag on the group. "Hey! Extra money in the bank!"
But is it really extra money in the bank if you lose key relationships that were putting all of the money in the bank?
The issue then becomes considering ways of repurposing people who would otherwise completely retire.
One client and his group found the solution: to share positions so that physicians who certainly had their skills, but desired to slow down, split a position. Two physicians sharing one role.
Other groups have looked at situations in which more than two physicians would share one role. Yes, there are issues. Do those physicians retain their full voting power? Do those physicians receive whatever other benefits the group gives its owners, for example extra year end distributions from a profit pool? All of those issues can be solved.
What I want you to focus on from the group’s perspective – and I suppose if you’re one of those physicians who’s about to retire, from your own perspective – is what retirement really means. What's it mean to the individual? What's it mean to the group? How can skills and relationships that would otherwise be lost, still be harnessed? |
| | | Wednesday - Why You Must Know About A University’s Captive Medical Group Filing Bankruptcy – Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
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| On November 7, 2018, the medical group affiliated with Michigan’s Wayne State University Medical School, University Physician Group, which does business as Wayne State University Physician Group (“WSUPG”), filed Chapter 11 bankruptcy.
How is that even possible, you ask? After all, you were told that there’s safety in what is essentially hospital employment.
Well, it’s not only possible, it’s likely the tip of the iceberg, not only for “stand alone” captive physician groups like WSUPG with its 873 employees, but for entire hospital hospital systems made more fragile, not stronger, by their size.
Hospital systems across the country suffer from bloated fixed costs, huge payrolls, layers and layers of bureaucracy, and management by managers, not by entrepreneurial thinkers.
Instead of bringing what the proponents of hospital-centricity promised would be stability, the actual result is becoming much different: The larger the hospital-centric system is, the more sensitive it is to declining payments from private payors, and the movement of procedures out of their facilities to freestanding, and often independent facilities, from clinical laboratories, to imaging facilities, to ASCs. And now, the federal government is getting increasingly into the act: It has cut reimbursement to hospital outpatient clinics, and has signaled its decreasing support for outpatient surgery performed in hospital outpatient departments (“HOPDs”)as opposed to in freestanding ambulatory surgery centers.
Hospital employment was hardly ever a good deal for any physician. The difficulty in holding a hospital together is tough enough. The difficulty in holding a hospital system together is even greater.
But both pale in comparison to the challenges of holding a hospital system plus its directly or indirectly employed physicians together. A shock that could have been absorbed by the pure hospital-side of the business can be fatal to the enormously expense-ridden hospital-plus-physician structure.
Why You Need to Know
1. Employment, directly or indirectly, with hospitals is far from “safe.” In fact, it may be far riskier for physicians.
2. In the event that a tightly aligned physician group fails, the employed physicians have no offices, no patient records, no staff, no “nothing” readily available to them to re-start independent medical practice.
3. For outside groups, the failure of a hospital-controlled medical group presents the ability to cherry pick physicians who may be desperate for quick reemployment. That is, unless those physicians are barred from accepting employment in the area due to ill negotiated covenants not to compete, assuming that they are enforceable.
4. The failure of a hospital-affiliated medical group will disrupt referral patterns, presenting opportunities on both the services-side and the facility-side for independent physician practices and their affiliated facilities.
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| | Thursday - Podcast: Fraud on Physicians in the ASC Setting |
| Listen to the podcast here, or just keep reading for the transcript
As the shift of surgeries from the hospital setting to the ASC setting accelerates, we’re seeing more fraud at the ASC level.
No, I’m not talking about the significant amount of fraud that comes from the “usual suspects,” criminal operators who bill for medically unnecessary procedures, for procedures that never occurred, and so on.
Instead, as more physicians rush to invest in ASCs, unscrupulous facility promoters/managers scheme to separate physician investors from their money.
This fraud on physicians takes various forms, from securities fraud arising from misrepresentations, failures to disclose, and outright disregard for federal and state securities regulations and the exemptions therefrom, to sophisticated (and even Clouseau-like bungled) financial fraud on investors within the facility’s business operation.
“Compliance” in terms of investing in a surgery center is generally thought of as paying attention to the federal Anti-Kickback statute, state law referral prohibitions, and similar concerns. However, for physician investors it’s equally important to pay particular attention to vetting the overall structure of the deal and its promoters, the past history of the center’s operations, and the conflicts of interest and related-party dealings of those purporting to “manage” the facility.
Think of it this way: The last time I checked, a “physician-money-ectomy” isn’t on the Ambulatory Surgery Center Fee Schedule.
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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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| | | | 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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