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| | Dear Friend,
Ah, hindsight. It's always 20/20.
Arguably, a Southern California ophthalmology group should have had its compliance eyes checked a few years ago.
According to a press release issued by the Department of Justice, Retina Institute of California Medical Group, a number of its physicians, its former CEO, and several related entities entered into a civil settlement, agreeing to pay a total of $6.65 million to resolve allegations that they defrauded public healthcare programs.
Among the allegations were that Retina Institute and the other participants billed for unnecessary eye exams, improperly waived Medicare co-payments, and violated other regulations.
The settlement arose out of a whistleblower complaint filed by . . . wait for it . . . two former Retina Institute administrators who will receive a to-be-determined share of the settlement funds.
Specific allegations against those settling were that bogus claims were submitted to Medicare and Medi-Cal in that simpler exams were billed as more complex, and that claims were filed for medical services that were not performed, that were unnecessary, or were undocumented in medical records.
In addition to Retina Institute, among those participating in the settlement were Drs. Tom S. Chang, Michael A. Samuel, and Michael J. Davis, former administrator Brett Braun, California Eye and Ear Specialists, and San Gabriel Ambulatory Surgery Center LP.
Note that the settlement is just that, a settlement of alleged claims, and none of the defendants admitted any liability.
The story, and others like it, underscore the fact that compliance is not simply a plan; instead, it has to be in ongoing set of behaviors. Additionally, medical groups and facilities should engage in a regular program of auditing, both internal (e.g., regular reviews and red teams) and, importantly, external audits.
If you learn only one thing from this post, understand that in compliance matters, foresight is always better, and a heck of a lot cheaper, than hindsight.
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| | Tuesday - Success in Motion Video: Would You Buy Your Own Business?
Watch Tuesday's video here, or just keep reading below for a slightly polished transcript: |
| | Let’s play a little car game. Now, not a speeding game, a car game.
If your business, no matter what it is – it’s an anesthesia group, a radiology group, a dermatology practice, whatever it is, an ASC – if it were for sale today, would you buy it?
In other words, if you were somebody on the outside, would you buy your own group?
Chances are, most of you wouldn’t. Now why is that?
It’s time for radical honesty here. Is your business performing as well as it should be? Is it returning as much profit to you as it should be? Is it being governed the way it should be?
Now, most people, if they’re honest (including myself, asking that question about my own practice) would say “Well, geez, there’s a lot of stuff I could fix.”
The question, then, is why don’t you?
You know, often we’re sort of stuck in a rut. We just keep doing business the way we’ve done it, because, well, that’s how we’ve always done it.
Or, maybe, you run your business or practice on a consensus basis and people just don’t want to rock the boat, so you haven’t rocked the boat. But is that really creating a business that is, in a sense, all it could be?
If your business is unattractive to you as an outsider, why is it attractive to you and your colleagues on the inside today?
There’s no right answer to this. There’s no wrong answer.
Just use that question as a strategic tool to help you focus your thinking and, maybe more than that, to help you focus your action.
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| | | Wednesday - Medical Group Minute Video: Not All Money is Green – Don’t Confuse Hospital Loans with Stipends
Watch the video here, or just keep reading below for a slightly polished transcript:
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| What does China's foreign policy have to do with hospital financial support? More than you'd think.
I recently read a news article about China’s efforts to expand its economic and political power into the regions west of its country, in particular into Afghanistan, Pakistan, and India.
As opposed to the model favored by the U.S., in which outright grants of cash, that is, foreign aid, is extended, China is loaning those countries billions of dollars to build infrastructure, but with a twist: the infrastructure is built out using Chinese companies, Chinese materials, and, in many cases, Chinese labor.
Instead of the result that China hoped to achieve, pulling Afghanistan, Pakistan, and India more into their political sway, it turns out that those infrastructure projects are putting those countries into significant debt and causing significant ire. Projects, such as light rail, are running way over budget and will never pay for themselves: The ticket prices that would have to be charged just to break even are way outside the budget of the local population, so usage will have to be subsidized, causing a loss on top of the fact that the countries will have to pay China back.
With many hospitals becoming averse to coverage stipends, some are proposing loans to help contracted groups meet expenses.
But, as Pakistan can tell you, the problem with a loan is that it has to be paid back. From what, is the question.
Take the case of a radiology group at a hospital at which the payor mix isn’t sufficient for you to make a go of it. Simply borrowing the money to meet payroll is solving your short-term problem of retention and recruiting, but exacerbating the long-term one, which is that you’re going to have to pay the hospital back with money that you don’t, and never will, have.
And, it’s highly unlikely that the hospital is just going to forgive the debt.
Don’t get yourself caught up in a mess like Pakistan. If you can’t profitably service a facility or some other practice site, and the problem is systemic and not merely poor temporary cash flow, you can never borrow your way out, not from a bank and not from a hospital.
Loans are not grants like foreign aid. Loans are not coverage stipends. Loans are just debt. Is that what you need?
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| | Thursday - Podcast: Marrying For Money – One Hospital’s Merger Urge Is Your Negotiating Lesson |
| Listen to the podcast here, or just keep reading for the transcript
Last fall, Milford Hospital, located in Milford, Connecticut, announced that it was exploring a merger with Bridgeport Hospital, part of Yale New Haven Health.
A week or so ago, Connecticut state legislators spoke in support of Milford’s request for required state approval of the merger, under the terms of which all of Milford’s employees would become Bridgeport employees.
After all, according to a report issued by the officials, “this partnership is necessary to save Milford Hospital….”
Reality Check!
“Merger.” “Partnership.” Both are nice words but, here, are simply nice euphemisms.
The deal between Milford and Bridgeport is structured as an asset purchase. Milford isn’t merging with anyone. Milford isn’t partnering with anyone. Milford, as an entity, is ceasing to exist. But yes, at least for now, the physical location will continue to be a hospital.
So what can you learn from this?
First, when you read about facility X or medical group Y “merging” or “partnering” with some other facility or group, don’t necessarily assume that they are breaking out the champagne. What appears to be a happy marriage may not be a marriage at all. What appears to be a date with destiny, rainbows, and unicorns may simply be staving off starvation.
Second, if you are ever in the position of needing, yes, truly needing to be acquired, you are not doing yourself any favor by letting the prospective acquirer know that closing the deal, or, euphemistically, “partnering up,” is necessary to save you. The more you need the deal, the less they need to pay you for it.
Think about it this way: If someone wants to marry you only for your money, would you jump into that relationship?
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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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