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| Dear Friend,
You’d have to be high to think you could get away with it.
That's the subject of this past Monday's blog post, Four Doctors, $150 Million, And 6.6 Million Doses of Opioids. What Could Go Wrong? Follow that link to the blog or just keep reading for the rest of the story:
“Oxy.” “OC’s”. “Oxycet”. “Oxycotton”. “Hillbilly heroin”. “Berries”. “Killers”. “Percs”. And, “roxi’s”.
Those are all street names for the same drug, a drug with a useful purpose but a drug that is purposefully overused: oxycodone.
In a scam that would make even the other quid pro Joe blush, Joe Betro, D.O, together with Mohammed Zahoor, M.D., Tariq Omar, M.D., and Spilios Pappas, M.D., were found guilty on February 4, 2020, of a $150 million health care fraud scheme in which they forced “patients,” many of them drug dealers or addicts, to undergo expensive, medically unnecessary back injections, as a condition to writing prescriptions for oxycodone and other opioids.
Over the course of the conspiracy, the four convicted physicians, together with 17 other defendants, of whom eight were physicians, all of whom previously plead guilty, were said to have prescribed over 6.6 million doses of opioids. They regularly passed out prescriptions for sky-high dosages of oxycodone meant only for the terminally ill.
But wait, there’s more. Among ordering a plethora of other unneeded and unnecessary ancillary services, all those drug taking “patients” had to be urine screened for drugs — actually, for 56 different drugs for every patient at every visit, regardless of the reason for the visit.
The defendant docs entered standing orders for urine tests for each patient’s every visit, with the tests performed at a lab owned by one of the defendants. The lab then kicked back tens of thousands of dollars to the ordering docs.
On the upside, if you can call it that, the four convicted physicians were fast workers. In a process described at trial as an “assembly-line”, the defendant doctors ranked in the top 25 doctors for dollars paid by Medicare for facet joint injections even though they only worked a few hours a week. Not satisfied with that portion of the “business,” they magically inflated the 15 to 25 patient visits of their 2 to 4 hour shifts, billing Medicare for office visits and procedure codes indicating that they spent as much as 2 hours and 22 minutes with each patient.
Lest you somehow believe (well, perhaps only if you were a patient of one of these fine fellows) that this mess was due to back office clerical errors, the U.S. Attorney reports that every piece of the fraud was consistently implemented and applied to over 94% of their patients.
It almost goes without saying to suggest that you think hard before getting into any arrangement that comes anywhere close to what these doctors did. Yet, in the last decade I’ve seen multiple instances of similar conduct. To be sure, each one came with an “explanation,” if you want to call it that . . . most would call it self-deception.
Depending on inflection, the term “criminal lawyer” can mean one of two things. “Criminal doctor” has only one meaning. The four criminal doctors are scheduled to be sentenced in July. |
| | Tuesday - Success in Motion Video: Profiting from Climate Change
Watch Tuesday's video here, or just keep reading below for a revised, more polished transcript: |
| It's a gloomy day here, but yesterday it was sunny and in the 70s. Today, it's in the 40s. The climate has changed.
We can look at climate change in terms of medical groups in a couple of ways.
One, we could look at it as the need to prepare for changes in the climate, the changing business climate.
But I’m thinking of another angle for you today and I want you to hang on and consider this.
Instead of being reactive, instead of thinking about changing as required by the business climate, the healthcare industry climate, think about becoming the climate and doing the changing.
What do I mean?
So many medical groups in whatever specialty, whether we’re talking office-based specialties, or hospital-based specialties, just do what every other group in their field does. They benchmark to best practices, which as you know if you’ve read any of my stuff, I believe is simply saying “I’m mediocre, I just do what everyone else does.”
Or, they even try to be perfect at what they do, but perfect itself is a destination. It is having “arrived," when the key isn’t being perfect and having “arrived,” it is continuing to experiment and continuing to improve.
Some physicians in office practices, in particular I’m thinking about primary care doctors who are leaving hospital employment and returning to private practice, aren’t just doing what the best private practice groups do (they don’t want to be just another "also ran"). Instead they’re doing something very different. They’re setting up consumer-focused clinics. They’re setting up twists on concierge care at varying price points. They’re not mimicking, they’re iterating.
Many of you, especially those in hospital-based practices and hospital-based specialties, where I’ve spent a lot of time with my clients, have practices where if you changed the name and threw out the ownership, they'd be the same.
In defense, they say they’re commodities. But I’ve always said stop being a commodity; deliver something different.
There are different ways to do that, too. There are ways of being organized “different.” There’s adopting a strategy and then adopting a structure that follows that strategy, as opposed to sticking to the “normal” strategy or structure that your competitors have.
It's simple but it’s not easy.
Think what you could do to break the mold and do something truly different to compete on a different level.
I don’t have the answer to spit out on this recording, but twists are out there. Doing things differently is out there. Find what that means for you. Do it and then continue to change.
Or, you will truly be "benchmarked to best practices" and that, mediocrity, is not where you want to be. |
| | Wednesday - Sexual Harassment Is In The News, Make Sure Your Group or Facilities Name Isn’t Included
Watch the video here, or just keep reading below for a slightly polished transcript:
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| From Harvey Weinstein to Al Franken to, now, a well known physician at Fenway Community Health Center, the Boston institution known for its pioneering care for LGBT patients, allegations of sexual harassment and bullying are surfacing on what seems to be a daily basis.
Even if the allegations aren’t aimed at you, they pose significant challenges for your medical group, facility, or organization.
Take the Fenway Community Health Center situation, for example. Last week, the Boston Globe initially reported that the health center’s CEO, Dr. Stephen L. Boswell, resigned, after 20 years in the position, under pressure from the board of directors. Then, the paper reported that Fenway’s board chairman, Robert Hale, was out, too.
The events center around years of sexual harassment allegations against Dr. Harvey J. Makadon. Makadon had allegedly sexually harassed at least three male co-workers and had “yelled at and belittled” male and female staff members. Dr. Makadon denies the allegations. He’s said to have resigned from the facility.
The Globe uncovered the fact that Fenway engaged legal counsel twice over the last four years relating to allegations against Makadon. In connection with the second instance, the CEO apparently ignored the law firm’s advice to terminate Makadon and didn’t report the matter to the board. The Globe also reports that the CEO didn’t tell the board about a $75,000 settlement paid to a former employee in connection with the allegations.
What’s your entity’s policy on harassment? Does it have one?
What action do you take to investigate?
Who conducts the investigation?
What rights do both the accuser and the accused have?
What steps do you take if the allegations are found to be true?
An investigation gone bad, or bad decisions made during and after a proper investigation, have an impact far beyond that on the accuser and the alleged. The easiest way to keep your name and that of your organization out of the press is not to do things that would get it in there in the first place.
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| | Thursday - Podcast: Repurposing A Failing Or Closed Hospital |
| Listen to the podcast here, or just keep reading for the transcript.
Almost every day, the story repeats itself. Another bankrupt or closed or closing hospital. Often the infected facility is rural. But sometimes it’s not.
Recently two such stories caught my attention.
The first of the infected hospitals is limping along and about to close. It’s located in a rural community. It’s actively looking for proposals from someone who can take it over.
The second is a closed facility. It’s issued an RFP, looking for proposals from buyers to, they hope, reopen the place as a hospital (probably a bad idea), or to take it over and convert it another sort of healthcare facility – which is a tremendous idea, if, and it’s a big if, the situation is right.
For example, what’s the population in the community? What are the demographics? How many physicians are there? How many procedures are those physicians performing? Can those procedures be performed at a surgery center? And so on.
My point is that while the notion that I call The Impending Death of Hospitals (download my complimentary book by that name here) is impacting hospitals of all sizes (certainly small hospitals very hard), some of their physical shells are built out close enough to the specifications for another type of healthcare facility. That makes a conversion a very manageable project, whether it’s a conversion for a single facility or for a multi-facility “medical mall.”
If this interests you, start paying attention to the news. You’re going to see a lot more of these types of properties becoming available. Then, let’s talk about what’s involved its conversion to a facility owned by you.
It’s not a question of how to do it yourself, it’s knowing who can do it for you and with you.
Hope to hear from you soon. |
| | | | 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 on June 5, 2020, at The Advanced Institute for Anesthesia Billing and Practice Management.
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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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