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| Dear Friend,
The coronavirus crisis has turned into a governance and structure crisis for many medical groups.
Good group governance, at least in theory and as borrowed from the publicly-held entity world, is often discussed as a balancing of issues, an avoidance of conflicts, and as giving credence to the interests of the providers of capital as well as to notions of corporate citizenship.
Great. But you’re not being tested by a business school professor whose only job has been as a business school professor. You’re being stress tested by the real world.
Do you have a structure that creates and fosters a single unified business?
Do you have a structure that, while giving shareholders or partners the right to vote (but not unanimity!) on “supreme” issues such as sale of the group, otherwise leaves decisions to a leader or to a small board?
Many medical groups are reacting to the crisis like threatened turtles; they’ve pulled their head and legs into their shells. Seemingly safe, they, like turtles, can't make any forward movement, any progress, without sticking their head and legs out; in other words, without acting decisively. So, the question is, do you allow your group’s leaders to actually lead, to take decisive action?
Does someone, or some small subset of someones, have not only the right, but the ability, to make tough decisions about the group’s future?
If the answer to any of those is “no,” then you’re damaging your future and aiding the competition.
It’s like you’re employed by Coke but wearing Pepsi T-shirts to work.
Stop it.
For assistance, including joining the queue for a governance audit, contact me now. |
| | Newsflash: Business Life In the Time of Coronavirus - Part 2
The coronavirus crisis has caused a short term economic crisis for many medical groups.
This video addresses the fact that, although it’s necessary to find solutions to short term problems, you can’t expect short term solutions to cure underlying long term structural problems.
The crisis is an opportunity to strategize for your future.
[If you didn't catch Business Life In the Time of Coronavirus - Part 1, click here to watch now!] |
| | Tuesday - Success in Motion Video: Exploiting the Hole in Big Data
Watch Tuesday's video here, or just keep reading below for a revised, more polished transcript: |
| I want to talk with you today about exploiting the hole in Big Data. There’s a lot of talk about how Big Data is going to revolutionize everything. Well, it might revolutionize a lot, but there are a lot of problems with the whole concept of Big Data.
First, and this is something I’m not really going to get into, is the problem of noise. You pick up a lot of data, you’ve got a lot of extraneous data. Believing that you’re seeing a pattern in noise is something that humans are very, very good at. That means that devices programmed by humans are going to be very, very good at that, too. But let’s not talk about that.
Let’s talk about something entirely different, and that’s the human side – the softer side, the psychological side – that will be completely missed because it can’t be represented in numbers. It can’t be collected and analyzed as say, the percentage of patients who develop some complication after getting a certain medication can. We’re talking about, in essence, issues that relate to value, which is subjective, to patient experience, which is subjective, to making referrals, which is subjective.
A lot of this relates to things I’ve addressed on the blog, such as the fact that chiropractors, who don’t use stethoscopes at all in connection with their practice, receive a much higher patient satisfaction score when they have a stethoscope draped around their neck when they come in to meet the patient.
Similarly, physicians who don’t wear lab coats get lower satisfaction scores on average than physicians who do. White lab coats drive higher patient satisfaction than blue lab coats. And, the comfortableness of waiting rooms and the length of the wait drives patient satisfaction, too.
So if we know all these things, what things can you do within your practice, even if it’s a hospital-based practice?
To play off of these notions of satisfaction, of valuation, what drives a higher value ascribed to you? Look at this not just in terms of your relationship with patients, but as to your "score" in the eyes and the minds of hospital administration.
It’s not necessarily, for example, in the context of an anesthesia group, how much you've reduced turnaround time, it’s not necessarily how quickly you deliver reports back to a referring physician if you’re a radiologist. I’m not saying those are not factors, I’m saying that the issues are far more complex and that the communication, the signals you’re sending along the way are perhaps equally as important.
Don’t limit your thinking about your strategies, about your image, about your business behavior to those things that are purely rational, to those things that can be measured. Think about other ways that you can leverage off of perception, other ways that you can create magic for those with whom you interface, for those upon whom your livelihood is dependent.
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| | Wednesday - The Impact of Change on Your Medical Practice
Watch the video here, or just keep reading below for a slightly polished transcript:
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| The common belief, and it may be quite true, is that change is the greatest cause of stress. But what if it can be used to your group's advantage?
In the mid 1980’s there was a well known West Coast billing service that told its clients that they had only follow three simple rules to obtain success: Do the cases. Turn in billing information. Go home. Then, they would be paid.
Fast forward to today. Far too many physician groups have a business model based on that same philosophy. As the writer Robertson Davies said, “The world is full of people whose notion of a satisfactory future is, in fact, a return to the idealized past.”
Today, it seems as if change is accelerating at a faster and faster pace: ACOs, government interference, fraud and abuse witch hunts, your services as someone else's "right," national groups poaching your opportunities, hospital-centric healthcare, and a "system" not a market – these are just some of the bats hitting you as you run the gauntlet of daily practice.
But change in the healthcare industry has always been a given. It's how you and your fellow group members react to the change that makes the difference.
If the change is feared – the fear of the unknown – then indeed it is a major cause of stress. So,if your group does nothing but engage in business as usual, then you will undoubtedly be victim to the winds of this change and, eventually, will be shipwrecked.
On the other hand, if you view the winds of change are presenting new opportunity, the opportunity to engage in practice in a way that previously, for ethical reasons or image reasons or economic reasons, was viewed as inappropriate, then change changes from fear to fuel.
The French got it wrong: The more things change the more things change. Use change to your advantage, to your success, and to your profit.
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| | Thursday - Podcast: A Not So Love Triange: When PE Met AKS Who Met Stark? |
| Listen to the podcast here, or just keep reading for the transcript.
It’s not quite when Harry Met Sally.
As you certainly know, there’s been a flood of investor money, notably private equity money, it into many medical specialties over the last decade.
Depending on what specialty you’re in, private equity investment is just beginning to ramp up.
For example, I’m seeing, both here at the law firm and at our M&A advisory firm affiliate, an uptick in deals in dermatology, ophthalmology, and orthopedic surgery. To use a sports analogy, in some medical specialties, the game is just getting started.
There are many factors that make your practice an attractive candidate for private equity investment, but that’s not what this post focuses on.
Instead, it’s essential, whether or not you ever plan on doing a private equity deal, to know what makes a practice completely unattractive to any buyer: potential compliance problems, in particular, potential violations of the federal Anti-Kickback Statute or of Stark.
Too many physicians approach compliance problems from the “who’s going to know” perspective. As I’ve written many times in the past, you’d be surprised (as in one of your partners or even an employee in the billing office).
But here, in the mergers and acquisitions context, the “how” has an actual name. It’s called “due diligence,” the investigation of the quality of the to-be-acquired entity that includes a proctological look into potential compliance issues.
The presence of unresolved compliance issues can easily result in a dead deal. And, even if it doesn’t, the representations and warranties – the risk allocation provisions – of the acquisition deal will shift responsibility for undisclosed, pre-closing compliance issues back onto you, the seller. In other words, that planned trip to a faraway tourist district might be swapped for an unplanned trip to District Court.
Whether you’re interested in a potential sale of your practice now, in the future, or never, the first step is always the same and should be taken now: Commission a “red team,” a self-sponsored, deep dive into your group’s compliance risks today. |
| | | | 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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