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| Dear Friend,
Originally published in 2015, this is one of my most popular posts in terms of contacts from clients and friends of the firm. Plus, it makes me smile when I read it. You’ll smile, too, which makes the lessons even more valuable. – Mark
I still remember the smile on Steve Cunningham’s face.
High School summer vacation. Thoughts of sand, sun, and surf.
Yet back to reality. We were applying for jobs at Magic Mountain, an amusement park. Employees got free passes to the park.
Out from the interview he came. “Ride operator!”
Now it was my turn! What job would I get? Roller coaster? Spinning bucket?
Fifteen minutes later, due to my “valuable experience” at McDonald’s the previous summer, it was “cook.”
Apparently, anyone (or so I told myself) could put someone in a roller coaster car, but few could cook hamburgers and fries, and, thanks to my mom’s training, could also make tacos, burritos and pizza.
Yet that summer was a petri dish of customer service and other business education. Here are 4.5 of the lessons that I learned:
1. If you hire right, people don’t need to be “managed.” They are not horses. They need to understand what it is they are supposed to do. They need initial training. Then they need to know that their supervisor has their back, assuming they’re doing the job within acceptable parameters. If they stray, guide and repeat.
2. Customers can be rude and make messes (like stomping on ketchup packets). Yet without customers there is no business. So smile and be kind. But if they’re drunk and throwing things, call for security.
3. Employees will screw with one another. One guy had the habit of throwing ice cubes into the fryer. Get rid of the troublemakers before someone is burned by flying grease. You’ve failed at #1 above, but at least you can succeed at #3. It’s very easy.
4. Ice machines make cool water not ice cubes when the temperature inside a restaurant approaches that of the sun. Things break and go wrong. You need to learn to expect it and must have plans to deal with it.
Oh, and number 4.5: Free isn’t always free. A free pass to someplace that you spend 40 hours a week at isn’t free. It’s a reminder of broken ice machines, scorching heat and rubberized blobs of ketchup. Think how you’re motivating your employees.
After that summer, I went to Magic Mountain two or three times. It was’t too much fun.
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| | Newsflash: Business Life In the Time of Coronavirus - Part 3
The coronavirus crisis has caused a short term economic crisis for many medical groups.
This video addresses seven immediate steps that medical group leaders can take to help cure their group’s economic crisis resulting from the coronavirus crisis. 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 haven't already seen them, follow these links to watch the first two installments in the series, Business Life In the Time of Coronavirus - Part 1 and Part 2 now!] |
| | Tuesday - How Physician Alignment Destroyed Hospital-Physician Collaboration
Watch Tuesday's video here, or just keep reading below for a revised, more polished transcript: |
| Over the last fifteen or so years, as hospitals have pushed to align physicians, hospitals have begun dying. Is alignment the cause of the death of hospitals?
It’s certainly not the sole cause. In fact, it’s probably only a small cause, but it is a cause nonetheless. Let’s think about why.
Hospital alignment is a very different concept from hospital-physician collaboration. The collaborative system is what enabled hospitals to become what they are today, to grow through an affiliated, not employed, medical staff, on which physicians were either completely independent or were independent within the context of groups, the groups being independent of the hospital.
As hospitals pushed for financial control over physicians under the guise of alignment, that alignment, that employment, that contracting, came packaged with something that never existed before: a term, and an end of the term, a 90-day termination, or maybe even without-cause termination.
What signal did that send?
Knowing that you’re in a relationship that can be terminated on rather short-notice from the hospital sends a very different signal: it’s a very different relationship than a relationship that was collaborative, that once it’s begun, other than by reason of perhaps a physician’s error, meaning a medical staff reason, continued as long as the physician wished it to continue.
Have hospitals simply sent physicians the message that "alignment" is a temporary relationship? And, if indeed it is a temporary relationship, who wants to "collaborate" under those circumstances?
So-called "alignment" is backfiring and that's helping lead to the impending death of hospitals.
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| | Wednesday - I Can See Clearly Now. Ophthalmology Group Settles Fraud Claim
Watch the video here, or just keep reading below for a slightly polished transcript:
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| 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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| | Thursday - Business In The Time of Coronavirus - Part 1 |
| Listen to the podcast here, or just keep reading for the transcript.
Thanks for joining me for some actionable business lessons from the coronavirus crisis.
The crisis, especially as it's become politicized, raises a number of business issues and, quite frankly, business opportunities in regard to future disruptive events.
We’re going to look at 4 items, the first 2 of which are longer term planning issues and the latter 2 of which are immediately actionable.
For our first item, if you don’t already have it, consider whether your next business insurance policy should contain tailored business interruption coverage.
In general terms, business interruption insurance is tied to physical damage to the business’s property. Some coverages apply to similar interruptions to a business’s customers or suppliers’ businesses. Most policies therefore turn on whether or not the damage is physical. It might, just might, be possible to assert a claim that coronavirus damage is physical, and it should certainly be investigated. So, too should other potential claims. But there are policies that do cover interruptions due to communicable or infectious diseases and which are not dependent upon physical damage. There is also freestanding communicable or infectious disease coverage. Think ahead to next time and, of course, check your current policy.
Let’s move on to item number 2. Should there be a crisis component for future “hazardous duty” working conditions? This is both an intra group issue impacting your group’s compensation plan, and, importantly, a bargaining point in connection with exclusive contract negotiations, that is, in connection with coverage stipend support. There are analogous valuation issues in connection with governmental workers who are exposed to hazardous organisms during the course of their work. In other words, it’s possible that a valuation analysis would support a hazardous duty multiplier provision. But it’s never going to happen unless you push for it in the context of your next negotiation with the facility.
Moving on to some immediately actionable issues, our third point is that I’ve noticed that some facilities are apparently using the current disruption to make dramatic shifts in contractual relationships. They signal that they need to put strategic discussions on hold, yet appear to be internally speeding up the process, including terminating exclusive contracts and reevaluating stipends.
It’s a prime example of the strength of the OODA loop, a strategy tool devised by Col. John Boyd, whom many widely consider to be the second most brilliant military strategist to have lived, second only to Sun Tzu, the author of The Art of War,
Boyd was an Air Force fighter pilot at the beginning of his career. He quickly gained the nickname “40 second Boyd” because he had a standing bet that in aerial combat training with a practice opponent it would take him 40 seconds or less to outmaneuver the opponent, getting into position behind the opponent’s tail, to be able to shoot the opponent down. In the years that he flew fighters, he never lost one of these bets.
As his career advanced, he began to see that the process that he used and developed in connection with aerial combat -- Observe, Orient, Decide, Act – OODA for short - was directly applicable to military strategy in general. That same structure has direct applicability in business, as well.
To be complete, the loop is more than a simple progression, there are internal feedback loops within the larger loop.
The power in the OODA loop comes from two sources. First, from the structure itself, that is, from the order of the process: Observe, Orient, Decide, Act. And, second, as the most important variable, from the pace of cycling through the process.
As Boyd proved, the faster you cycle the more in control of your situation you become. And, the opposite is also true; if you allow the hospital or any contracting opposite to get inside of your OODA loop, then you’re shot down, dead, metaphorically speaking of course in the contracting context, but, perhaps, metaphorically speaking, just as finished off.
That brings us to the fourth and final issue, one that is related to the prior point: Many of my clients are, of course, heavily impacted, some positively and some negatively, by the coronavirus situation. But no matter which way the crisis has impacted your practice, it’s not the time to be lulled into thinking that “things”, business “things”, of any sort, are actually on hold.
Sooner or later this crisis will end. You can’t lull yourself, or even be too busy, too occupied, too concerned with current events, to not devote time and efforts to strategizing for your future.
Let me know if you have any questions. Stay well. Stay strong. Stay strategic.
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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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