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| Dear Friend,
Petty bureaucrats.
A few months ago, while waiting at the gate for a flight, I couldn’t help but notice a gate agent making some woman unpack and repack and unpack and repack her expandable carry-on suitcase because it was too wide to fit into the measuring “box” for carry-on luggage.
It was obvious from the gate agent’s face that she took sublime pleasure in the exercise of her “power.”
When I commented to her a few minutes later that I next expected her to make the woman remove her underwear, she responded, “no one gets on my flight unless I say so.”
The reality is that such mini-dictators, the peons of bureaucracy, are nearly replete of any actual authority. Frustrated by their inability to control their destiny, they act out their near total lack of authority by overcompensating within the one slice of power they have – in this case, the power to drive a woman close to tears because her suitcase had to be pushed into the measuring device instead of sliding right in.
You’ve run into these people. They’re at the DMV and the post office and the TSA.
And, they’re at hospitals: The petty midlevel “executives” who occupy places on an org chart that looks like IBM’s in the 1960’s or a plate of spaghetti. They are the bureaucrats who can say “no,” but who lack any authority to actually say “yes.”
Lord Acton commented that power tends to corrupt, and absolute power corrupts absolutely. It appears that the lack of actual power does the same.
The quiver required to effectively deal with these people includes multiple arrows. Some are polite, others are political, and more than a few are pointed. An effective strategy involves knowing when and how to get the petty bureaucrat to open the gate, when and how to get around him, and when and how to get him pushed out.
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| | How to Deploy the Secret Sauce of Opportunistic Strategy - Webinar
They say that COVID-19 has changed the world, creating the "new normal." Many of your colleagues and many hospital administrators are running scared.
Others, leaders like you, know that crisis means opportunity.
Let me provide you with the strategic tools and insights that you need in order to seize opportunities, whether they’re in the context of your current business relationships, the expansion of your business activities, or the creation of new ventures.
Join me for a live webinar event on June 25, 2020 at 4pm Central. Only by participating will you learn:
•Defense as a defective default: It’s necessary, but not sufficient.
•Exploiting weakness: Drop the guilt and identify opportunity.
•Flat line negotiation is fatal: Understand its myths and limitations.
•Negotiation reality: Learn to identify and deploy on multiple planes to affect the outcome.
•Maneuver: Harness the power of maneuver, both in overall strategy and in specific negotiation strategy.
Others see a crisis and freeze in fear. Learn how to see the opportunities and obtain the tools to increase your odds of obtaining them.
The price to attend is $479. The cost of not attending is astronomical.
In order to respond to live and emailed questions, attendance is limited.
You'll receive a recording of the webinar if you can't attend live. |
| | | | Business Life in the Time of Coronavirus Mini-Series
The coronavirus crisis caused a short term economic crisis for many medical groups. Our mini-series shows you the way out. Plus, many of the concepts discussed are applicable during both good times and bad.
[If you haven't already seen them, follow this link to watch our entire series.] |
| | Tuesday - If You Thought Covid-19 Was Bad for You...
Watch Tuesday's video here, or just keep reading below for a revised, more polished transcript: |
| So the coronavirus, COVID-19, the economic impact of it, caught you off guard. And, if you’re the leader of a medical group or a facility (a surgery center, an imaging facility, or even a small hospital) then, like most others, it knocked you for a significant loss.
But what other things lurking out there – negative and potentially positive – haven’t you planned for? What haven’t you thought about in terms of structuring your group, in organizing the group, and in fashioning the compensation system?
Let’s talk about some scenarios. This relates to my process which I call the Scenario Survey Process™, which is a look at all the potential situations and at all of the types of potential situations that you can come up with. Each of those is a potential future. The next step is figuring out how to make changes to your group, to strengthen it and to make it far more resilient in as many of those potential futures as possible.
Let’s talk about some real-life examples. The coronavirus crisis, the economic crisis for entities, is a temporary crisis. In other words, the crisis is going to subside, and it is subsiding. Case volumes are picking up. Elective cases are now being performed, perhaps at a slower pace, but they are back. All good, but many are not out of the woods yet.
But there are other types of circumstances that have happened to client groups that have had far more lasting impacts, and others which would have had longer lasting impacts but for the taking of quick action, and but for the strategy of “planning ahead" for those scenarios.
What if you’re an office-practice physician -- let’s say you’re a plastic surgeon with an office on the hospital campus. What happens if the hospital closes? I’ve had this happen to multiple clients. One day the hospital is there, the next day, it’s boarded up. And we’re not talking temporarily boarded up due to a riot; the hospital is completely closed for good. Those nice planters in the parking lot are now filled with weeds.
What does that do to your practice when someone is coming for plastic surgery and your office building is sitting there in what looks like a disaster zone? The answer is, of course, that's it’s not good.
Had you thought about that scenario up front, you would have thought about provisions in your lease that would allow you to terminate if the hospital closed. We would have thought about what type of notice – if the building were owned by the hospital – you had to be given before the hospital boarded-up. You would have thought about what your alternatives are and how you could have made a quick transition.
What about a hospital-based group that held an exclusive contract with that hospital – the same one that just boarded-up. How would your practice be doing if that were your only practice site? What if you ran a radiology group, with a single exclusive contract with "Hospital St. Boarded-Up"? There would no longer be any reason for your groups’ continued existence.
The process involved, the Scenario Survey Process™, that I’m discussing here, is one in which we look at multiple scenarios, both good ones and bad. We then review your corporate documents and adjust your strategy in line with those scenarios.
You come out the other end with a plan of what to do in terms of your organizational documents, governance documents, employment agreements, partnership documents, and so on to make your group not only survive those events, but thrive in those events; just like clients that I have today who are now on the hunt for acquisitions at very favorable prices, because almost everyone else in their specialty is running scared. |
| | Wednesday - Solving the Physician Retirement Crisis
Watch the video here, or just keep reading below for a slightly polished transcript:
You'll feel good about yourself today because, together, we're going to solve the physician retirement crisis.
What, 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, "retirement."
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, 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 otherwise healthy physicians make to retire. Why are they making that choice? 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 their group, that someone is either in or out, should 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 the group, and, therefore, the remaining members, money?
On paper, the first year or the second year after the "retiree" is 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!" Or, just, "extra money for me!"
But is it really extra money in the bank if you lose key relationships that were putting all of the money in the bank or in your pocket?
The issue then becomes considering ways of repurposing people who would otherwise completely retire.
One client group found their 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. Even three.
Other client groups found different solutions, some involving workload and some involving governance and leadership.
Yes, there are issues. Do those physicians retain their full voting rights? Do those physicians receive whatever other benefits the group gives its owners, for example extra year end distributions from a profit pool? But all of those issues can be solved.
What I want you to focus on from the group’s perspective – and, if you’re one of those physicians who’s about to retire, from your own perspective – is what retirement really means.
How can skills and relationships that would otherwise be lost, still be harnessed?
Just like those wealth management people say, the best time to plan for retirement is years in advance. Or today if you haven't yet stated.
The same rules apply to the governance and group structure issues that can prevent the "retirement" of Dr. X from leading not simply to his death, but to the death of your group as well.
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| | Thursday - Four Doctors, $150 Million, and 6.6 Million Doses of Opioids. What Could Go Wrong? |
| Listen to the podcast here, or just keep reading for the transcript.
You’d have to be high to think you could get away with it.
“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.
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| | | Calibrate Your Compass
Read our exclusive RedPaper to guide you through this evolving situation.
The coronavirus crisis caused a short term economic crisis for many medical groups. Our RedPaper shows you the way out. Plus, many of the concepts discussed are applicable during both good times and bad.
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| | Help Us Help You With Helpful Content
What tailored content would you most like to see during this time? How can we focus on solutions to your most pressing strategic concerns?
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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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