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| Dear Friend,
CMS is steadily on course to do away with the inpatient-only procedure list.
Evolutionary psychologists say that the reason we see a stick on the trail ahead of us as a snake is that it's far better for our survival to see sticks as snakes than snakes as sticks.
This and other biases cause us to more readily focus on the relatively immediate threat as opposed to the long-term one.
So, when earlier this month CMS released its various proposed 2021 payment schedules, physicians quickly focused on what's in it (or, rather, out of it) for them, that is, for their specialty.
But at the same time, a focus outside one’s own immediate specialty reveals other trends, ones that may have a longer term but more significant impact on your career.
As anyone who's been reading my posts and articles (and my book, The Impending Death of Hospitals, available here for download) over the past six or so years knows that the trend of shifting procedures from the hospital setting, including from the hospital outpatient department setting, to the ASC setting is of tsunamic proportions.
In accordance with that trend, CMS’s August proposed payment pronouncements have hundreds of procedures moving to the ASC setting. For example, they propose moving more than 266 orthopedic procedures from the inpatient-only list, which means soon to be done in an ASC.
Even more revealing is that CMS is proposing to eliminate the inpatient-only list in its entirety over the next 3 years.
Shh . . . hang on for second. Can you hear that? Yes, it's the American Hospital Association screaming.
In the long run, for those physicians performing facility-based services, such as anesthesiologists, these very strong continuing signals, in fact, stronger signals than in the past, are clear signs that unless your business model takes into account the fact that hospitals as we know them will soon no longer exist, your business might soon no longer exist.
And, on the flip side, those physicians who understand that competing with hospitals on the facility-side is becoming easier and easier, it's time to consider ASC development.
Comment or contact me if you’d like to discuss this post. |
| | | 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 - Cement Feet or Fear of What Others Will Think?
Watch Tuesday's video here, or just keep reading below for a revised, more polished transcript: |
| Good morning! It's Mark Weiss. I hope you're having a good day today.
I want to talk to you about an underlying issue, an issue that prevents many medical group leaders from taking action.
It's a simple one. It is basically one of fear. One of a fear of criticism, of "what are people going to think?"
Those other people might be in your own group, or professional colleagues in another group. They might be hospital administrators.
What are they going to think about the action you took? Whether that action was successful or whether it failed, the fear is the same.
It sounds simple, but unfortunately, in my experience over the last four decades of working with medical group leaders, I find that it's often the thing that holds people back.
A clue to the cure to the fear comes from a the line in the musical "Evita": “It doesn’t matter what those morons say. [Yes, I know that Ms. Peron and her husband turned out to be dictators. That's not my point. Don’t shoot the gift horse in the mouth.]
Make decisions and take actions that you, as the group’s leader, believe are best. Don’t worry about criticism. Even if you make the world’s best decision, someone later with 20/20 hindsight is going to criticize it.
So here's the thinking tool:
1. You know how to make decisions.
2. You are in charge of making decisions.
3. If the others, whoever they might be, don’t like the decisions, well just “b-l-e-e-p” them.
It might sound harsh to the uninitiated, but it's liberating. |
| | How to Deploy the Secret Sauce of Opportunistic Strategy
Webinar On Demand
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.
You will 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. |
| | | The Problem Is the Cure - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
Many medical group leaders come to me for help when they’ve got a “problem” and they’re looking for a solution. |
| Oftentimes, they think that the solution lies outside of the problem.
But I want you to think about things a different way: Most problems, maybe even all problems, are themselves the kernel of the solution.
Let’s take an example. Currently, many medical group leaders are looking for the cure for the “cure” for surprise medical billing. It’s a big issue for many hospital-based physician group clients.
They’re facing threats of being thrown out-of-network and relegated to new out-of-network payment schemes. Those schemes are, in essence, cram-down rules imposed by the bureaucratic “cures” for surprise medical billing.
They’re also being forced to feel the pressure of reduced “offers” of reimbursement from those payors still willing to contract. The implied, and sometimes vociferously stated, threat is that unless the group agrees to work for peanuts, their only other choice is to work out-of-network pursuant to a sham payment methodology in which they’ll be paid in metaphorical peanut shells.
It’s win-win for the payors. Higher reimbursed groups are either pressured to work for less or are tossed out-of-network. And, by reducing their average in-network rates, they’ll eventually lower what they are forced to pay the groups pushed out-of-network under the arbitration system mandated by surprise medical billing statutes or regulations.
Faced with those problems, many medical group leaders seek to know how to deal with that arbitration system.
But query whether the problem isn’t something different. Instead of seeing it as in-network versus out-of-network, perhaps the problem is the lack of control over patients and the ultimate means of funding patient care. With that mindset, perhaps there are other ways (there are!) to bypass carriers, or to turn the legislation and regulations inside out to make what was a problem for physicians, a problem for payors.
Think about problems a different way. Think about solutions from other industries to similar problems and how they’ve played out. Think about whether you want to “game the system.”
There are ways to accomplish far more than you think. But that means you’ve got to look at things differently and invest in yourself by obtaining help.
If you’re not willing to do those things, consider shutting down your business, it might be cheaper.
If you are willing to do those things, get in touch now.
Comment or contact me if you’d like to discuss this post.
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| | Thursday - Doctor Exclaims, “I Wasn’t The Target, So Why Are They Gunning For Me?” |
| Listen to the podcast here, or just keep reading for the transcript.
Perhaps the target wasn’t Day-Glo orange, but the wound was life changing, if not life threatening. More often than not, whistleblowers file False Claims Act lawsuits against the entity they allege as being at the center of fraudulent activity, for example, the entity that is paying kickbacks. Whether that entity is a hospital, an ambulatory surgery center, or an implantable device manufacturer, the entity is typically the prime target because it’s the nexus of the claims that the whistleblower alleges are fraudulent. Because the entity is, metaphorically speaking, painted Day-Glo orange with a gun range target on its front, back, and sides, many physicians involved in questionable “arrangements” often feel that they won’t be swept up in the mess, that their risk is smaller. Bypassing the issue of the difference between a feeling and either thinking or knowing, they are wrong. Back on March 16, 2020, in my post, Free Stay Out of Jail Pass, I wrote about the FCA lawsuit in which the United States government intervened and alleged that SpineFrontier, a spine device manufacturer, and Kingsley Chin, M.D., its founder and Chief Executive Officer, as well as other Chin-controlled entities, paid spine surgeons over $8 million in sham “consulting” payments ostensibly for product evaluations, when in fact the payments were for the use of SpineFrontier devices. In the weeks that passed, the government settled civil health care fraud claims against five physicians, each of whom admitted to seeking and obtaining kickbacks from SpineFrontier via a sham intermediary called “IME,” for consulting work he did not perform, and then cooperated with the government’s investigation. Each of the five also admitted that one or more of SpineFrontier, Chin, or Aditya Humad, the CFO of SpineFrontier and a defendant, specifically instructed him to bill “consulting” hours to SpineFrontier for each and every surgery in which he used a SpineFrontier device, regardless of whether he spent any time actually consulting. The five physicians are: - Dr. F. Paul DeGenova, an orthopedic spine surgeon in Ohio, agreed to settle the government’s claims for $486,985.
- Dr. Michael Murray, an orthopedic spine surgeon in New York employed by the Department of Veteran Affairs, agreed to settle the government’s claims for $330,668.
- Dr. Joseph Shehadi, a neurosurgeon in Ohio, agreed to settle the government’s claims for $323,419.
- Dr. Agha Khan, a neurosurgeon in Maryland, agreed to settle the government’s claims for $310,843.
- Dr. John Atwater, an orthopedic surgeon who worked in Florida and in Illinois, agreed to settle the government’s claims for $105,149.
And then, on April 24, 2020, Dr. Jeffrey R. Carlson, an orthopedic surgeon in Virginia, became the sixth surgeon to agree to settle with the government in connection with SpineFrontier. The “price” for his deal was astronomically higher: he agreed to pay $1.75 million to resolve the civil claims. Dr. Carlson admitted that he estimated his purported consulting hours based on the number of times he used a SpineFrontier product in a given month, as opposed to tracking actual time he spent consulting. He admitted that he cannot document the consulting hours he submitted for payment to SpineFrontier and IME. In addition, he admitted that he sought and received consulting payments from SpineFrontier for time he spent during his surgical procedures, for which Medicare and other federal health care programs were already paying him. Last, Dr. Carlson also admitted to accepting free meals from SpineFrontier, for himself and his surgical staff, on almost every day that he performed a surgical procedure with a SpineFrontier product. In total, SpineFrontier provided Dr. Carlson and his staff meals that cost thousands of dollars. Note that each of the settlements, which one may safely assume was made without admission of liability, relates to a civil action, only. However, you should bear in mind that the type of activity that was alleged to have occurred underlying the FCA allegations would also support criminal charges for violation of the federal Anti-Kickback Statute should the government bring them. In other words, these civil settlements may not be the end of the matter for Drs. DeGenova, Murray, Shehadi, Khan, Atwater, and Carlson. Of course, the same lesson, potential civil and criminal liability applies to anyone caught up in a kickback mess. As I always say, think like a carpenter and measure twice (or even thrice), vetting each deal carefully with healthcare counsel, before cutting once, cutting your own neck, that is. |
| | | 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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