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| Dear Friend,
Who's actually managing your medical group?
When I was a kid, my dad used to let me sit on his lap and steer the car while he was driving down the road. We’re not talking just around the block, we’re talking miles. I couldn’t touch the pedals; I was five or six years old, but I was sure doing the steering.
It occurs to me that that same thing goes on within many medical groups. There’s someone who’s supposed to be doing the driving, the president of the group, say, or a managing partner.
But instead of actually doing the driving, that "leader" allows somebody else to grab onto the wheel of the group and point them in a different direction.
Bad idea.
What if my father wanted to go left and I wanted to go right? We probably would have gone somewhere in the middle. The car would have crashed and burned.
Many groups today have two drivers: The person who’s supposed to be driving and the person in the passenger seat. Or even worse, someone in the back seat who’s reaching all the way from there to the steering wheel.
Where's the group’s going? Who knows?
Don’t allow backseat drivers. If your group has a board, they establish broad policy. But someone must be in charge, and that someone must have the power to make decisions, and that someone can’t make decisions by running a constant consensus contest.
If you’re supposed to be driving your group, grab the wheel, put your feet on the pedals, and go.
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.] |
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Watch Tuesday's video here, or just keep reading below for a revised, more polished transcript:
I've got a press release here from the Department of Justice. It was just issued last Friday, July 3, 2020. It's about a physician, Michael J. Ligotti, D.O.
He practices, or maybe practiced, in Palm Beach County, Florida, I think actually in Del Rey Beach.
He's been arrested pursuant to an indictment that alleges that he is at the center of a $681 million fraudulent billing scheme involving laboratory testing and other services that resulted in about $121 million in payments from Medicare and other payers.
Apparently what's alleged is that this guy became the medical director of a huge number, I think it's 50, of addiction treatment facilities. It's also alleged that he issued standing orders for a plethora of urine analysis and other tests that resulted in hundreds of millions of dollars in fraudulent bills.
The government also claims that the scheme required referrals back to his own medical practice in connection with which he billed for a whole range of services, some of which he wasn't even qualified to perform, and some of which resulted in $10,000-plus charges per patient visit!
Note that the government's claims relate to an indictment only; they are allegations. Ligotti has not been convicted of any crime.
Setting aside issues of fraud, the story also shows you what kind of a mess someone can get into serving as the medical director of a facility.
In my own practice, I've seen things such as physicians doing deals with medi-spas and then finding themselves roped into situations in which the medi-spa was using their name and their provider number in a whole range of fraudulent medical billing.
Be careful what you get into. Obviously, if Ligotti did what they're saying he did, it doesn't have much to do with being careful, it has to do with engaging in criminal activity.
But often, types of events like this, much, much less criminal, still result in criminal allegations against physicians otherwise as innocent as you.
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| | How to Deploy the Secret Sauce of Opportunistic Strategy
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| | | | | Medical Bills! Language, Framing and Your Bank Account.
Both state and national level politicians certainly know what side the bread is buttered on, and who’s doing the buttering.
There are far more patients than there are physicians, thus the rush to fix the problem they’ve defined as “surprise medical bills.”
Sure, just like I’m surprised when I pay good money for admission to a baseball game and then find out that the beer isn’t free! What? It’s completely unfair!
By framing the issue from the position of the average voter, politicians think the solution to the problem that they’ve defined as “surprise” is to force physicians to take contracted rates that they never bargained for or, and why not, simply go to arbitration.
But wait, will you be “surprised” when you find out that arbitration isn’t free or even discounted? What do you mean, why isn’t it free? Will there be legislation to remedy the surprise arbitration cost problem? Don’t hold your breath.
Physicians can’t change the fact that most politicians are simply second handers who create nothing, but crave power. But at least physicians can make an attempt to define the language used in the out of network situation to gain traction in framing what the issue really is:
Insurance companies refuse to contract at reasonable rates. Insurance companies want to cut out the cost of contracting and still force “contracted” rates down physician’s throats.
By narrowly contacting, insurance companies can then put their fingers on the scale of what contacted rates in “the community” (supposedly) are.
But, of course, if insurance companies don’t have a contract with someone to accept a lower, contracted rate, why should they be entitled to any rate other than full rates?
The one-sided “right” to impose a discount is, in essence, imposing a form of slavery on the non-contracted physicians: it’s taking value from you without paying you an agreed upon value in return.
Perhaps physicians are afraid to talk this way.
So how about this frame: Why should anyone be forced to accept a contracted rate they didn’t contract for?
If insurance companies are interested in contracting they should reach out and do it. If they’re not, then either they or the patient should be responsible for the full fee. I
t’s as simple as that. Just like my ticket to the game doesn’t get me free beer unless I bought some sort of package deal.
If you simply sit back and leave it up to political power, then the situation will become what is attributed to Benjamin Franklin (I know, I know, he probably didn’t actually say it), “democracy is two wolves and a lamb sitting down to the vote on what to have for lunch.”
Unless you frame the issue, you will continue to be on the menu.
Hungry anyone?
Comment or contact me if you’d like to discuss this post. |
| | | Listen to the podcast here, or just keep reading for the transcript.
According to Karen Teitelbaum, President and CEO of Sinai Health System, “all hospitals are looking at how to transform care delivery and responsibly allocate resources to address changing patient needs.” But what if patients no longer need you, or, at least, not as much of you? Well, for Sinai, and, in particular, its Holy Cross Hospital located in Chicago’s Marquette Park neighborhood, it means cutting the number of licensed beds from 264 to under 110, in addition to what’s being billed as a temporary suspension of OB/GYN services. The moves are a tourniquet to staunch the loss of financial blood, more than $2,000,000.00 a month, from the facility. Pursuant to the health system’s press release, Sinai is looking at creative opportunities to market and lease space at Holy Cross to other providers offering acute care services. Perhaps that presents an interesting opportunity, but query how smart it is to hitch one's future to a sinking ship, especially when freestanding alternatives divorced from health system bureaucracy and the regulatory issues of operating a for-profit venture within the realm of a not-for-profit facility abound. [Author’s note: I would normally refer to Holy Cross as a “non-taxpaying” venture, not a “not-for-profit,” but at a $2,000,000.00 a month loss, my guess is that “not-for-profit” is a better descriptor.] Of course, miracles happen and perhaps Ms. Teitelbaum and her team will right the ship. I just wouldn't bet on it. The Holy Cross story, together with that of the incredibly shrinking hospital (three floors lopped off of a five story hospital), the story of the miniaturized hospital (865 beds to 70), and the story of the completely bedless hospital are simply stops along the way to what I describe as The Impending Death of Hospitals. If you haven’t yet read my book by that title, follow the link to download your complimentary copy, or visit Amazon to buy yours in print. Some people refuse to read the news because it's almost always bad, like the stories about the fate befalling hospitals. However, most bad news contains the kernel of opportunity for someone else. Why not make it for you? Comment or contact me if you’d like to discuss this post. |
| | | 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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