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| Dear Friend,
Monday's blog post, Laboring on [About] Labor Day, is an annual classic, originally written and published on September 5, 2016. Follow that link to the blog or just keep reading.
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Originally proposed by union leaders, Labor Day commemorates American workers. Just as unions have mostly outlived their usefulness to all but union leaders, Labor Day has become a day for barbecues, family gatherings, and just plain old fun.
Some claim that there is a thing called “work-life balance.” My opinion is that we have only one life (I’m not betting on reincarnation) and that work is an essential part of it. It’s a main driver in why we’re here. Work gives us a purpose in life.
I’ve often heard people say things akin to “I have four years left,” in reference to the time until they “retire.” I shake my head in wonder, both because it seems to me as if they’re talking about a prison sentence (i.e., four years until parole) and because it seems as if they believe that work is getting in the way of some idealistic “life” that hasn’t yet begun.
I’m certainly not advocating that you work, work, work and have no fun, for what is life without fun. I believe that we should approach work and non-work as building blocks for your day. You not only have to work smarter (do the right thing) but there’s no getting around the fact that you also have to work harder.
I can almost guaranty that your competitors are not just sitting around the pool today, they’re also doing some thinking about how they can snatch away your opportunities. Even if I’m wrong and they’re all floating around on inner tubes, it’s even more of a reason for you to outwork them into the ground.
I took some time off this morning. Now I’m about to get back to work preparing for a meeting. After all, it’s Labor Day. |
| | | 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:
Let’s talk today about keeping your strategy fresh.
I spoke with a friend from Colorado yesterday (you know who you are!). The discussion was about strategy, our favorite topic, and we’re both big John Boyd buffs.
Boyd was the Air Force fighter pilot who developed the strategy tool called the OODA loop, Observe, Orient, Decide and Act, which he gleamed from his success as a fighter pilot before he became a pure military strategist. That was the system, the strategy, that he used when flying planes in training to get behind the student (the "enemy") to be able to metaphorically shoot him down.
Boyd realized that the same process worked in military strategy in general, and I maintain it works in business strategy as well.
So the object here is to observe what’s going on, observe the environment to orient yourself in terms of where you are and where the target is, and to then make a decision based on that information, and then to act on that decision.
However, it's not just 1, 2, 3, 4, OODA; it’s the notion that it is a loop and that as the loop keeps iterating, you keep gathering more information and acting quicker and quicker. The faster you can move through that loop, the stronger your position is vis-a-vis your enemy, your target, your goal in the business setting.
OOOD involves the concept of maneuverability, the ability to not only go in a direction toward a goal, but to quickly change direction because the goal has changed or moved (which information you’ve gathered from moving through the loop). We see this in business, not just warfare, especially as we see environments change.
For example, in the hospital business, it was once extremely important for hospitals to capture as many primary care physicians as possible to serve as “feeders” into the hospital system. We saw hospital systems grow, almost in hub and spoke fashion, with a figurative “mother hospital” and “children hospitals” out in the community to act as “feeders” back to the mother facility.
But, over time the environment changed.
As a result, we see an increasing number of hospital bankruptcies and of hospital systems merging "to become stronger" (which is a euphemism for survive).
So what does that tell us about your strategy? For example, your strategy as a medical group leader.
It's that when you develop strategy, you can’t just allow that strategy to be your only strategy, your "forever strategy". You must keep observing, orienting, deciding, and acting in order to keep that strategy fresh as the environment changes. Either that or end up with a perfect strategy for a time that no longer exists.
If you want to talk about an analysis of your current strategy, or of ways to go far beyond what the normal notions of what strategies are, get in touch.
See what we can do to help you. |
| | 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 coronavirus has closed their office doors, but the U.S. Department of Justice is still prosecuting healthcare crimes and extracting painful settlements.
Last week, the DOJ settled a case involving what might be described as a twist on the “free with purchase” promotion so popular with regular merchants, “regular” in the sense of not having anything to do with healthcare. Here, the allegations were “free with referral.”
In the case at point, the allegations were that the defendant physician, Mubashar Choudry, M.D., a cardiologist who treats patients for peripheral arterial disease in Maryland and Washington, D.C., and three medical practices with which he’s associated, Washington Cardiovascular Institute, Advanced Vascular Resources, and Washington Vascular Institute, performed free “ankle-brachial index” tests on the patients of other physicians and allowed those physicians to bill for the procedures, thereby providing remuneration in exchange for referrals.
On April 17, 2020, the DOJ announced that Dr. Choudry, and the three medical practices have agreed to pay the United States $750,000 to resolve the underlying False Claims Act allegations that they knowingly billed Medicare and TRICARE for claims in violation of the Anti-Kickback Statute (“AKS”). As mentioned above, the defendants allegedly induced patient referrals by providing ankle-brachial index testing on patients under agreements with the referring physicians but without collecting from the physicians the fair market value for the tests.
As readers are well aware (right?), the AKS prohibits the knowing and willful payment of any remuneration to induce the referral of services or items that are paid for by a federal healthcare program.
Kickbacks can take many forms, from good old cash in a bag, to free rent, to undervalued services (e.g., the so-called company model of anesthesia services problem), to, well, tests that someone else can bill for.
One final point, one that falls into the category of “last, but not least” – the settled allegations arose from a whistleblower action brought by Steven Pringle, a former sales and operations employee of the practices, under the False Claims Act, which permits private parties to sue on behalf of the government for false claims and to receive a share of any recovery.
“Who’ll ever find out?” is a question that many physicians ask themselves when hatching too-clever plans. The answer, of course, is your own staff.
In the Choudry settlement, the “why” for the whistleblower probably includes the fact that he’s about to receive a check for his share of the government’s recovery. |
| | | Listen to the podcast here, or just keep reading for the transcript.
Models, no not the skinny kind walking the runway or even the plaid wearing types in an L.L. Bean catalog.
But the guesses that are given gravitas. “Our guess is that blah blah blah” sounds like, well, a guess. “Our model reveals that blah blah blah” sounds far better educated. And, “our predictive model” — sheesh, it must be true; give the scientist a Nobel prize.
But as anyone still alive knows, models are just guesses. Make an error in design, put the wrong data in, or hold your metaphorical finger on the “algorithm” so that it gives you the desired outcome, and sooner or later, the “guess” is revealed, Wizard of Oz style, to be less than all-seeing, perhaps even as a prediction by a panderer with a publicist.
Are these the ramblings of an “anti-modelist”? No.
The reality is that we all construct and use models. Often, these are mental models, concepts or representations about how the world works. These concepts can be grand, as in the concept of human rights, or specific, such as in the concept of hospital-centric healthcare.
In fact, the more models we use to understand the world, the better. It’s like the difference between looking at a picture of someone only from the back, versus a series of shots from every angle, plus maybe even an MRI.
But here’s the thing: Models are fine as long as we don’t confuse them for reality. Take, for example, a map, which is a type of model. It’s an error to confuse the map with the actual terrain. It’s an even bigger error to blame the terrain for not matching the map.
Yet, we see modeling errors play out all the time in healthcare.
For example, many hospital CEOs bought whole hog into purest model of hospital-centric healthcare in which physicians would be “aligned” via direct or indirect employment. They ignored the input of other models. Billions were spent acquiring practices. And then, reality hit. These behemoth entities were almost universally unprofitable and were far more fragile due to their bloated overhead. Add a few months of coronavirus cancellation of both elective procedures and nearly all physician office visits, and, well, it’s either bankruptcy time or, how do they put it, oh, time to consider merging with a strategic partner. Sick hospital plus sick hospital equals Sears plus Kmart.
Or, consider a far more everyday modeling mistake; the physician group leader who believes that hospital contracting, say for an exclusive contract, follows a certain process and that all negotiation takes place within its “traditional” bounds. It’s certainly true that hospital CEOs want physician group leaders to completely buy into that mental model, but you’re blind to possibility if you actually do so.
The takeaways for you involve understanding a few problems to avoid:
You need to understand that multiple models, not simply blind adherence to one, are useful to inform your analysis, decisions, and actions.
You need to develop the ability to cycle faster through the analysis of your model as it hits the windshield of reality, and then to cycle faster through the process of deciding on and taking your next action, that is, a faster cycling through the OODA loop.
Note that I said that those were needs. They may not be your wants. But not wanting to do something that needs to be done is simply an example of a model that has no utility in this real world domain.
P.S. We’re designing a small group program for medical group leaders like you who want to understand the secret sauce underlying opportunistic action. If you’d like to be on the invitation list, send a message to one of my assistants.
Act fast! |
| | | 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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