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| Dear Friend,
The cure is worse than the disease.
As I write this on the evening of December 27, 2020, Congress’s buffet of public spending (H.R. 133) includes federal unemployment relief, $600 grants to eligible individuals, hundreds of billions in new PPP loans, and billions in relief to foreign nations.
You, doctor, weren’t so lucky.
Included in the potpourri is the latest “cure” for surprise medical billing, the “No Surprises Act”. If my analysis is correct, the cure will lead to a death spiral in both out-of-network and in-network reimbursement.
First, in what’s probably a surprise to the American Hospital Association, the No Surprises Act broadens the concept of “out-of-network” to include, in the emergency services context, both hospitals and physicians.
If a payor covers services in an emergency department of a hospital or in an independent freestanding emergency department, that is, a freestanding E.R. that is not part of a hospital, then the payor must pay the facility and the physicians (ah, the question is how much) for emergency and related services, whether or not delivered via the E.D.
Although HHS is supposed to develop regulations, the payment amount is linked to the “median” contracted rate, including cost sharing amounts, recognized by the payor in the same market. If the payor and provider do not agree on the payment as determined by the payor, there’s a mandated “independent dispute resolution process” by which a third party sets the amount. There appears to have been no consideration of the fact that it might cost more than the disputed amount to participate in the dispute resolution process; either that or the insurance companies and HMOs spend more on lobbyists.
There does appear to be deference to state “surprise billing” laws.
Not satisfied with mandating a rate to be paid to those who didn’t agree to, or were never offered, a contract with a payor, the No Surprises Act repeats the process with regard to
out-of-network physicians who do not give notice and obtain consent before treating patients at an in-network facility.
Consider this: If there’s a way for payors to put their fingers on the scale of the median rate, such as by threatening to toss out of network/actually tossing out of network physician groups that won’t cut their supposed “high end” rates, they’ll do it. As the median lowers, the median will continue to lower. Crap reimbursement today will become high reimbursement tomorrow.
Remember, the overall bill, H.R. 133, continues to hand out fiat printed money at a rate that I don't believe has ever before been seen. The inevitable result is rampant inflation. Combine that with low, lower and lowest reimbursement and, before we know it, we’ll be at single payor as the solution enacted under the "Surprise There Were No Physicians Willing to Work But Now We’re Forcing Them To Act of 2023".
Hey, it’s all for the greater good. |
| | | 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.] |
| | Watch Tuesday's video here, or just keep reading below for a revised, more polished transcript:
Are you being pound cheap and ton foolish when it comes to the advice you're getting, in the preparation that you are engaging your advisors in, to advance your group, to advance your facility?
Let me ask you this: Have you ever been played, say, by a hospital, who says something like, “Oh, your lawyer is just wasting time on these minor points!” or, by an insurance carrier or other payor that says: “Oh, it's just our form! Your lawyer is just going to want to negotiate it and we don't negotiate."
Have you ever done a deal where you've run the question by your lawyer or run the question by your accountant and then not talked to them again about the deal, but simply reviewed the document yourself to, what, save yourself five thousand bucks, ten thousand bucks, twenty thousand bucks? And, then, two years later, discovered that you've screwed yourself over, or found out that you are now in a lawsuit that is going to cost you a million dollars to get to trial?
The same hospitals that are poopooing your obtaining legal advice have law firms working for them. They sometimes have hundreds of in-house attorneys. The insurance companies have many times more than that.
It pays to get the best advice that you can't afford.
If you want to skip that and spend $300 talking to your cousin to get some advice, and then think that you can handle it from there, well, you're just being stupid.
On the other hand, it's your business, you're free to destroy it at will. Unless of course, you consider your fiduciary duty to your partners.
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| | 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. |
| | | Wednesday - Why You’re Unbalanced
If You Believe in Work-Life Balance - Medical Group MinuteWatch the video here, or just keep reading below for a slightly polished transcript:
Recently, I saw an article in The Wall Street Journal about pandemic economics and work
life balance.
In particular, they wrote that people’s balance was off because they were working from home. In fact, they stated that work was keeping people from having a life.
But that’s an entirely fallacious concept. If you like what you do, if you’re doing something that energizes you, that empowers you, that gives you a purpose, then that is your life. It’s not something separate from your life.
This reminds me that many physicians live by the concept of what I call the “physician expiration date”. You know, like some date stamped on the bottom of a can: Good until September 15, 2025. Then, all of a sudden, they are retired.
But yet, what happens to so many people who retire, when they lose that larger purpose, that work that somehow “interfered” (so the WSJ claims!) with life? They no longer have that work and they’ve lost the purpose for life.
Don’t fall into that trap.
It’s a trap that not only has an unfortunate payday when that big piece of your life called work is gone, but it’s also one that prevents you from taking on new challenges, from expanding your practice, from expanding your business.
Look, even if it were true that you had 12 months to live, would you want to stop doing anything new because your last day is about to come? I maintain that you wouldn’t.
Think about that. Think about how that actually intersects with your business strategy, your group’s business strategy, or your facility’s business strategy.
Take work life balance, turn it on its head, and make it pay off for you. |
| | | Listen to the podcast here, or just keep reading for the transcript.
You’re all set to embark on some new project or endeavor, such as expanding the scope of your medical group’s operations to the neighboring community, or even to a site hundreds of miles away. Great. These are the type of projects that engender excitement, commitment, and passion, as well as bring profit.
But can you pull it off if your practice is built as a metaphorical house of cards? Not a house built on flimflam, but one built of negligence or perhaps indifference, or one bending too far to the will of the crowd.
Growing up in Southern California, I’d see the cliffs rising near vertically above Pacific Coast Highway, running from Santa Monica up towards Pacific Palisades, a towering, sheer face of dirt that year after year, day after day, was slowly giving way. The beautiful homes perched on top were inevitably headed for the slow lane of the highway below.
That’s a perfect metaphor for the false belief that there’s a strong foundation holding up the structure of your group. In reality, the truth can be much different.
Consider the group that discovers but it wasn’t actually formed as a medical corporation 34 years ago; it was formed as a general business corporation and is engaged in an illegal business operation.
Consider the group with a defective governance system, such as those with fully collaborative decision-making structures.
These and other defects put your group on the same footing as what was once a $20 million mansion, now about to slide over a cliff.
The fortunate thing for medical group leaders, and where the analogy breaks down, is that it’s far easier to correct foundational defects in medical group structure, than it is to shore up a house headed down a 200 foot cliff.
Start with a structural audit.
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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 Free.
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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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