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| Dear Friend,
You're fired! Oops.
Here, courtesy of Tenet Healthcare and two terminated cardiologists, is a lesson about firing physicians . . . and, when not to.
In 2018, cardiologists Amir Kaki, M.D. and Mahir Elder, M.D. were terminated from leadership positions at Detroit Medical Center hospitals and, as a result lost their medical staff privileges.
In an award that became public earlier this month, an arbitrator agreed with the physicians’ claims that Tenet Healthcare, DMC’s parent, acted with malice in terminating them and discontinuing their medical staff privileges as retaliation for Drs. Kaki and Elder raising quality of care and improper billing concerns. The arbitrator awarded $10.6 million in damages and ordered that their medical staff privileges be reinstated. In addition, the award included $624,000 in attorneys’ fees as well as discovery abuse sanctions of $110,000 against Tenet.
The doctors’ lawyer is seeking court affirmation of the award and, as might be expected, Tenet announced that it will seek to vacate the arbitrator’s ruling.
Although the story is certainly interesting on its own accord, it presents lessons for employers, whether they be facilities or medical groups.
It’s certainly not unheard of for healthcare employers to terminate physicians as a result of their advocacy for patient care or their other compliance/quality of care complaints.
And, it’s certainly not unheard of for fired physicians to claim that their termination resulted from such advocacy when it actually didn’t, or even that there was advocacy when
there wasn’t.
Here are some takeaways:
1. Employers must be diligent in implementing their compliance programs and in their overall efforts to take seriously any complaint concerning unsafe medical practices. Complaints and demands must be documented and they must be investigated to the level appropriate under the circumstances. Depending on the circumstances, for example a complaint by a physician that new equipment or supplies are required, the physician making the complaint should be kept apprised of the process and, even included in it. Fully vetting complaints and demands takes some, even if not all, of the sting out of a later claim that the complaining physician was fired to hide the complaint.
2. I thought about not including this because of obviousness, but I changed my mind: Don’t fire the messenger. And, even if that’s not the reason for the termination, remember that bad timing will almost always cut against you.
3. Disruptive physicians are wont to claim that their termination for cause was actually termination in retaliation for valid patient advocacy or as a result of some other improper motive. Employers must carefully screen out potentially disruptive job candidates. If it’s too late and they’re already employed, don’t bend over backwards to “fix” them, allowing them time to “fix” you.
4. Be careful to preserve corporate or other entity structure. Although it’s unclear from the story reporting the award against Tenet, I assume that there are multiple entities in-between the parent company and the facilities that employed, and granted staff privileges to, the two doctors. Follow required entity formalities in order to compartmentalize liability.
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| | | 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:
I read today that Haven, the revolutionary healthcare venture brought to all of us by
J.P. Morgan, Berkshire Hathaway and Amazon is closing down.
Is it off to heaven… or is it going to hell? Let's think about it.
What was Haven supposed to do?
On the one hand, it was touted in the press as a drive by the smartest people in the world to revolutionize health care. But it was also said that it was simply a collaboration to reduce the cost of health care on the part of its three component entities: J.P. Morgan, Berkshire Hathaway, and Amazon.
But query this: Was it a real business or was it a publicity stunt?
Would you have hired an a pundit who is also a part-time surgeon but primarily a writer for New Yorker magazine, with little or perhaps no management experience, to be the CEO of a venture to revolutionize health care?
So, what lessons that we can draw from this?
Number one, if Haven were really about revolutionizing healthcare, it didn't do it. Perhaps it was too big a project. Perhaps it was poor leadership. Perhaps money doesn't solve all problems. Or, perhaps revolutionizing healthcare was never the goal, after all.
We won't know whether feigning (if that's what it was) to revolutionize healthcare achieved its actual goal, which was, perhaps, to reduce current healthcare costs for Amazon, J.P. Morgen, and Berkshire Hathaway.
But even so, we can learn some valuable lessons to apply to ourselves:
1. Don't bite off more than we can chew. Don't claim that you are going to change healthcare if all you are actually attempting to do is lower your own costs. 2. If you are going to create a multi-billion-dollar venture, find someone who has run
a multi-billion-dollar venture to be in charge, not someone who writes about multi-billion-dollar ventures. 3. Communicate what you are doing to your team. Communicate truthfully. Paint an actual story that they can believe in. In the Haven situation, there were two stories: There was the revolutionize healthcare story and there was the reduce our costs story. What's the real version? Communicate your vision.
Think big, but think with a laser focus. Communicate what you are doing to your team.
It will dramatically increase the chances that you're going to achieve your goals, not simply get you publicity for announcing a new initiative, and then front-page news for when that initiative fails.
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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 - To Serve Man - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
Yes, the title of this post is a tip of the hat to the Twilight Zone episode of the same name. It raises a somewhat similar question: Do you, that is your medical group, really exist to serve others, in this case “the hospital,” or are you simply serving yourself up as a tasty meal to be taken and devoured?
Many medical groups, certainly many hospital-based groups but, increasingly, even office-based groups, view themselves as simply providing a “service” for the hospital, functioning
as a sort of clearinghouse for income and expenses. This mindset severely limits your
group’s future.
It limits the willingness, and the ability, of your group to pursue outside opportunities. That’s chiefly because there is tremendous pressure to pass through to the owner, and often to the non-owner, physicians all available income, instead of immediately investing in, or creating the capital reserves necessary to pursue, other opportunities.
Additionally, “service” groups often suffer from the mindset that the group was formed to provide services at only that hospital, thus taking off the table completely the consideration of other opportunities, even if the group were able to deal with the notion of holding back what would otherwise be income available for distribution.
Of course, “service status” results in a severely weakened position vis-a-vis the hospital, which knows that your group’s very existence depends on renewal of its exclusive contract. That’s a horrible position for your group to be in, both in terms of the concessions that the hospital may demand, and that your group may be forced to give – not to advance its position in some other respect, but merely to save its own life.
In the Twilight Zone episode, aliens, the Kanamits, come to earth on professed humanitarian grounds. The first Kanamit visitor leaves behind a book, the title of which cryptographers translate as “To Serve Man.”
The Kanamits bring about the end of hunger, world peace, etc., etc. and invite humans to visit their beautiful planet, which they begin to do in droves.
Then, just as one of the cryptographers, Chambers, starts to board a Kanamit spaceship for the voyage, one of his colleagues, Patty, who’s been working to translate the text of the Karamit book, rushes to the departure site and frantically yells, “Mr. Chambers, don’t get on that ship! The rest of the book To Serve Man, it’s… it’s a cookbook!”
The warning came a bit too late for Mr. Chambers. Don’t let it come a bit too late for you.
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| | | Listen to the podcast here, or just keep reading for the transcript.
Double your felony,
Double your sums.
Oops we got caught,
Now we’re jailhouse bums.
The second of the felonious, guilty-pleading “twins,” Semyon Narasov and Andrew Hillman, was sentenced on May 29, 2020, for his role in twin healthcare fraud schemes, one referred to as the Forest Park scheme after the now-defunct hospital group of that name, and the other the NextHealth scheme after the lab company “arrangement” controlled by the “twins.”
Narasov, who pleaded guilty in 2018 to conspiracy to commit money laundering in the NextHealth case and to conspiracy to pay and receive healthcare bribes and kickbacks in the Forest Park case, was sentenced on May 29 to 76 months in federal prison.
Narasov admitted that Forest Park paid the “twins” $190,000 to refer patients to Forest Park or to surgeons with privileges at the facility, and that they submitted phony invoices to conceal the bribes, which were funneled through a shell entity.
Narasov also admitted that while at NextHealth, he and his “twin brother” submitted fraudulent claims to private and government health insurance providers for prescriptions that were medically unnecessary, prescriptions for misbranded, non-FDA-approved drugs, and prescriptions prescribed by physicians who were receiving kickbacks, all while falsely claiming they had charged patients co-pays.
Hillman, too, pleaded guilty in 2018 and made similar admissions. Hillman was sentenced in December 2019 to 66 months in federal prison.
Hillman, formerly of Dallas, now resides at Federal Correctional Institute Texarkana. Where Narasov will serve time is, as of yet, not known.
In addition to the large slice of schadenfreude, you can take away more than a few valuable lessons from Narasov and Hillman at a cost far lower than 66 to 76 months of your life:
“Sharp” marketers and other scheme promoters, even hospital CEOs (how shocking!), will tell you that their lawyers have thoroughly vetted the arrangement. Don’t take their, or their lawyers’, word for it. They’ll be going to prison themselves for themselves, so they won’t be doing your prison time for you.
Over the years, I’ve kept clients out of what would surely have been the slammer in connection with schemes as diverse as:
paying for “marketing” (marketing being a euphemism for kickbacks);
paying (or receiving) “rent” for supply closets (“rent” being a euphemism for kickbacks);
providing “employees” to ASCs (“employees” being a euphemism for kickbacks);
receiving “fees” to prescribe pain medication over the phone to strangers (“fees” being a euphemism for kickbacks);
and, well, other schemes that are so bizarre they don’t even pass the laugh test.
Do yourself a favor. Think for yourself and get competent legal advice for yourself.
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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
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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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