| View this email online if it doesn't display correctly |
| |
|
|
| |
| Dear Friend,
Giving patients less choice.
Chalk up a victory for less care at higher prices. Hey, aren't those two of the Anti-Triple Aim?
Maine is a Certificate of Need (“CON”) state. Want to build a new ambulatory surgery center to provide better care than a hospital at lower prices to patients and payors? Well, in Maine and other CON states, it is not so easy. You need permission from the state and from your competitors, a so-called Certificate of Need.
Earlier this month, the state’s CON board recommended against approving an application submitted by Central Maine Healthcare to build a $14 million, 20,000 square foot ASC in Topsham, a town outside of Portland. In opposition was a competitor, Mid Coast Parkview Health, a health system that includes a hospital and an affiliated physician group.
Why the “no” vote, you might ask? Because, in the world of CONS, competition is bad. Somehow, in the rarified air of regulatory ridiculousness, reminiscent of the former USSR, top down is the way to keep prices low. Or, is it to keep prices up?
Let's say that instead of being in the health care business, Central Maine and Mid Coast ran competing chains of supermarkets. Central Maine decides to build a new store across the street and down one block from Mid Coast’s Topsham market location. Once they open the new market, do you think that prices for potatoes and pickles are going to go up in Topsham or down?
Please don't interpret this the wrong way if you are a public “servant”: I know that food is a bit more essential than healthcare, and I am not trying to plant the idea that you need to regulate whether someone can open a new supermarket.
CONs are simply a variant of “I’ve got mine, you can’t have yours.” They never served a useful purpose and they certainly don't serve one now. In essence, they are a con on consumers.
Or, as an activist might put it: “How many people have to die before the CON system is put in the grave?” OK, it is a bit over the top . . . but you are free to use it.
|
| | | 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 a piece online from a newspaper in Rhode Island - it's about nurses at a psychiatric hospital, all union members, who announced a vote of no confidence in respect of their hospital's entire leadership team.
Why?
Well, the nurses say, of course, that it has nothing to do with protecting their jobs but with protecting patients.
They allege that the hospital's leaders, in whom they have no confidence, are taking action designed in the long run to force patients out of the hospital before they are ready to be discharged. The nurses claim that the end goal is to cause the hospital to shut down.
The story is a bit reminiscent of the other "flea" stories that I've written for the blog at weisspc.com. Check them out.
One of them is called “What You Need to Know About the Flea That (Metaphorically) Killed the Medical Center CEO”. It's the story of Dr. Sheldon Retchin, CEO at Ohio State University’s Wexner Medical Center, who lost a vote of no confidence among a relative handful of members of the medical staff and subsequently resigned.
The notion of the "flea" is a tip of the hat to Robert Tabor who wrote the seminal book on guerrilla warfare, The War of the Flea. Tabor analogized the guerrilla to the flea fighting the "dog": the government in power. Like the dog, the government has too much to defend against a small and very agile enemy.
What will happen in this case of the Rhode Island psychiatric hospital and the nurses' vote of no confidence? I don't know.
But, consider this: Sometimes physicians have honest beefs against hospitals and hospital administrators that they don't believe they can never win. As a result, the physicians don't fight; they don't do anything about it.
This also occurs as a dynamic within medical groups.
Yet very often, a small group that is well organized and agile can depose a much larger opponent.
Sure, not always. Sometimes that dog finds the flea, bites it, and chews it to death.
But there are a lot of flea-ridden dogs.
|
| | 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 – Free $10.6 Million Dollar Lesson on How Not to Fire Physicians – Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
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 is 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 is certainly not unheard of for fired physicians to claim that their termination resulted from such advocacy when it actually did not, or even that there was advocacy when there was not.
Here are some takeaways:
- 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.
- I thought about not including this because of obviousness, but I changed my mind: Don't fire the messenger. And, even if that is not the reason for the termination, remember that bad timing will almost always cut against you.
- 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 is too late and they are already employed, do not bend over backwards to “fix” them, allowing them time to “fix” you.
- Be careful to preserve corporate or other entity structure. Although it is 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.
|
| | | Listen to the podcast here, or just keep reading for the transcript.
In a move reminiscent of prohibition-era crime fighter Eliot Ness, the U.S. Department of Justice recently announced a coordinated enforcement action against 345 alleged healthcare criminals, including over 100 physicians and other licensed (for now) healthcare professionals, in 51 judicial districts.
The defendants were charged with submitting more than $6 billion in false and fraudulent claims to federal health care programs and private insurers.
Of that sum, over $4.5 billion relates to telemedicine, more than $845 million is connected to substance abuse treatment facilities, or “sober homes,” and over $806 million relates to other health care fraud and illegal opioid distribution schemes.
Telemedicine Scheme
Unfortunately, the structure of the telemedicine scheme is one that I have seen play out multiple times, sometimes with enough time to avert a client’s participation:
Step 1: Certain defendant telemedicine executives allegedly used marketing networks to lure unsuspecting “patients” into the scheme via telemarketing, direct mail, TV ads, and internet ads. Call centers confirm Medicare or Medicaid eligibility and transfer the individuals to the telemedicine company.
Step 2. The telemedicine companies controlled by the defendants then allegedly pay defendant doctors and nurse practitioners to order unnecessary durable medical equipment, genetic and other diagnostic testing, and pain medications, either without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen.
Step 3: The telemedicine defendants then allegedly sell (as in illegal kickbacks and bribes) the physician's or nurse practitioner's orders to defendant DME companies, genetic testing laboratories, and pharmacies, which, pursuant to the Government’s allegations, subsequently submitted false and fraudulent claims to Medicare and other government insurers.
Sober Homes Scheme
In connection with the substance abuse treatment facilities (also known as “sober homes”) scheme, the Government alleged an $845 million scheme of false and fraudulent claims for tests and treatments for drug and/or alcohol addiction.
The defendants include physicians, owners and operators of substance abuse treatment facilities, as well as patient recruiters (AKA “body brokers”) all alleged to have participated in schemes involving the payment of illegal kickbacks and bribes for the referral of scores of patients to substance abuse treatment facilities.
According to the charges, those patients were subjected to medically unnecessary drug testing – often billing thousands of dollars for a single test – and therapy sessions that were frequently not provided, and which resulted in millions of dollars of false and fraudulent claims being submitted to private insurers.
It is also alleged that medical professionals prescribed medically unnecessary controlled substances and other medications to these patients, sometimes to entice them to stay at the facility. The patients were then often discharged and admitted to other treatment facilities, or referred to other laboratories and clinics, in exchange for more kickbacks.
Opioids Scheme
The DOJ’s announcement included charges filed, and guilty pleas obtained, involving more than 240 defendants who allegedly participated in schemes to submit more than $800 million in false and fraudulent claims to Medicare, Medicaid, TRICARE, and private insurance companies for medically unnecessary, and often never provided, treatments involving more than 30 million doses of opioids and other prescription narcotics.
Takeaways for You
- The first takeaway is one that that I often urge: Just because some other party to a proposed venture tells you that the deal has been vetted by their lawyers and is “legal,” do not bet on it. Vet it through your own counsel and assess your own risk. As in carpentry, measure (assess) twice, cut (do the deal) once. Or not do the deal – you get the idea.
- Government funds spent pursuing healthcare fraud result in a return on investment that Warren Buffett could only dream of. As a result, the federal and state governments will continue to pursue and pursue and pursue potential defendants. Since 2007, the DOJ’s Health Care Fraud Strike Force program had charged more than 4,200 defendants who have collectively billed the Medicare program for approximately $19 billion. And now, according the DOJ’s announcement, they have kicked those efforts up a notch or three through the creation of a National Rapid Response Strike Force within that existing program. It’s mission? To investigate and prosecute fraud cases involving major health care providers that operate in multiple jurisdictions.
- Do not get swept up (and away, as in put away) by either of those enforcement programs.
|
| | | 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.
|
| | 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?
|
| | | | 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.
|
|
|
| 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.
|
| | | | 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. |
|
|
