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| Dear Friend,
Help from an insurer?
Need a marketing consultant to help grow your ASC? You might want to check with your carriers first.
Background
As the latest step in a trend that began several years ago, effective for 2021, CMS added 267 new codes to Medicare’s ASC covered procedures list.
These are the codes for procedures that Medicare recognizes for payment in the ASC setting. Put another way, no code, no payment. Put even another way, with a code, it is not only Medicare that follows, that is, pays, commercial carriers look to Medicare in that regard.
And, put even another way, procedures that previously could be performed, meaning performed and reimbursed, only in a hospital setting, whether inpatient or outpatient, can now be performed in an ASC.
In addition, CMS has announced the phase out over 2021, 2022, and 2023 of the Inpatient Only List, the list of procedures, that to be reimbursable, must be performed in a hospital on an inpatient basis.
Those procedures that were once inpatient only will be going to HOPDs and to ASCs. Over time, when CMS reaches payment parity between HOPDs and ASCs, all will be ASC procedures.
Carriers Helping Push Procedures Out of HOPDs Today
Complain as you might about carriers raising premiums and cutting reimbursement, often on the same day, they know a good deal when they see one.
Take, for example, New York’s Empire BlueCross BlueShield, which announced a new coverage policy to push more procedures out of the HOPD setting to ASCs by making ASCs the default site of service for a host of outpatient procedures for commercial plan patients.
Patients need a medical necessity review to have their procedure performed in an HOPD. No medical necessity review applies if the procedure is performed in an ASC.
According to a carrier spokesperson, “Empire BlueCross BlueShield is committed to being a valued healthcare partner in identifying ways to achieve better outcomes, lower costs and deliver access to a better healthcare experience for consumers.”
What This Means For You
How the story has changed!
Just two decades ago, carriers saw ASCs, predominately owned by physicians, as “conflicts of interest.” How could they, they claimed, trust a physician to admit his or her own patient to a facility he or she owns?
But now, it is clear that ASCs provide better care at lower cost, in a setting that is preferred by both patients and physicians.
Some see the payment policy shift, governmental and commercial, as motivation for hospitals to acquire or build their own ASCs.
As to 100% hospital-owned ASCs, physicians who have already given up control of their practice to the hospital through employment will have no choice but to go along, meaning without ownership.
But as to all other physicians, as well as in connection with potential joint venture ASCs, why would physicians want to partner with a hospital at all? It can not be for their ASC management skill; they have none. And, if the hospital proposes a three way JV to independent physicians, you have got two “partners” and a diluted physician ownership percentage.
As I see it, we are about to witness a huge increase in the already tidal shift in the site of surgical service to the ASC setting. Partnering with the right long-term, and, therefore,
non-PE backed, management company makes sense, as they bring skills to the table that you’re lacking.
However, be careful to avoid a manager that is as bureaucratically impacted as a hospital (or an insurance carrier!) or you will risk losing both your competitive advantage and the fun, yes, fun, of doing your cases in an enjoyable environment. |
| | | 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:
Thanks for joining me today, because together we're going to solve the physician retirement crisis.
You haven't heard about the crisis?
Well, obviously as the baby boomer generation is getting older, there are more and more physicians using the “R” word – in my estimation, the “R” word is worse than the “F” word. The “R” word – retirement – is basically a signal to God, to the universe, however you want to put it, to take the parts back.
I can’t tell you how many physicians I’ve known who’ve retired only to die shortly thereafter. Just like other clients who sold their businesses, lost purpose, and then, well, dropped dead.
I know that many disagree with me. They think retirement is some sort of goal. They’ve fallen for the notion of the “golden years”, blah blah blah, and so they are letting their colleagues, and their medical groups, know that they are going to be retiring soon.
Now, certainly, I understand that if a physician is losing his or her skills, if they’re in a specialty that requires very small motor movements – placing needles, for example, or using a scalpel – and their hands are beginning to shake, well that’s another story.
But that’s not what I’m talking about. I’m talking about the choice that physicians make to retire. Why are they making that choice to retire? Is it that they actually want to stop working, which is the assumption. Or is it actually something else? What underlies the “why”?
For many, it’s that they want to slow down. They don’t want the same level of intensity. But if that’s really the underlying “why,” perhaps the assumption made by the group, that someone is either in or out, can change.
Why would it change? Certainly, some medical groups function like accounting firms, where the older partners are pushed out because, if you look at the numbers, it makes sense to push them out . . . there’s more money left for the younger partners.
But is that really the case if, for a medical group, what’s walking out the door is the relationship with the hospital CEO, or if what’s walking out the door is the twenty years of experience as the group’s president? Is it really a savings to have that person leave? Or is it actually something that’s going to cost you money?
On paper, for the first year or the second year after the "retiree" is gone, it certainly looks like you saved money because their compensation is no longer a drag on the group. "Hey! Extra money in the bank!"
But is it really extra money in the bank if you lose key relationships that were putting all of the money in the bank?
The issue then becomes considering ways of repurposing people who would otherwise completely retire.
One client and his group found the solution: to share positions so that physicians who certainly had their skills, but desired to slow down, split a position. Two physicians sharing one role.
Other groups have looked at situations in which more than two physicians would share one role. Yes, there are issues. Do those physicians retain their full voting power? Do those physicians receive whatever other benefits the group gives its owners, for example extra year end distributions from a profit pool? All of those issues can be solved.
What I want you to focus on from the group’s perspective – and I suppose if you’re one of those physicians who’s about to retire, from your own perspective – is what retirement really means. What's it mean to the individual? What's it mean to the group? How can skills and relationships that would otherwise be lost, still be harnessed?
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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 – IBM Might Be Kicking Watson Health to the Curb: The Danger in Big Data – Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
According to a February 18, 2021, article in the Wall Street Journal, IBM is considering the sale of its touted-to-be-game-changing big data crunching wizard, Watson Health.
Although the venture has big top line revenue, around $1 billion a year, it is a consistent money loser.
It appears that the overall feeling inside IBM is not that it is IBM’s fault . It is just that doctors do not seem that interested in turning over decision making to a machine. Go figure.
And that brings me to the point of this post.
Big data and business decision making, especially in your practice, are two very different things. I am not qualified to tell you about the dangers as relate to the domain of medical practice, but I am certainly qualified to tell you about the dangers as they relate to the domain of healthcare business.
Data is data, but it is not decision making. Artificial intelligence is not intelligence, it is just a tool.
Yes, so-called “big data” is a faster tool with more inputs than, say, notes written on index cards spread out across the floor because there is no more room to tape them to the walls.
But no amount of data should ever be confused with making a decision.
Instantly being able to vet the financial performance of an acquisition target against thousands of other similar targets, or being able to assess the combination of education and training across tens of thousands of x-ologists to gauge your new hire, do not supplant, or come even close to supplanting, your own judgment concerning the decision. Decision-making can not be outsourced.
Oh, I can hear someone saying, “But without all of the data there is more risk.” But big data, simply as a function of being tremendously big, suffers from the problems of noise.
There is far more data, but how much of it is bullshit? And, of course, there is no reward without risk. (With the exception of being a government employee.)
It makes you wonder if those who have opted for big data as a decision making tool as opposed to a decision support tool, are simply afraid to make decisions themselves or are preselecting a scapegoat.
Think of it this way: IBM’s Watson, for all of it big data, could not figure out that it's essential intended audience, physicians, did not want to use it. |
| | | Listen to the podcast here, or just keep reading for the transcript.
It was a breezy day. Dozens of sailboats dotted the sea outside of the safety of the Santa Barbara harbor.
Many were running with the wind, being propelled quickly in the direction chosen by it.
Others were heading, in general but not absolute terms, against it by tacking at angles across it.
L'air du temps, the spirit of the times, in healthcare is not much different from the wind buffeting those sailboats: Communal, "we" not "me," top down not bottom up.
For your medical group to succeed, you need to understand the direction of the societal wind. You might like it. You might hate it. Either way, it is still windy.
Just as the boat captain must deal with the wind, not ignore it, medical group leaders must in any event accept that l'air du temps is real, that it exists.
If you want to go where that wind is pushing you, then go for it and adopt a business strategy in conformity with it. If you find l'air du temps to be polluted, then chart a course across it, not into it.
But in any event, you can't simply allow the wind to buffet against you without navigation, and you can not simply drop sail and pray to be rescued.
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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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