| View this email online if it doesn't display correctly |
|
|
|
| |
Why You Must Read the Funniest Healthcare Headline Ever
It's been over a week, but I keep laughing every time I read the article’s headline: Bankruptcy Trustee Fires Missouri Hospital Chief Strategy Officer.
Other than as amusement, what news value is there in the fact that a bankruptcy trustee perceived there may be some issue with retaining the chief strategy officer of a hospital that ended up in the toilet?
To be fair, the chief strategy officer in question claims that the termination was in retaliation for reporting preventable deaths to regulators. Maybe that’s true, maybe it’s not. But this article isn't about the particular instance.
Instead, it's about the general proposition of allowing an entity’s leader, say the president of a medical group or the managing officer of an ASC, to run the entity into the ground or to make errors of biblical proportion, even engage in self-dealing, and yet still keep his or her job.
And, the strange thing is, it happens all the time.
"Give him another chance, I’m sure he didn’t try to steal our group’s contract.”
"I don't believe that she really meant to give our confidential information to a competitor."
"You know, I'm sure there's a reasonable explanation for why our ASC has a Mercedes and a ski boat on its books."
Honest mistakes are one thing. Not all business strategies succeed. Learning from those failures is part of a leader’s growth curve.
But the cost of not learning and of repeating the same mistakes over and over again should not be acceptable. And, without question, acts of dishonesty or disloyalty or self-dealing should not be forgiven: He or she must go.
But of course, that involves two elements: You must have the, well, nerve, to actually assert that position. And you have to have organizational documents that enable you to take action.
Many organizations fall short on both grounds.
But certainly, even if your group is comprised of owners of high self-esteem, if your partnership agreement or shareholders agreement or operating agreement doesn't permit the removal from office or termination of a leader, whether elected or employed, without a near impossible super-majority vote and complex rights of appeal, it often becomes easier in the short run to leave a dysfunctional or even disruptive individual in a position of power.
But, of course, “in the short run” doesn’t mean in the long run: The person who must be terminated but who remains in power is certain to continue to do damage on one level
or another.
Run an audit of your group’s organizational documents. What right do you really have to get rid of an anchor that’s pulling you down, the metaphorical strategy officer of a failed facility? |
| | 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.
|
| | | Newsflash: Business Life In the Time of Coronavirus - The Way Out
The coronavirus crisis, especially as it's become politicized, raises a number of business issues and, quite frankly, business opportunities in regard to future disruptive events.
Check out our mini-series, with actionable business lessons for medical group leaders.
Sooner or later this crisis will end. You can’t allow yourself to be too busy, too occupied, too concerned with current events, to devote time and effort to strategizing for your future.
|
| | Wisdom. Applied. 142 - Let's Find the Cure for Surprise Physician Services Stealing[Author’s note: Today's post deviates from my usual method of addressing a topic in short form and then later, when it gains traction, building it into a full length article for publication. Instead, the post is an initial draft of an essay on surprise medical billing, a thorny subject which, I believe, has an immoral undertone, but not the immorality popularly seen. I welcome your comments and suggestions.]
There is a crisis. But it's not the one you've heard about.
It's time to fix that. It's time to change the conversation.
But to do that, you have to change the frame.
From the framers of the constitution, to the framing around that velvet Elvis, to what's in and, therefore, what's out of a Robert Frank photograph, framing controls the point of view. Framing, too, controls a conversation and, therefore, the argument, and, therefore,
the outcome.
Tucked away in the wallet of Merry Mittleklass, our avatar patient, is her Blue United Free From Worry Plan insurance card. She's been covered by Blue United for years, but had never (as she says, “Bless my stars!”) seen the inside of a hospital.
That is, until last Tuesday at 7:44 a.m., when she had surgery at Community Memorial St. Mark’s Hospital to repair a hernia.
Community Memorial St. Mark’s and the surgeon were in-network with Blue United. But the anesthesiology group wasn’t. And, so the story goes, Merry was “surprised” when she found out that Blue United had paid the group $200 and that she was “stuck” with a bill for the remaining balance, $1,375.
The popular press, the press of payors, and the populism of politicians all frame this as the out-of-network hospital-based group’s problem. Or, they allege with glee, a problem caused by the out-of-network physicians’ predatory practices.
The name for this frame? “Surprise medical billing”. The resulting cure? Force the group to take, as payment in full, an amount to which they never agreed, the so-called “average.”
But let’s take a closer look.
Earlier this year, the press was abuzz with coverage of the fact that UnitedHealth was not renewing its contracts with Mednax for services in 4 states because those agreements pay Mednax more than UnitedHealth now wants to pay. Come the termination dates, Mednax’s anesthesiologists and neonatologists will be out-of-network. Out-of-network wasn’t Mednax’s strategy. It’s just a fact. As a result, under the common frame, patients will be “surprised” . . . and it will be spun as Mednax’s fault; every one of their bills will be deemed a “surprise medical bill”.
Let’s take a look from another angle. Last week, a radiology group determined that the 80% cut proposed by payor X was unacceptable. (They actually used a different term.) They will not sign the offered contract nor is there any legal or moral reason for them to do so. They will soon be out-of-network, which wasn’t their strategy. It’s just a fact. As a result, under the common frame, patients will be “surprised” . . . and, once again, it will be spun as the
group’s fault.
One more view: Some group of anesthesiologists, let’s call them the “Live Free or Die Group” doesn’t want to contract with any payor. They are out-of-network by choice. And, that makes them an outlier. Once again, under the common frame, patients will be “surprised.”
The "cure" proposed, even legislated, by those constructing the frame of "surprise medical billing" is to force non-contracted physicians, whether those physicians are out-of-network by reason of choice or by coercion, to work for a rate to which they never agreed, the so-called "average" rate.
Why? What's the philosophy, the morality, behind that frame, the frame of "surprise medical billing”? Why should anyone be forced to work for a rate to which they didn’t agree?
Almost at the same time that the UnitedHealth/Mednax story broke, the news was awash with a new round of what's become a familiar story, one that “activists,” even musicians, rail against: people being forced to work for wages to which they didn't agree. Only those folks are, it is said, constructing iPhones and computer parts.
In that context, stealing one’s labor is seen for what it is, coercion and theft.
Yet, in a leap over the moral chasm, I'd be surprised if we could find one of those activists who sees forcing physicians to work for rates to which they didn't agree as the equivalent.
In the context of any of our avatar hospital-based medical groups, Mednax which has been tossed out of network, the radiology group which refused to take an 80% cut, or the anesthesia group which doesn't want to contract with any payor, is there someone, some entity, which has in fact contracted to provide coverage to the patient, to our avatar
Merry Mittleklass?
You bet there is. For one can't be out-of-network unless there is a network. And that network is a result of Blue United’s contract to provide coverage to Merry Mittleklass.
If Blue United were a general contractor instead of an insurer or health plan, and they contracted to build Merry Mittleklass’s house for $500,000, but then couldn’t get tradespeople to do the actual work for less than $600,000, it would be Blue United’s problem.
If general contractor Blue United can’t force plumbers and electricians to work for less than they’ll agree to accept, why would anyone think that payor Blue United can force pathologists and radiologists to work for less than what they’ll agree to accept? After all, it would be surprise physician services stealing.
Unless the frame is changed as I suggest, that being forced to work for a rate that wasn’t agreed to is theft, hospital-based physicians will never be able to succeed in battling against working for “average” in a universe in which payors throw higher paid groups out-of-network to reduce the resulting average. That’s a spiral to the bottom, which in turn, will sooner or later cause a bigger crisis, the unavailability of, or reduction in quality of, hospital-based services and hospital-based providers.
Over 160 years ago, Frederic Bastiat, the French politico-economic thinker, warned of the danger of quick fixes like the one we’re seeing for “surprise billing.” In his essay, That Which is Seen, and That Which is Not Seen, he wrote that:
“ . . . a law, gives birth not only to an effect, but to a series of effects. Of these effects, the first only is immediate; it manifests itself simultaneously with its cause — it is seen. The others unfold in succession — they are not seen . . . . Between a good and a bad [politician] this constitutes the whole difference — the one takes account of the visible effect; the other takes account both of the effects which are seen and also of those which it is necessary to foresee. Now this difference is enormous, for it almost always happens that when the immediate consequence is favorable, the ultimate consequences are fatal . . . .”
For hospital executives and office-based physicians who think that the legislated cure to surprise medical billing is simply a hospital-based physician problem, think again: I recently heard someone refer to his larger than expected share of in-network care as “surprise medical billing.” Yes, it’s a slippery slope.
Re-frame the issue for what it really is before it is too late: Surprise physician
services stealing.
|
| | All Things Personal
Only once before in this column’s history have I used it to recommend someone else's service or product. I’m highly discerning about customer service and quality, so pay particular attention to the following; you’ll thank me for it.
Suits, the official outfit of the attorney. For years, I'd buy suits from Barney's, Nordstrom, and Saks, spending thousands on each one.
But earlier this year, I purchased one, then another, and then one more from Black Lapel via their online made to measure program.
The price? Fantastic, less than a third of what I’ve spent elsewhere. The fabrics? Wonderful. The fit? Ah, this is the best part: because they’re made to measure, they’ve required very little tailoring adjustment upon arrival and fit ten times better than the others I own.
And here's the most interesting part: In connection with that third suit, the pants arrived without cuffs, even though I had ordered them. A quick email to Black Lapel resulted in a quick response: Keep the first pair and we’ll send you another pair with cuffs, without any charge. Yes, they made a mistake, but the way, and the speed at which, they corrected it sets them apart — they are truly the gold standard.
In fact, I ordered another suit from them right away!
Through that interaction, I’ve come to know Warren Liao, one of the co-founders and CEO of Black Lapel. A former investment banker, he and his colleagues founded Black Lapel nearly 10 years ago.
Warren and his team know fine men’s clothes, and they know the price point, and they know customer service.
I get nothing from Black Lapel for making this recommendation, actually, for urging you to give them a try.
Well, that’s not 100% true: I’ll get back your gratitude that I told you about Black Lapel. |
| | 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?
|
| | Podcast Compilation Greatest Hits - Strategy Edition 1.0
We've curated our most popular podcasts on strategy into our first compilation album.
Sit back, enjoy, and think about your future.
Listen here. |
| | | | | | 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 here.
|
| | | 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. |
| |
|
