Wisdom. Applied.: Recent Episodes
Mark F. Weiss
California’s crackdown on the friendly physician model may signal broader risks for MSOs nationwide.
Most discussions about healthcare AI focus on replacement. What if the real opportunity is the opposite? By taking administrative work off physicians' plates, AI may help restore the very thing industrialized medicine has eroded: the physician-patient relationship.
There is a wide middle ground between going it alone and giving up control, built on physician-led collaboration, shared resources, and strategic alignment.
The most successful physicians aren’t depending on one job or one source of income. They’re building out a range of skills, roles, and ownership opportunities so they have real flexibility—and control—over what comes next.
Artificial intelligence is challenging the traditional legal framework that places physicians as the “learned intermediary.” As AI systems increasingly participate in clinical decision‑making, the legal standard for physician judgment, documentation, and liability may shift in ways physicians need to understand now.
Medical group mergers often fail not because of economics, but because of governance. When groups preserve separate identities instead of fully integrating, the result is conflict, inefficiency, and eventual breakdown.
As corporate medicine expands, physician autonomy declines, but opportunity grows. Why “rent seekers” are creating a powerful edge.
Physician groups often believe they’re negotiating price when, in reality, they’re negotiating value, positioning, and long-term relationships. The groups that succeed understand that contracts aren’t commodity transaction, and that the outcome is shaped long before negotiations begin.
Utah has launched a program allowing AI to process prescription refills, but without clear regulatory authority or defined liability.
AI can either tighten institutional control over physicians or restore autonomy and human‑centered care. The difference isn’t technology, it’s who holds the strings.
Many physicians leave hospital or private‑equity owned practices only to recreate the same factory model they wanted to escape. Real differentiation comes from rejecting throughput medicine in favor of human‑centered care.
AI may assist clinicians, but replacing them creates a liability gap. Malpractice caps protect physicians, not algorithms, and the risk exposure is unlimited.
The FTC has abandoned a blanket ban on noncompetes, but is aggressively enforcing them in healthcare. What physician groups and physicians need to know now.
AI won’t replace radiologists, but it will change throughput, FTE math, and leverage in hospital contracts. Groups that ignore this will lose negotiating ground.
Nearly 30% of anesthesiologists are projected to leave practice by 2033, creating a workforce shortage hospitals can’t ignore. How can hospital-based groups can turn the reality into real negotiating leverage — before the window closes.
Hospitals talk about “alignment,” but when leadership changes or incentives shift, the relationship often looks very different.
Mark F. Weiss sat down to chat with Justin Harvey, ChFC, CFP, a well-known financial planner whose practice focuses heavily on working with anesthesiologists and pain management physicians, about preserving wealth, not just accumulating it. The talk centered on the importance of having hard money conversations to keep your family together.Get in touch with Justin Harvey: https://www.linkedin.com/in/justin-harvey-46625516/https://apm-wealth.com/Sign up to receive complimentary educational materials at: http://www.weisspc.com/subscribehttp://www.weisspc.com
Four surgeons practicing together, ophthalmologists, for example, plan to build their own ASC. It goes without saying that they would think that distributions from their ASC must be in proportion to ownership interests. But that’s not necessarily true.
When a hospital system terminates a 35‑year relationship with its ER group, it tells you far more about leadership than about performance.
Does banning physician-owned hospitals worsen shortages? Explore how ownership limits affect hospital-based coverage and alignment models.
Time and again, physician group leaders, smart, experienced, and otherwise hard-nosed, regularly fall prey to a simple proposition when dealing with hospitals: “You can trust us.”
When distraction in patient care leads to criminal charges, medical groups face serious risk. Learn how distracted doctoring exposes physicians and groups alike.
Five ophthalmology practices agreed to pay nearly $6M over alleged kickbacks and unnecessary testing. Learn the FCA risks every physician group must understand.
USPS postmark delays can make timely contract notices look late. Learn why this matters to protect deadlines and reduce legal risk.
Hospitals can’t be reformed. Committees create the illusion of influence, not authority. The real solution? Exit—and build independence.
Now that they’ve been sentenced to prison, I can reveal the fate of the healthcare power couple, Alexandra Gehrke and her husband, Jeffrey King, whose wound care graft graft put close to $615,000,000 in their pockets, albeit temporarily.
Mark Weiss and Jason Almiro (Quantum Health Advisors) sit down for a candid conversation on the major changes in Medicare’s 2026 Physician Fee Schedule—what’s new, what’s gone, and what entrepreneurial physicians need to know now.
Are hospitals becoming modern company towns for physicians? Explore the parallels, risks, and emerging alternatives for independence.
When you’re negotiating for any agreement, any deal, especially one that is creating an ongoing relationship, which is the hot molten center of services agreements such as exclusive contracts, you not only want to, but you need to, play to human cognitive biases in establishing that relationship.
Few doubt that things need fixing in healthcare. But many, from DIYer docs to industry leaders, suffer from being inside an echo chamber.
Some laws derive from morality and others are purely the result of politicking and protectionism.
Medical groups don’t usually collapse because their revenue dropped 3% last quarter. They collapse because someone, usually someone important, disappears, and no one bothered to think about what happens next.
Is your medical group’s bank just holding your money—or helping you grow? Strategic banking relationships can unlock leverage, improve deal flow, and strengthen your group’s financial position.
The No Surprises Act wasn’t about patients. The fine print told a different tale: it was an insurer-protection law.
The law isn’t physics—it’s power, people, and positioning. For physicians and medical groups, the best legal outcomes start with smart planning.
Contracts in healthcare are built like block towers—each deal-point matters. Remove the wrong one, and the entire structure may collapse.
Dogs wag their tails. Humans do too—just not the same way. In negotiations, your counterpart is sending signals you might be missing. Learn how to spot the “tail tells,” control your own, and use them to your advantage.
Most healthcare negotiations fail before they begin—because leaders don’t prepare. Learn how physician groups can approach contract talks like elite athletes: with strategy, rehearsal, and a winning mindset.
Non-Competes After the FTC’s Pivot: A Balancing Act for Medical Group Leaders by Mark F. Weiss
FTC ditches a full non-compete ban, but healthcare employers still face targeted crackdowns. Physician groups, take note.
Even the strongest physician-hospital relationships are transactional. Survival depends on diversification, not loyalty myths.
Several years ago, it would’ve been difficult to write too much about the strategy of responding to an RFP, i.e., a request for proposal, for physician services. Today, however, with an extreme shortage of physicians, RFPs are not so much a thing.
$500 Million in Alleged Phony Charges and the Dangers of Medical Directorship by Mark F. Weiss
Some models were once useful, but no longer are. How’s the “reliant on Medicare”, or even the “reliant on commercial payors”, model working out for you?
Your business exists and interfaces on multiple planes and, therefore, the far smarter approach is to explore and adopt protection on each.
Out of state and still billing for in-person care? A physician submitted claims while vacationing in Hawaii—and now faces criminal sentencing and a $500k civil payout.
Deals involving management services agreements, consulting contracts, or similar structures can appear completely legal at first glance. But dig deeper, and they might turn out to be elaborate covers for kickbacks or bribes.
The majority of healthcare fraud schemes center on fraud perpetrated by physicians, but what about schemes orchestrated to victimize physicians?
It’s been said that people read published lists of disciplined fellow professionals out of a sense of schadenfreude, the pleasure derived from another’s misfortune.
Bureaucratic sorts are drawn to numbers because numbers can be gathered and processed and manipulated, all with the goal of lifetime employment for those bean counters.
Certainly, Oregon is a small state in terms of medical practice, but what’s happened in Oregon could, and some say will, spread across the country.
Was it a scam or an error? A settlement is just that and there’s been no determination of liability.Neither you nor I can know for sure what went on, but either way, there’s a lesson here about billing compliance.
Considering honey bees have been on earth for between 40 to 150 million years, it pays to consider their hive strategy for success, especially because it maps perfectly onto medical groups.
There’s huge danger in any arrangement in which you put your prescribing imprimatur on any script or order for any item, especially those reimbursed by Medicare.
It’s imperative that you get started now and that you become willing to invest in your own future.
Hospital-based medical groups, notably anesthesiology and radiology groups, are increasingly turning to creative means to provide coverage and to improve collections.
In healthcare, size used to signal strength. Bigger meant more services, more specialists, more veritas. But what if all that bulk is actually a liability?
As healthcare payers, tech platforms, and pricing vendors increasingly collaborate through sophisticated analytics, this case is a clear reminder: if you're coordinating decisions that competitors used to make...
Supervisory requirements aren’t just administrative niceties; they’re the difference between compliant practice and a lawsuit waiting to happen.
It’s not news to you that there’s a huge shortage of physicians in many medical specialties, such as in anesthesiology and radiology. With the overall aging of the physician population, shortages in other medical specialties, including those that are office-based, will intensify.
There are dumb crimes, and then there are crimes so dumb they come with a built-in paper trail leading straight to prison.
Even in the face of the provider shortage, during which you think that you have substantial negotiating leverage, when a significant chunk of your revenue comes from the hospital, you’re no longer just a contractor. You’re an appendage.
Over the past several weeks, I’ve seen multiple posts and comments on LinkedIn about the horrors of practicing as a cog in the wheel of Big Medicine, employment schemes facetiously referred to as “medical groups” by their health system or insurance company owners.
According to Bain & Co, nearly one-quarter of physicians employed in health-system-led organizations are considering switching employers.
Buying a healthcare business, from a medical practice to a medicine manufacturer, is a lot like buying a house—you hope for the best, but sometimes, there’s wood rot hiding under that fresh paint.
The False Claims Act (“FCA”) is a powerful tool to fight fraud against the government, especially in healthcare. It contains a “qui tam” provision that lets regular people—called “relators” or whistleblowers—sue individuals and entities for fraud on behalf of the government.
There are, depending upon the particular arrangement, potential end runs around contractual pass-through billing prohibitions, but they are highly fact specific and technical.
Although any particular crisis can’t be predicted, classes of crisis are capable of prediction and, even if that is not true of a specific situation, the way in which your group or business will respond to a crisis can, should, and must be planned far in advance.
Are you sure those consultants are helping to improve your business? Or are they potentially sending you to jail?
Re-frame the issue for what it really is: Surprise physician services stealing. Now’s the time for the No Surprises Act, and each state counterpart, to go.
Although no one is going to do time as a result of thinking that wet sidewalks cause rain, in the case of the federal Anti-Kickback Statute, confusion over correlation can put you in jail.
After having represented medical groups with a particular emphasis on hospital-based groups for 30 years, it has become strikingly clear that what distinguishes the most successful groups, from the great majority of the mediocre.
Medical group organizers generally confine their entity's business structure to a corporate or partnership type entity and then proceed to conduct business through it.
People are internally inconsistent. Many contracts in the healthcare sphere are inconsistent, too. The first causes grief, the second shifts power.
The volleys in this battle move slowly--think pendulum as opposed to ping-pong. And right now, despite the appeal, the pendulum is still on the side of “state law controls”.
Uncover the history of the whistleblower provisions in the False Claims Act and their significance in fighting fraud.
Fueled by the failure of large medical groups, the disappointments of hospital employment, and the ratcheting down of care by private equity, physicians are increasingly seeking alternatives to their current practice arrangements.
The “friendly physician.” Boy, is that’s a term of art or, perhaps better said, of artifice.
There is no such thing as static demand for services over a contract’s multi-year term, and it’s a fool’s bet, yet one many take, to believe that one can place a set value on total fair market value.
Cars go in reverse. So do ceiling fans and electric drills. But did you know that kickbacks go in reverse, too, and that there’s no safe harbor for that?
There’s a good chance that you can accomplish some or all of what a covenant not to compete addresses, even if the “law” says you can’t.
It’s no secret that hospital-based medical groups, particularly anesthesia and radiology groups, are experiencing significant trouble recruiting and retaining their professional staff due to increasing compensation demands combined with declining reimbursement.
Despite the fact that some states have strong prohibitions against the enforcement of non-competes, there are still ways to create agreements functioning as proxies for non-competes.
Certifying to Medicare that you’re here when you’re really there is a ticket to nowhere, or maybe to jail.
Health care fraud is far from harmless. Fraudulent activities drain billions from health care programs like Medicare and Medicaid, leading to higher taxes and less money for other important services.
You’re signed in to the hospital’s electronic medical record system. What’s the harm in just typing in the name of a friend to see what pops up?
According to 2023 reports, by 2021, nearly 70% of physicians were employed by hospitals or investor-owned corporations.
No, I don’t have a crystal ball and I can’t predict the future. But that doesn’t mean that I’m blind and can’t see a cliff dropping off on the near horizon.
Telehealth can be used to vastly improve patients’ access to medical care. At the same time, it can be used to vastly improve criminals’ access to Medicare dollars. It shouldn’t be that difficult for physicians to assess the bona fides of their proposed participation in a telehealth “business model” when the ones doing the proposing are telemarketers.
If what the government alleged were true, it would be an emergency physician’s dream job: billing for services without ever treating or even speaking with the patient.
The financial impact was immediate and momentous: Neither new nor existing claims, nor payment for them, could be processed.
The financial impact was immediate and momentous: Neither new nor existing claims, nor payment for them, could be processed.
Many predicted that the financial behemoths run by the smartest guys in the room would swallow up every physician on the planet.
Many people tend to think within professional silos. Barbers cut hair. Farmers farm. And, doctors practice medicine. Why?
The first purchase price is the one that the seller receives. The second purchase price is the one that the seller pays by having sold to the wrong buyer.
What policies does your group have? How are they enforced . . . or even, how can they be enforced?
Picture a revolving door.Even though many physicians and facility administrators don’t realize it, a revolving door can be a useful analogy for anti-kickback analysis. Or, I suppose, just for kickbacks.
I remember, as a kid, walking around Disneyland, noticing yellow "no parking" size signs labeled Kodak Moment. They indicated a great vantage point for taking a photo.
Don’t make the mistake of thinking that being late signals your importance or your power.
There are many reasons why contracts are usually contracted -- made compact, that is -- by having them contained within one fully integrated document.
I’ve written about hospital closures, shrinking hospitals, and hospitals that became holes in the ground. I’ve even written an entire book on The Impending Death of Hospitals. But before today, I’ve never written about a hospital that turned to crowdfunding to stay afloat.
I represent physicians in transactions across the country and there are plenty of ways to make a profit and to do the right thing for patients.
I was driving when I saw the sign, one of those large plasticized canvas ones, tacked up on the side of a small office building: "FREE* First Chiropractic Visit"
As I’ve mentioned many times on the blog, medical groups and facilities often create whistleblowers – their own compliance officers and other executives flip on them with regularity.
What’s a hospital surprise bill? Well, it’s something slightly different from the concept applied to physicians.
Not only is all that glitters not gold, shipping containers thought to contain nickel might just contain carbon steel.
Sometimes, I think it's Groundhog Day. No, not the Punxsutawney Phil kind, but the Bill Murray movie kind, you know, when things keep repeating themselves over and over and over again. Like stupid kickback schemes.
We’ll take your $15 billion stipend, but as to those strings you put on it, “F*^%” you”.
The context was the sale of various healthcare facilities, deals which, by definition, involve the sale of the business...
The paradigm for physician hospital relations is completely at odds with society's other trends.
How will physicians fit within the bureaucratically envisioned healthcare system of the future?
Employment by hospitals is no safe harbor for physicians; in fact, it's quite the opposite.
There is no question that the healthcare market is changing rapidly. This means that groups must have the ability to make business decisions rapidly.
It’s often how the mistake maker, not the “victim,” reacts that makes the difference in the outcome.
Lowering your goals just to tell yourself that you’ve hit them is a crime against your potential.
Lawyers hear this all the time from newer members of their firm. Doctors, too, hear it from junior members of their medical group.
In a personal services business, from medical groups to acute care hospitals, what's more important, your people or your tangible assets?
People often cite Newton's First Law as something akin to "an object in motion tends to stay in motion with the same speed and in the same direction."
There's little question that most, if not all, medical groups should be led by practicing physicians.
Words matter. They are the bullets in the fight for public perception, in the battle for change.
What good is an exclusive contract if the facility demands that it become non-exclusive?
Speed and size are often an advantage, but in some situations, and in some markets, they're not. For medical groups, the current healthcare market is one of them.
Consider now that people, not institutions, are capable of morality. At best, institutions are amoral. At worst, they are immoral.
It was June when I saw it. The boarded-up stores of Main Street, paved red with bricks and lost hope.
Is your group being governed or governed? Yes, it’s a trick question. But the answer might just be a joke on you.
My dog stood body frozen stiff yet ready to lunge. His eyes fixed on the only object in his world, the squirrel eating seeds off the ground 14 feet away.
It's hard enough to watch what you say when you're speaking, but at least you've got inflection on your side.
- Look before you leap. CHECK.2. Measure twice, cut once. CHECK.3. Document your deal with your partners before commencing joint practice. WHAT?
It was 9:00 p.m. The restaurant was clearing out. I was eating alone after returning to the hotel following a meeting.
You’ve heard that old expression to the effect that it’s better to do and then ask for forgiveness than it is to ask for permission in the first place.
"How do you become a millionaire? Make a billion dollars and then buy an airline." -- Warren Buffett
I'm no enemy of fast food. I just don't want to eat it. I don't care if you do. I wouldn't make it illegal. But some mayors would.
A friend told me about his old boss, a guy who thought he was sending a message of his own importance by showing up late to meetings with his clients.
Many medical groups (actually, many of all sorts of businesses) shortchange their future as a result of their past.
Compounding pharmaceuticals, specific drugs for specific patients, offers tremendous benefit. The problems arise when the benefit is for the prescribing physician.
approve, doctor, gate, gatekeeper, group, keeper, medical, negotiate, negotiation, physician, power, yes
If, as I’ve written before and as we’re now beginning to see, a hospital need not have beds, then what’s the difference between a hospital (which physicians can’t develop as a Medicare facility) and an ASC?
It's Friday night. After leaving the restaurant you turn onto the sidewalk and walk down the street. Ah, an art gallery! You wander inside.
July 4th, Independence Day in the United States, celebrates the original 13 colonies’ declaration, in 1776, of their independence from Great Britain.
Contracts exist so all the information can be located in one convenient place. It’s easier to enforce an agreement, when you can find all the details easily.
The new Chevy Spark is probably the most efficient car currently available, delivering an average 119 combined city MPG. The Nissan Versa 1.6S, the least expensive vehicle currently available, averages at around $11,990. Are you a value buyer? Or a price buyer?
You know that I strongly believe that the future of hospitals isn’t hospitals, it’s outpatient facilities.
You can download our most popular strategy podcasts, all compiled for you in one convenient album.Sit back, enjoy, and think about your future.
Why hospitals are destroying themselves, and setting their CEOs up for termination, when they bring in national groups and “contract management companies.”
Be sure you're armed with our best information, in an easy and transportable audio format.You'll be ready, wherever the road ahead takes you.
You can listen to our most popular podcasts on the subject of managing your practice, all compiled for you in one convenient album.Sit back, enjoy, and think about your future.
A diamond and a rock, sitting side by side. Both discovered near the bottom of the Udachny diamond mine in the Sakha Republic region of Russia, one of the world’s ten deepest open-pit diamond mines.But are they of the same value?
"I can't put it in the agreement, but trust me on this. You have my word."Those are famous words from a hospital CEO. And, maybe you can trust him. But can you trust his successor?
The right question regarding the uncertain future, is to ask is what underlies your profession, your specialty, or its role. What’s the motivating desire or overriding function?
Sure, unlike immigration love, less than heartfelt medical group merger isn’t a federal crime.
In a personal services business, from medical groups to acute care hospitals, what's more important, your people or your tangible assets?
In a personal services business, from medical groups to acute care hospitals, what's more important, your people or your tangible assets?
Knowing how to develop emotion-based strategies and how to implement them are simply among the "combined arms" tools that medical groups must develop in order to thrive.
People can’t separate emotions from decision-making. They can lie about it and claim emotions are not a factor, but it’s frankly impossible for emotions not to be a major driver of decision-making.
In the U.S., it seems that lots of people expect a tip, from the person who simply hands you your coffee at Starbucks to, I’d expect, hospital administrators (but only at for-profit facilities). Okay, just kidding, but you get the idea.
Anita Roddick, the late founder of the highly successful natural cosmetics chain, The Body Shop, which she sold to the cosmetic giant L'Oréal for $1.1 billion, was a tremendously driven entrepreneur and an extreme social and political activist.
Anita Roddick, the late founder of the highly successful natural cosmetics chain, The Body Shop, which she sold to the cosmetic giant L’Oréal for $1.1 billion, was a tremendously driven entrepreneur and an extreme social and political activist.
If you were going to sell your house, you’d make sure that it’s put into decent or even prime shape before listing it, right?
Let other physicians worry about surviving the down economy: Take these steps now in order to thrive.
Let other physicians worry about surviving the down economy: Take these steps now in order to thrive.
Let other physicians worry about surviving the down economy: Take these steps now in order to thrive.
I see a tremendous amount of tension, especially when it comes to the relationship between administration and hospital based groups.
In many medical specialties, both hospital and office based, national groups have become significant competitors.
Let’s say you are the leader of a medical group. It could be a small group of a handful of physicians. Or, you could be the President and CEO of a 600 or 6,000 provider group. It does not make any difference.
Hospitals are employing more physicians. So why don't they want them to become really successful?
Strategic advantage is gained by being able to process information and take action faster than one's opponent
Hospitals are focusing their hard and few-earned dollars exactly where it counts, spending big bucks on the physician executives...
If you're selling medical services but collecting only peanuts (or even hot dogs) let me know. You need a better agent.
That’s odd, because physicians sometime demonstrate that ability, at least on billing records.
Why are physicians working much harder for less money? Why is it proper that there are so many regulatory burdens interfering with physicians’ abilities to own and refer to facilities?
Here, courtesy of Tenet Healthcare and two terminated cardiologists is a lesson about firing physicians . . . and, when not to.
The layers of bureaucracy that were supposedly meant to insulate the doctors from the “hassles of running a medical practice” out hassled the actual “hassles of running a medical practice.” Go figure.
The layers of bureaucracy that were supposedly meant to insulate the doctors from the “hassles of running a medical practice” out hassled the actual “hassles of running a medical practice.” Go figure.
Obviously, there's balance to be had. Some customer service is expected. Other customer service delights.
An outsider with no knowledge of any single fraudulent claim brings a False Claims Act suit. Listen now to find out what you must know.
An outsider with no knowledge of any single fraudulent claim brings a False Claims Act suit.
A recent U.S. District Court ruling serves as a reminder that more than fair market value is needed to remove an arrangement from scrutiny under the federal Anti-Kickback Statute (“AKS”).
Structuring a payment or a transaction such that the deal is at fair market value is not the be-all and end-all of AKS compliance.
As you know, it’s hard to make a decision when you might have to pay a large price for it. It’s much easier to make decisions when there’s only an upside, that is, when there’s an upside if it succeeds and an upside if it fails.
There are tremendous opportunities in the market, opportunities that you can exploit. But in doing so, you must think twice, or even thrice, about the proper structuring of your deals.
Although much of the attention has been placed, for good reason, on the operative billing-related restrictions imposed by the NSA, the technical notice requirements require immediate attention.
These regulations require that patients be given a notice of rights and, should they so request, a good faith estimate of charges.
Negotiation doesn’t take place in a vacuum, it takes place within a context. So why not control the context?
Medical group leaders are busy focusing on day to day activities: Most are deeply involved in direct patient care. Some, yes, some, also devote some time to working on their business. But there’s a pressing need to engage in strategy.
Are you planning for your ideal future reality, or focusing on slight incremental improvements?
Like the visible horizon, the apparent line that separates the earth from the sky, your business horizon is directly tied to height.
Planning is less effective than strategy and strategy is most effective when strengthened through the Scenario Survey Process.
Over the weekend, I took a road trip out to the middle of nowhere. Once in a while, you'll see a sign that says, “No Services Next 32 Miles,” and what do you know, there isn’t even an exit for 32 miles.
All medical groups have a culture, whether or not it's been purposefully created. It exists.
Politicians legislate to correct a problem (and then bask in the glory of having taken action) but never truly consider what problems they create when they enacted the legislation.
Don’t set yourself up to go to prison by thinking you are setting the government up to overpay you.
Some say that you’re the composite of the five people with whom you spend the most time.
It’s the middle ground between light and shadow, between medical science and stupidity, and it lies between the pit of man’s desires and the summit of his bank account.
Just like hypertension, inflation is the silent killer, the hidden tax on your business, dreams, and desires.
Several years ago, I read a review in a magazine for consultants of a new book by an “expert” who advises that since business now moves at the speed of light, the “old” strategic question of “where do you want to be X years from now?” must now be “where do you want to be a few days from now?”
Just as no vote was required for a dictator like Castro to take over Cuba, no medical staff vote, no survey by Press Ganey, no long and drawn-out process among “stakeholders,” is required to topple the status quo.
You don’t have to have read any Hemingway or have had an uncle with a taxidermied marlin on the wall of his den to know about fishing for big ones.
Speed kills. I read it on the message board that stretched across the lanes of the highway. (I suppose that reading message boards kills, too, bu
You’re probably familiar, if not personally, then at least conceptually, with the notion of “F.U. money” – having enough money that you can simply walk away. That concept, whether you have the money or not, applies directly to your negotiation strategy.
Hospitals purchased physician practices, employed and otherwise aligned physicians, and pushed into outpatient care.
Breaches of fiduciary duty and of contractual commitment within medical groups occur every day. The question is, are those duties enforced?
Breaches of fiduciary duty and of contractual commitment within medical groups occur every day. The question is, are those duties enforced?
Unless you have developed a unicorn type practice or healthcare business, you need to adjust to the new reality.
The value of the services received by a patient can only be assessed from her point of view, not the hospital’s.
“Bob, we’ve got to give you your two weeks notice. Here’s a check for the next two weeks’ compensation. Just pack your personal belongings and Jerry, here, will see you to the door.”
Listen while Mark discusses converting a closed or failing hospital into a surgery center or other outpatient facility.
Do you know this key to negotiation? The key that will open the door to a done deal, a deal that delivers on your wants?
If you were going to sell your house, you’d make sure that it’s put into decent or even prime shape before listing it, right?
Running a hospital based group as “service” for the hospital, functioning as a sort of clearinghouse for income and expenses, severely limits your group’s future.
Running a hospital based group as “service” for the hospital, functioning as a sort of clearinghouse for income and expenses, severely limits your group’s future.
If you're a medical group leader, you must view your practice as consisting of several independent, yet coordinated, units, each of which requires a separate focus.
Ford focused on keeping things simple, building one model that (had to) suit all, using interchangeable parts that relatively unskilled workers could assemble.
If you're a medical group leader, you must view your practice as consisting of several independent, yet coordinated, units, each of which requires a separate focus.
Airlines have figured out that there are different customers who are flying for different reasons and at different price points. They’ve also figured out that some are willing to travel in a slightly different style. And yes, there's an analogy here to healthcare.
Ford focused on keeping things simple, building one model that (had to) suit all, using interchangeable parts that relatively unskilled workers could assemble.
Why are physicians working much harder for less money? Why is it proper that there are so many regulatory burdens interfering with physicians' abilities to own and refer to facilities?
oints. They’ve also figured out that some are willing to travel in a slightly different style. And yes, there's an analogy here to healthcare.
Will today’s physicians soon be referred to as “human physicians” or “carbon-based docs” as opposed to the silicon-based kind? Paging Dr. Robot?
I knew that I had taken the wrong job after my first day at the firm. More than thirty years have passed, so now I can laugh about it. But back then, I thought I was screwed.
I knew that I had taken the wrong job after my first day at the firm. More than thirty years have passed, so now I can laugh about it. But back then, I thought I was screwed.
ASCs can be great investments for physicians. Oh, as long as they are real. But if all they are are rainbows, unicorns, and clear blue skies, then you’d better stay away.
Letting each partner write his or her terms of partnership is not a long-term strategy for success, it’s a short-term strategy for failure.
Perhaps you've carefully structured your medical group's relationships with hospitals, referral sources, and other influencers. But did you pay attention to what's going on inside your practice's own house?
As always in these types of cases, which are civil actions, the settlement does not involve any admission that the allegations were true.
Maybe those excuses worked in fourth grade, and maybe Samirkumar J. Shah, M.D. should have tried them, but the one he went with, “I can’t show up at my sentencing for health care fraud because my doctor says I need to rest at home following a Covid vaccine reaction,” didn’t impress United States District Judge David S. Cercone.
You don’t have to have read any Hemingway or have had an uncle with a taxidermied marlin on the wall of his den to know about fishing for big ones.
Under the regulations a group practice must consist of a single legal entity operating primarily for the purpose of being a physician group practice.
What if you were running a restaurant instead of a medical group? Let’s say you decide to measure and reward on the basis of the time a waiter or waitress takes to picks up food in the kitchen and deliver it to the table...
A CMS advisory opinion [Advisory Opinion No. CMS-AO-2021-01] issued in June 2021 provides guidance that a parent-subsidiary medical practice entity structure in which the subsidiaries themselves don’t qualify as “group practices” under Stark can, in total, qualify as a “group”.
running a restaurant instead of a medical group. Let’s say you decide to measure and reward on the basis of the time a waiter or waitress takes to picks up food in the kitchen and deliver it to the table. Soon, waiters would be jogging through the joint, tossing plates onto the tables...
One thing is for certain, it will be no more walk in the park for the seven defendants convicted for their roles in a bribe and kickback scheme related to referring patients to Forest Park Hospital, a now defunct chain of Texas facilities.
With the tip of the hat to T.S. Eliot, the world for Community Regional Anesthesia Medical Group (CRAMG) ended on June 16, 2021, not with a bang but a whimper.
cry about it, the bottom line is the same: they are cutting costs by moving all cases that can be moved out of the hospital out of the hospital. Where does that leave you?
Quoting from his speech on August 28, 1963, King stated, "I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin, but by the content of their character. I have a dream today!”
What if you were running a restaurant instead of a medical group? Let’s say you decide to measure and reward on the basis of the time a waiter or waitress takes to picks up food in the kitchen and deliver it to the table…
How prepared are you if, despite the prophylactic precautions taken by your in-house team, taken by your outside coding and billing provider, and by your EHR vendor, your defenses are breached?
In my experience, most kickback schemes are not as brazen as this. They involve fewer numbers of people and, sometimes, behavior that is more easily rationalized by the participants as “sort of legal”.
Was the Cure Worse Than the Disease? Surprise Medical Billing and U.S. Anesthesia Partners v. UnitedHealthcare
Need a marketing consultant to help grow your ASC? You might want to check with your carriers first.
Laugh about it or cry about it, the bottom line is the same: they are cutting costs by moving all cases that can be moved out of the hospital out of the hospital. Where does that leave you?
Chalk up a victory for less care at higher prices. Hey, aren't those two of the Anti-Triple Aim?
Well the story as told by the Government is a familiar one: They allege that the events were payments to benefit Dr. Asfora and induce him to use Medtronic's SynchroMed ll intrathecal infusion pumps.
It was perhaps the funniest healthcare headline ever: “Zimmer Biomet to combine spine, dental businesses to form company called NewCo.”
The healthcare world was supposedly abuzz last week when the New England Journal of Medicine published (on Jan 2, 2020) the report of a study that shows that consolidation in the hospital industry doesn’t lead to higher patient satisfaction or to higher quality.
Strategic advantage is gained by being able to process information and take action faster than one's opponent.
How would your reorganize your medical practice, healthcare business, and relationships if you were paid only for successful outcomes, no matter how they are measured?
What is your favorite dessert, something that goes well with barbecue?Whether it's pie or vanilla ice cream (or both!), it's probably not 10 years in federal prison.
Here, courtesy of Tenet Healthcare and two terminated cardiologists is a lesson about firing physicians . . . and, when not to.
Over the years, I have dealt with many hospital CEOs that I thought were criminals. In fact, I have dealt with some who were indicted, and, in at least one case, a CEO who later became a long-term “guest” in the Gray Bar Hotel.
Over the years, I have dealt with many hospital CEOs that I thought were criminals. In fact, I have dealt with some who were indicted, and, in at least one case, a CEO who later became a long-term “guest” in the Gray Bar Hotel.
Big data and business decision-making, especially in your practice, are two very different things.
Let’s say you are the leader of a medical group. It could be a small group of a handful of physicians. Or, you could be the President and CEO of a 600 or 6,000 provider group. It does not make any difference.
Let’s say you are the leader of a medical group. It could be a small group of a handful of physicians. Or, you could be the President and CEO of a 600 or 6,000 provider group. It does not make any difference.
Medical groups must understand the direction of the societal wind. You might like it. You might hate it. Either way, it is still windy.
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.
We used to joke about the name of Midway Hospital, an acute care hospital in L.A., saying that it was midway between life and death. An anesthesiologist, commenting on my theme that inpatient care is becoming outpatient care and that the center of outpatient care isn't the hospital but the freestanding facility, in his case the ASC, told me that I was missing an element in the analysis.
Another week, another hospital closes. Well, at least one. This is a popular topic because each additional hospital closure underscores the risk for physicians and medical groups that don’t spread risk. The lesson applies to both hospital-based and office-based physicians, although not necessarily equally.
It is a crime, a violation of antitrust law, to conspire to allocate a market, thus driving up the price. It is particularly egregious when the conspiracy involves the market for medical care for cancer treatment.
There is nothing wrong with the notion of getting a little bit better each day, month, or year. That is if you discount the fact that improving the current structure of your group might keep you from getting where you really could be.
Many medical groups, certainly many hospital-based groups but, increasingly, even office-based groups, view themselves as simply providing a “service” for the hospital.
In reality, the “CEO” never really owned his business. He was simply its caretaker. He just realized it a bit too late.
Recently, I saw an article in The Wall Street Journal about pandemic economics and work-life balance.
To succeed in business, you have to focus on sufficiently satisfying, that is, satisficing, the needs and expectations of your customers and on reminding them of that fact.
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.
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.
There’s lots of advice out there suggesting single track “cures” to the cash crunch that many medical groups and facilities are experiencing as a result of the coronavirus economic crisis.
This is 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.
Walmart is famous for its slogan “Save Money. Live Better.” It’s no surprise that the slogan is aimed at the customer. But what about the supplier?
This is 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.
Walmart is famous for its slogan “Save Money. Live Better.” It’s no surprise that the slogan is aimed at the customer. But what about the supplier?
Evolutionary psychologists say that the reason we see a stick on the trail ahead of us as a snake is that it’s far better for our survival to see sticks as snakes than snakes as sticks.
Super Bowl commercials garner all sorts of buzz for being “creative,” but creativity isn’t selling. Listen below to find out how this concept applies to your medical group.
Today, employers reward for the value you create. The factory worker, whether in what is readily recognized as a factory or one which looks to outsiders, like a medical clinic or hospital, who simply shows up on time, does what he or she is told (you know, follows protocols) and then clocks out at the end of the shift, creates no real value in comparison with the next worker.
Uniforms send a message to others. A uniform can create tainted uniformity among its wearers, uniformity of thinking and uniformity of action.
Uniforms send a message to others. A uniform can create tainted uniformity among its wearers, uniformity of thinking and uniformity of action.
What’s a laptop cost? How about $1,040,000? Nope, it’s not the world’s first quantum computing MacBook. It’s just a regular old one. Heck, it’s even used! Listen to Mark explain the costs of unsecured devices.
Just as no vote was required for a dictator like Castro to take over Cuba, no medical staff vote, no survey by Press Ganey, no long and drawn out process among “stakeholders,” is required to topple the status quo.
The coronavirus has closed their office doors, but the U.S. Department of Justice is still prosecuting healthcare crimes and extracting painful settlements.
The tides of healthcare ebb and flow like the width of men’s ties and the political affiliation of Michael Bloomberg.
Listen to Mark as he discusses that it’s not the people that you have to fire that ruin your organization; it’s the people you should have fired but didn’t.
Listen to Mark as he discusses that a few months ago, while waiting at the gate for a flight, I couldn’t help but notice a gate agent making some woman unpack and repack and unpack and repack her expandable carry-on suitcase because it was too wide to fit into the measuring “box” for carry-on luggage..
Listen to Mark as he discusses in the real-world context of opportunistic action, “partnership” is a euphemism for “acquired” or “controlled.”
Listen to Mark as he discusses how many medical group leaders come to him for help when they’ve got a “problem” and they’re looking for a solution.
Listen to Mark as he discusses how many medical group leaders come to him for help when they’ve got a “problem” and they’re looking for a solution.
Listen to Mark discuss a topic that you’re probably familiar, if not personally, then at least conceptually, with the notion of “F.U. money” – having enough money that you can simply walk away. That concept, whether you have the money or not, applies directly to your negotiation strategy.
Listen as Mark discusses that both state and national level politicians certainly know what side the bread is buttered on, and who’s doing the buttering. There are far more patients than there are physicians, thus the rush to fix the problem they’ve defined as “surprise medical bills.”
Listen to Mark as he discusses the reality that we all construct and use models. Often, these are mental models, concepts or representations about how the world works.
Listen to Mark discuss a recent lawsuit which resulted in a $500,000 plus settlement by Sac Cardio and a $30 million plus settlement by Sutter in regard to their relationship.
Listen as Mark discusses what could happen if patients no longer need you, or, at least, not as much of you.
As I always say, think like a carpenter and measure twice (or even thrice), vetting each deal carefully with healthcare counsel, before cutting once, cutting your own neck, that is.
Remind yourself that, as you watch this today and three weeks from today when you remember to pull out your get out of jail free card, that physicians like you are sitting in their cells today and that you don’t want to join them.
Listen in as Mark talks about how healthcare models, such as Clinically Integrated Networks, are simply tools, not destinations, for structuring deals.
Walmart doesn’t think like you. They have a strategy to seize opportunity. They make decisions quickly. They act on those decisions quickly.
As we come out of the economic crisis resulting from the pandemic, use the opportunity to redesign your group to take advantage of OODA loop thinking.
Use my concept of the Scenario Survey Process™ to develop potential future scenarios and then to devise a strategy that will help you not only survive, but even potentially thrive, in as many of those futures as possible.
Use my concept of the Scenario Survey Process™ (read about it here) to develop potential future scenarios and then to devise a strategy that will help you not only survive, but even potentially thrive, in as many of those futures as possible.
Sure, hindsight is always 20/20 but sometimes the “smartest people in the room” can’t manage their way out of a paper bag. Watch some of the stupid business mistakes revealed in the declaration of Hygea’s President and CEO.
We’re living in a time of fast-paced change. Sure. But, I think people have been saying that since the Enlightenment.
Four Doctors, $150 Million, And 6.6 Million Doses Of Opioids. What Could Go Wrong? by Mark F. Weiss
At first, I couldn’t believe my eyes. It seemed like a plot from the old Divorce Court TV show. But no, it wasn’t a battle of the spouses over the failure of a marriage, it was a battle of a hospital and a medical group over what appears to be the failure of an exclusive anesthesia contract.
The problem, which can hardly ever be seen from inside the situational loop, is that you want, even need, to be liked. “Am I pushing too hard?” “What will they think?”
Be sure you're armed with our best information, in an easy and transportable audio format.
A few weeks ago, Walgreens, the giant drug store chain, announced that it was planning to close the 157 in-store health clinics that it owns. It will continue to keep those clinics run by third parties.
Arguably, a Southern California ophthalmology group should have had its compliance eyes checked a few years ago.
The common belief, and it may be quite true, is that change is the greatest cause of stress. But what if it can be used to your group’s advantage?
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The coronavirus crisis, in fact, any crisis, is like a magnifying glass. It shows the best and the worsts of your business structure and practices.
Many underlying defects can be seen as symptoms of underlying group structural and governance problems. They can be corrected.
Of course, other first order problems are a result of events outside of your control.
But even so, you’re not powerless.
This podcast introduces a tool you can use to thrive in an uncertain future.
Whether you're the leader of a group in crisis or of a group that is using the crisis to advance your position, the current times have very much in common with your own past.
Think back to when you first started in business. Whether it was truly starting from zero — from the formation of a new group or a venture of whatever sort, or whether it was simply your zero point, those times were fraught with difficulties.
You can harness that once again.
Whether you're the leader of a group in crisis or of a group that is using the crisis to advance your position, the current times have very much in common with your own past.
Here are seven immediate steps that medical group leaders can take to help cure their group’s economic crisis resulting from the coronavirus crisis.
The coronavirus crisis has caused a short-term economic crisis for many medical groups.
This podcast addresses the fact that, although it’s necessary to find solutions to those short term problems, you can’t expect short term solutions to cure underlying long term problems.
The crisis is also an opportunity to strategize for the future.
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.
This video covers four 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.
The tides of healthcare ebb and flow like the width of men’s ties and the political affiliation of Michael Bloomberg.
Seemingly set with a huge population of baby boomers needing their wares to remain healthy or, metaphorically speaking, to “come in for a soft landing,” and spurred on by politicians who thought they were anointed to nudge us, hospital systems grew rapaciously.
There are many factors that make your practice an attractive candidate for private equity investment, but that’s not what this post focuses on.
A few weeks ago, Walgreens, the giant drug store chain, announced that it was planning to close the 157 in-store health clinics that it owns. It will continue to keep those clinics run by third parties.
Arguably, a Southern California ophthalmology group should have had its compliance eyes checked a few years ago.
Actors scramble to audition for a part, but stars choose from offered scripts. So why are you responding to that RFP?
The layers of bureaucracy that were supposedly meant to insulate the doctors from the “hassles of running a medical practice” out hassled the actual “hassles of running a medical practice.” Go figure.
At first I couldn’t believe my eyes.
It seemed like a plot from the old Divorce Court TV show. But no, it wasn’t a battle of the spouses over the failure of a marriage, it was a battle of a hospital and a medical group over what appears to be the failure of an exclusive anesthesia contract.
An investigation gone bad, or bad decisions made during and after a proper investigation, have an impact far beyond that on the accuser and the alleged.
We’re living in a time of fast-paced change. Sure. But, I think people have been saying that since the Enlightenment. Maybe it’s the one thing that’s remained constant. But maybe it’s not. Some things have certainly remained the same.
Perhaps it’s only anecdotal, but the several hospital executives and well-connected hospital-affiliated physician group leaders I’ve spoken within the past few weeks tell the same story: a spate of resignations by hospital-employed physicians.
There are many factors that make your practice an attractive candidate for private equity investment, but that’s not what this post focuses on.
Listen while Mark discusses a hospital’s announcement that it’s closing down its physician joint venture ASC. Was it really their decision? Or have the physician partners realized that they no longer need the hospital?
Compounded drugs are valid treatment. Prescribing them is legal. However, accepting (or paying) kickbacks to prescribe them is a crime.
Listen while Mark discusses converting a closed or failing hospital into a surgery center or other outpatient facility.
Herman Cain withdrew his name from consideration for a Fed seat because he couldn’t afford (or didn’t want) to work for the relatively low pay.
Herman Cain withdrew his name from consideration for a Fed seat because he couldn’t afford (or didn’t want) to work for the relatively low pay
An outsider with no knowledge of any single fraudulent claim brings a False Claims Act suit. What you need to know.
Former Tenet Healthcare Executives Facing Criminal Trials For Kickbacks by Mark F. Weiss
Why You Must Understand the Intersection Of Incentives And Negotiation Strategy by Mark F. Weiss
Driverless Cars Might Not Crash But They Will Impact The Business Of Healthcare by Mark F. Weiss
$2.6 Billion Collected By Feds From Compliance Cheats. ROI Makes Warren Buffet Look Like An Amateur by Mark F. Weiss
4.89 Billion (Dollar) Reasons for Physicians To Love Owning Surgery Centers by Mark F. Weiss
What You Need To Know About The High Cost Of 15 Minutes Of Fame, HIPAA Edition by Mark F. Weiss
What Herman Cain Knows About The Defect In Medical Group Compensation Plans by Mark F. Weiss
Uncompensated Medical Directorship Leads to $3.2 Million False Claims Act Settlement by Mark F. Weiss
Community Hospitals Must Change Or Die. Change Presents Opportunity For Entrepreneurial Physicians by Mark F. Weiss
Anesthesia Company Model Arrangement Fuels $1.718 Million Dollar FCA Settlement by Mark F. Weiss
Allegations of Underpaid Debt Lands Big Healthcare Players in Whistleblower Hell by Mark F. Weiss
One Giant Leap Toward Success: Avoid One Simple Misstep For “Fraud-kind” by Mark F. Weiss
Physician Behind Bars for Referrals: Kickbacks, Bribes, And Mail Fraud by Mark F. Weiss
FTC Challenge To Sanford Health/Mid Dakota Clinic Physician Group Merger And The Lesson For You by Mark F. Weiss
How Walmart's Latest Healthcare Announcement Can Be Your Key To Higher Prices by Mark F. Weiss
Clueless and Dangerous - “Your Medical Records Are Safe Because They’re Entered into Our System” by Mark F. Weiss
Listen in as Mark discusses Walmart’s latest foray into healthcare via its Walmart Town Center concept.
Listen while Mark discusses how “fair market value” compensation will gut your future, and what to do about it.
We’re all aware of the push for greater efficiency in healthcare. Unfortunately, doing the absolute wrong thing the right way is incredibly efficient.
We’re all aware of the push for greater efficiency in healthcare. Unfortunately, doing the absolute wrong thing the right way is incredibly efficient.
We were talking about the people that we had separately observed at concerts who, instead of actually watching the concert, were filming the concert on their phones.
In essence, they weren’t watching the concert live, they were watching a video screen of the concert.
What appears to the unknowing and unsuspecting to be a normal day-to-day business transaction is really something quite different.
What appears to the unknowing and unsuspecting to be a normal day-to-day business transaction is really something quite different.
It is difficult to control human nature: The impulse, when dealing with a potential deal partner, to have the mindset of a seller.
As humans, we’re primed by evolutionary forces to fear the loss of something much more than we value an equivalent gain.
Call them mental models, call them viewpoints, the point is the same: the box in which we conceive of what’s possible serves as an artificial barrier that confines our thinking.
Call them mental models, call them viewpoints, the point is the same: the box in which we conceive of what’s possible serves as an artificial barrier that confines our thinking.
What’s a relationship worth to your business, whether your business is a medical practice or a healthcare facility such as an ASC or an imaging center?
Mark discusses the fact that trends, even those that seem modern, such as home delivery of fully prepared meals, are simply history repeating itself or, at least, rhyming. Understanding this facilitates your exploitation of trends in healthcare.
Mark discusses the fact that trends, even those that seem modern, such as home delivery of fully prepared meals, are simply history repeating itself or, at least, rhyming. Understanding this facilitates your exploitation of trends in healthcare.
We were talking about the people that we had separately observed at concerts who, instead of actually watching the concert, were filming the concert on their phones. In essence, they weren’t watching the concert live, they were watching a video screen of the concert.
What does China’s foreign policy have to do with hospital financial support? More than you’d think.
Sure, you can buy a new 2019 Bentley Continental GTC for around $300,000. But you can pick up a gently used 2016 model for around half the price.
But did you know that the same bargain can be had on a slightly used ambulatory surgery center?
Sure, you can buy a new 2019 Bentley Continental GTC for around $300,000. But you can pick up a gently used 2016 model for around half the price. But did you know that the same bargain can be had on a slightly used ambulatory surgery center?
Last fall, Milford Hospital, located in Milford, Connecticut, announced that it was exploring a merger with Bridgeport Hospital, part of Yale New Haven Health.
ASCs can be great investments for physicians. Oh, as long as they are real.
But if all they are are rainbows, unicorns, and clear blue sky, then you’d better stay away.
The problem, of course, is telling the difference.
Hospital systems across the country suffer from bloated fixed costs, huge payrolls, layers and layers of bureaucracy, and management by managers, not by entrepreneurial thinkers.
What appears to the unknowing and unsuspecting to be a normal day-to-day business transaction is really something quite different.
There are tremendous opportunities in the market, opportunities that you can exploit. But in doing so, you must think twice, or even thrice, about the proper structuring of your deals.
As more physicians rush to invest in ASCs, unscrupulous facility promoters/managers scheme to separate physician investors from their money.
Many people tend to think within professional silos. Barbers cut hair. Farmers farm. And, doctors practice medicine.
Why?
I read a Wall Street Journal article about a company in the gym business that’s expanding beyond the gym business into – yep, you got it – healthcare.
Several years ago, I read a review in a magazine for consultants of a new book by an “expert” who advises that since business now moves at the speed of light, the “old” strategic question of “where do you want to be X years from now?” must now be “where do you want to be a few days from now?”
In the Wild West days of the 1980s and 90s, it wasn’t uncommon to see as many medical directors receiving stipends from a hospital as there are aspirins in a Costco-size bottle.
There were medical directors of this and medical directors of that. All designed, of course, to cement or bond or align (which, in 1990, was a word chiefly applied to automobile wheels) physicians who directly or indirectly referred significant numbers of patients to the hospital.
For years, hospitals have pushed to “align” physicians. Take a ride with Mark as he talks about a reversal in the trend: As what were hospital cases now flow out to independent ASCs, hospitals are begging to be aligned with physicians. But why allow a hospital to be a partner in your ASC deal?
They say that a journey of 1,000 miles starts with a single step.
Note that the saying doesn’t discriminate between heading in the right direction or the wrong direction.
We all place a different value on what we receive and we’re willing to pay a comparable price. It has nothing to do with the cost to the producer or provider.
We still love you but, hey, we’re in love with someone else who spends less on clothes stipends.
Conflicts of interest. Everyone’s talking about them. Do you have one? They’re apparently bad. Or are they?
Conflicts of interest. Everyone’s talking about them. Do you have one? They’re apparently bad. Or are they?
We kids joked that “new math” was going to make 1 plus 1 equal 3. Despite our teacher’s inability to conceive that it ever could, in the domain of medical group mergers 1 plus 1 can equal 3.
Let’s say that you’re the CEO of a hospital with fifty or five hundred employed physicians. Who’s your competition? The hospital five miles down the road?
Hospitals are focusing their hard and few-earned dollars exactly where it counts, spending big bucks on the physician executives who will surely rescue them from nosocomial existential syndrome: chief officers of this or that trendy trend.
One thing’s for certain, it will be no more walk in the park for the seven defendants convicted for their roles in a bribe and kickback scheme.
Depending on the circumstances, there might be ways to legally structure deal participation on the part of referring physicians. On the other hand, some deals just stink from the start. The problem, of course is determining which is which.
Just like your leg bone is connected to your knee bone, many of your contracts are connected to each other even though you might not readily know it. You can obtain significant leverage by making sure the agreements are coordinated.
Do you know this key to negotiation? The key that will open the door to a done deal, a deal that delivers on your wants?
A physician raises honest criticism or files a heartfelt complaint concerning another member of the medical staff or another member of her group. She’s fired.
If you were going to sell your house, you’d make sure that it’s put into decent or even prime shape before listing it, right?
I recently attended a continuing legal education seminar. From a purely legal standpoint, the models made sense. However, from the practical standpoint, one apparently lost on the presenter, the structures were unfinanceable.
Learn how valuation consultants’ refusal to opine at higher than the 75th percentile is taking the fairness out of fair market valuation and robbing you of your income.
Most medical groups are unable to gain strategic advantage due to their own management bureaucracy. Here’s the cure.
How to apply, and defend against, psychological pressure during your next negotiation session.
The tactics being used by proponents of accountable care organizations against physicians are eerily reminiscent of those used by auto manufacturers to crush the prices charged by their suppliers.
The so-called “Company Model” of providing anesthesia services at an ASC presents serious kickback concerns. But the problem is far greater than simply anesthesia deals.
Obamacare mandates that physicians participating in Medicare or Medicaid have operating compliance programs. Turn the mandate into a strategic advantage.
Socialism is alive and well, and I’m not simply talking about the socialistic charade of Hugo Chavez.
Instead, I’m talking about the employee or subcontracted members of your group who, even though they are being paid every penny due to them pursuant to their employment agreement or subcontract, have the misguided mindset that “there is money missing” or that the partners are “stealing money,” as if any purportedly “missing” or “stolen” money would, in any event, be theirs.
Perhaps this is simply a symptom of a larger societal problem: the cancer of social justice which is simply a pig-in-a-skirt term for an entitlement attitude magnified to the level of socially acceptable theft.
But whatever it is, it’s a cancer within your group. If allowed to fester, it will, at best, cause dissension within the ranks. At worst, it will result in employees and subcontractors running off to hospital administration to complain about their “unfair” treatment, the likely result of which will be their use by the administrator as weapons to destabilize your group’s leadership structure.
Yes, to use another socialist analogy, this time from the other side, your employees and subcontractors will be used as useful idiots to destroy your leadership and, in the long run, to destroy the idiots themselves.
If your patient had cancer it would be removed. If your group has cancer . . . .
Medical Groups and entrepreneurial physicians must learn to manage business risk as a part of their overall strategy.
How will physicians fit within the bureaucratically envisioned healthcare system of the future?
The talking heads of healthcare are at it again: A new acronym to save healthcare has arrived, the ACO, an “accountable care organization.” But to whom is an ACO accountable?
Negotiation doesn’t take place in a vacuum, it takes place within a context. So why not control the context?
The dominant business and financial paradigm for many physicians, especially hospital-based specialists, is that they are a commodity, a valuable one, perhaps, but a commodity nonetheless. If you are ever to break out of the current paradigm, it will not be by benchmarking to the best practices of other groups headed downward in the same maelstrom.
Stop kidding yourself that the delivery of expert, even world-class, medical care is sufficient to guarantee your group’s future. Understand how to identify and incentivize high level customer service.
Planning is less effective than strategy and strategy is most effective when strengthened through the Scenario Survey Process.
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Let other physicians worry about surviving the down economy: Take these steps now in order to thrive.
Hospitals are employing more physicians. So why don’t they want them to become really successful?
The first step in establishing your group’s future is telling the truth about its present.
Highly successful medical groups operate in concert with bureaucratic hospitals but avoid the taint of bureaucracy themselves.
Hospital administrators are involved in ACO formation, but physicians are being asked to fully commit.
Most hospital based groups focus on outside competitors but ignore the threat from within.
In order to thrive in the “WE” society sweeping through healthcare, medical groups must adopt a different focus.
Not only is fair market valuation resulting in a spiraling down of employed physician income, the same amount of money earned as an employee is worth less than that amount earned if you still owned the practice.
RFPs for physician services come in several varieties – some real, some scams. Responding to any RFP takes considerable time and requires significant investment. So how much should your group charge to provide its proposal?
Hospitals and the government have decided that physicians must collaborate financially in order to deliver quality healthcare. Of course, that’s a lie.
As hospitals quicken their pace to replace physicians with paraprofessionals, physicians must brand their role in healthcare or suffer the consequences.
Employment by hospitals is no safe harbor for physicians; in fact, it’s quite the opposite.
The battle between patients’ physicians and hospitalists rages on. But who asked the patient?
Many physicians, even physician group leaders, have trouble with the notion of transformational change because today’s payor and hospital centric status quo is their “normal.”
For many physicians, the winds of change are of hurricane force. Consider how they can be harnessed.
Consistent with the communal notions of the “We” society, physicians are being told by politicians, pundits and the press that you are in social services – do you really believe this?
Success is as dependent on what you decide not to do as it is on the action you decide to take. So, why do we measure success only by action?
Does your medical group have a strategy to succeed, or are you simply hoping not to fail?
To succeed, groups must strategize for their own desired future and that involves telling the truth about the current state of affairs.
The perception of the truth plays an important role in group and individual physician success.
Many physicians, even physician group leaders, have trouble with the notion of transformational change because today’s payor and hospital centric status quo is their “normal.”
Is that carve out from your exclusive contract really a kickback to referring physicians?
Mark Weiss interviews Reed Tinsley, CPA on the business challenges facing medical practice.
Risk to your medical group can be broken down into two elements, both of which can be managed.
A recent trip to a restaurant and the post office illustrate the difference between entrepreneurial medicine and the brave new bureaucratic world of healthcare.
Top level hospital-based groups cannot merely be concerned about maintaining a relationship; they must be concerned about delivering a transformational experience to their relationship partner.
How unlikely is it that in twenty years, the only physician actually in the O.R. will be the anesthesiologist?
Medical groups must demonstrate communal involvement as a part of the negotiating process.
Does the death of Hostess offers a glimpse into the future of hospital-centric healthcare.
Hospital employment provides physicians no more safety than any other type of employment.
Kodak chose to ignore the threat of digital photography. What threat is your medical group ignoring?
Why hospitals are destroying themselves, and setting their CEOs up for termination, when they bring in national groups and “contract management companies.”
Mark Weiss interviews ERISA expert attorney Christine Roberts about implementing Obamacare’s coverage requirements.
Medical groups must understand the direction of the societal wind. You might like it. You might hate it. Either way, it’s still windy.
If you don’t like the direction of change in health care, start instituting some change on your own.
In my work with physician groups across the country, I often encounter this defeatist attitude.
If your group can’t develop a strategy because of internal dissension, then you’re allowing someone else to choose a future for you.
Many “experts” tell physicians that the key to financial security is employment by hospitals. Do they really think you’re that blind?
Just because you don’t see risk to your future on the horizon doesn’t mean it doesn’t exist.
Hospitals are becoming more coercive in thinning the medical staff ranks of independent physicians.
ERISA attorney Christine Roberts of EFORERISA.COM interviews Mark F. Weiss on the impact of Obamacare.
What’s the right way of looking at ACOs, physician alignment, hospital-physician collaboration and other initiatives to bind physicians to hospitals?
Earning $X, net, self-employed and earning $X, net, as an employee are two very different things
Actors scramble to audition for a part, but stars choose from offered scripts. So why are you responding to that RFP?
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Physicians focus on the correct answer. But succeeding as a business leader requires acceptance of failure.
Your group is actually, and actively, branding itself every day, whether or not you’re aware of it.
Sorry. None of your patients, referral sources, or the hospitals at which you practice cares about your success.
Survey reveals sixty-seven percent of physician who participated in an ACO in 2012 realized no personal financial benefit.
Adopting a purely defensive position can never advance your or your medical group’s future.
Physician compensation surveys assume that you’re average. It’s up to you to break out of the paradigm.
“I deserve it” is a meme infecting society . . . it affects medical group thinking, too.
Many physician groups are fighting the last war, imagining that the threat to their existence is from, say, the hospital.
It’s often how the mistake maker, not the “victim,” reacts that makes the difference in the outcome.
Lowering your goals just to tell yourself that you’ve hit them is a crime against your potential.
As the chill of Obamacare becomes felt, more and more physicians are looking for alternatives to commoditized medical practice.
A study found little correlation between nonprofit hospitals’ CEO pay, which averaged almost $600,000 per year, and performance.
Eighteen wheelers speed down the highway, the second or third or fourth following way too closely for my comfort as they are sucked along, “drafting” off the the truck in front of them.
Letting each partner write his or her terms of partnership is not a long term strategy for success.
“From a dog’s point of view his master is an elongated and abnormally cunning dog.” – Mabel L. Robinson
Decisions and paths are flexible, fluid, customizable. They are infinitely adjustable, like Gumby.
As the business of healthcare becomes more complex, many physicians are seeking certainty. It’s not there.
“This is a golden opportunity to choose patients over profit” said U.S. Representative Jackie Speier as she announced the “Promoting Integrity In Medicare Act of 2013,” HR 2914.
You have been coming into work every day for years. Now there’s no need to come in tomorrow because your group no longer exists.
If you’re like most people, you hate shopping for a car. But even if you hate it, you probably follow the rule of negotiating with multiple dealers.
Bigger or larger or more providers or more locations do not, in and of themselves, make a stronger business.
Where fairness is judged by outcome, not opportunity, it soon takes on a surreal twist.
Are you creating physical touch points for your patients, customers, referral sources and other potential deal partners?
The physician subsidiary entity is a physician alignment model sold as a kinder, gentler, freer alternative to direct hospital employment.
I’m not really one for documentaries, but I recently watched, for the second time, Jiro Dreams of Sushi.
I’ve been thinking today about Pareto-type distribution, you know the “80/20 rule,” and physician employment.
In a personal services business, from medical groups to acute care hospitals, what’s more important, your people or your tangible assets?
You’ve seen it before. Some customer in a store is bitching and moaning about something. I’m not saying that he might not have a point. But the way he goes on and on and on, the way that he’s rude to the store staff, it’s just too much.
When I was 14, my friend Steve and I were stopped by the police for breaking into a car.
As a recent Wall Street Journal article recounts, Japanese manufacturers, once the world’s leaders in electronic goods and especially in cell phone technology, lost big in the switch to smartphones.
Models. No, not the skinny kind in a magazine. But conceptual frameworks. Like global warming “models” or even Obamacare.
Many medical groups operate as partnerships, generally partnerships of professional corporations.
As hospitals gather more power courtesy of Obamacare, some are becoming more daring in terms of extracting cash from non-aligned physicians who don’t control referrals.
“Bob, we’ve got to give you your two weeks notice. Here’s a check for the next two weeks’ compensation. Just pack your personal belongings and Jerry, here, will see you to the door.”
A congressional study compared the performance of San Francisco International (SFO) Airport’s privately contracted screeners with those of LAX’s TSA staffed screeners. SFO’s staff screened 65% more passengers per screener than the government employed TSA personnel at LAX.
The physicist Niels Bohr is reputed to have quipped that prediction is very difficult, especially if it’s about the future.
Some hospital attorneys and, therefore, some hospital administrators, believe that every contract for professional services should be subject to a request for proposal (RFP) process. That’s ridiculous.
It’s not uncommon for some physicians to be engaged in multiple ventures. For example, an ophthalmologist may be a partner in a group with a practice location in City X as well as a shareholder in a group providing weekend ophthalmology coverage in Suburb Y.
Your medical group’s most important assets, its physicians and other providers, walk out the door each night.
A few years ago, I wrote two articles on physician group governance, both available on the ALG website, one for AuntMinnie.com, a radiology publication, http://www.advisorylawgroup.com/radiologygroupungov.html , and the other for Anesthesiology News, http://www.advisorylawgroup.com/anesgroupungov.html.
There’s little question that most, if not all, medical groups should be led by practicing physicians.
When my kids were younger, we used to play a game when we left a store. We’d critique the way that the store employees greeted and treated us, whether or not we made a purchase.
During junior high school summers, my friend Steve Cunningham and I would ride our bikes across the San Fernando Valley to buy a root beer (and sometimes a chili cheese burger) at The Munch Box. The root beer was ice cold. The burger hot, it’s cheese melty. It was a special blend of distant, delicious, almost forbidden fruit.
As the old bumper sticker says, shit happens. Despite all you do to prevent it, all the systems and all the rules, when humans are involved, things can and will go wrong.
The reason why countries revolt simply to turn to another dictator, why the spouse of some politician is feted as savior, and why hospitals turn to national organizations to provide items and services as varied as toilet paper to neonatology, is the same: People — all of us, from Joe and Josie on the street to hospital administrators on the third floor — have an innate desire to be led.
We used to get bomb threats all the time.
Far too often, medical groups – in fact, closely held businesses of all kinds – have bombs, of sorts, within them, too.
I was finally on the plane. The flight was already 3 hours late to take off. And then the flight attendant announced that one of the overhead luggage bins had a broken latch. The plane could not take off until it was fixed. A mechanic was called.
Extending a brand means to branch it out from one product or service line to another. Like Barbie dolls to Barbie bikes. Or, like Community Hospital to Community Hospital Medical Group.
If you’re selling medical services but collecting only peanuts (or even hot dogs) let me know. You need a better agent.
The big muddy. The Mississippi River flows thousands of miles before reaching the Gulf of Mexico. A huge river.
What about your practice? Is it a single channel, even a very large single channel, or is it supported by multiple streams, streams of income, that is?
If the hospital can, both through practice acquisition and the expansion of its system, acquire sufficient market power, it can also pressure insurers, individual consumers, and others paying for healthcare to pay more for the same services.
It was just such a possibility of higher prices that led the federal courts to order the dismantling of a major medical group acquisition.
Marcus Lemonis of the TV show, The Profit, says that there are three “P’s” to business success.
Like a dry cleaner, healthcare providers have to screw up to lose a customer’s loyalty.
As much actual tension as there is between physician groups and ACOs, they share a common weakness.
There’s a significant amount of timing involved in respect of the negotiation of agreements between physician groups and hospitals, especially in connection with exclusive contracts.
If you think the rate of marriage failure is high, consider the fate of business marriages. Depending on whom you ask and whose data is available for analysis, 70 to 90 percent of all business combinations fail to increase owner value.
I recently read an article about hospitals training physicians for “leadership” roles. What those hospitals are really doing is training more physicians to become hospital-employed or hospital-controlled managers.
Market consolidation – that’s what’s impacting medical groups of all stripes and sizes.
That summer at Magic Mountain was a petri dish of customer service and other business education. Here are 4.5 of the lessons that I learned.
Remember attending that auction in which people overbid for that obvious-to-most mass produced ceramic vase?
The attractiveness of a deal multiplies by the number of “buyers.”
As healthcare entities become larger they appear as formidable competitors in the marketplace.
So what’s an independent group to do?
Shh! We’re eavesdropping right now on a discussion between two healthcare executives who’ve just identified an issue that needs to be resolved.
I recently read that taken together, the value of all airline shares from the beginning of the industry to date would be a net loss. Is anyone surprised?
Your group has held the exclusive contract for your specialty services, for example anesthesiology or radiology, for decades, but now the hospital is holding an RFP.
I’m simply reminding medical group leaders that you need to use the resources of your medical group’s members to advance the group’s strategy through everyday interactions with referral sources, hospital employees and patients.
Ever watch those old black and white B-movie Westerns?
The bad guys would ride into town and rob the bank. “Hands up! Give us all the money!” And then they’d ride off carrying bags of cash.
Many professionals, from architects to anesthesiologists, from structural engineers to surgeons, make the mistake of focusing solely on developing their skill sets and in delivering those skills to their customers, patients or clients.
If you attended my recent webinar, The Impending Death of Hospitals, you know that I firmly believe that healthcare delivery is shifting away from hospitals and their aligned physicians. In fact, the prognosis for hospitals, at least as we know them today, is guarded.
On a January day in 1493 off the coast of the island of Dominica, Christopher Columbus reported seeing three “mermaids” — in reality manatees. Columbus commented that in real life, mermaids were “not half as beautiful as they are painted.”
I recently read an article about a woman bemoaning the fact that she had been “cheated,” as her investment in General Motors bonds was about to become worthless. The system had failed her, she cried!
Earlier this year, a federal trial court in Idaho struck down, and ordered unwound, a hospital’s acquisition of a medical group on grounds that it violated antitrust law.
Words matter. They are the bullets in the fight for public perception, in the battle for change.
A diamond and a rock, sitting side by side. Both discovered near the bottom of the Udachny diamond mine in the Sakha Republic region of Russia, one of the world’s ten deepest open-pit diamond mines.
But are they of the same value?
Hospital based medical groups are often faced with a choice upon exclusive contract renewal: The expectation or demand on the part of the hospital that the group must provide its services, perhaps even at a higher level of intensity, for lower or no stipend support.
Speed kills. I read it on the message board that stretched across the lanes of the highway. (I suppose that reading message boards kills, too, but they aren’t advertising that.)
Years ago, one of my former partners had a case in which a stock broker built up a huge book of business, only to have his clients “reassigned” to a famous heavy-hitter at the firm that took over the brokerage.
I know. In light of tons of illegal profits, complying with the federal anti-kickback law (“AKS”) is a hard sell.
But, it’s easier than a prison cell. And better than paying a $125 million fine.
I knew that I had taken the wrong job after my first day at the firm.
More than thirty years have passed, so now I can laugh about it. But back then, I thought I was screwed.
I stood there with the other workers, a large rotating table separating us. As the parts moved by we each glued on another piece until Mary took them and put them in a box.
His comment still sticks in my craw. The so-called expert said something like, “In the new economy, physicians need to lower their income expectations.”
Why?
When I was 17 I worked at a McDonald’s. The store was a franchise location.
Franchise models exist in medicine as well as in hamburgers. For example, in the urgent care center market.
The hospital approaches you and says that they are building an ACO – won’t you join with them and become an employee of their sponsored foundation or medical group?
Where are the flying cars and the metal and glass houses, and the robots walking dogs? I was promised that future and it’s not here and I’m mad as hell.
Is your group being governed or governed? Yes, it’s a trick question. But the answer might just be a joke on you.
Kodak was once the country’s leader in photography. Then along came both Fujifilm and digital photography. And bankruptcy. And a lesson for medical group leaders.
I just read an article on Modern Healthcare’s website about balance billing in the out-of-network context.
We’ll begin boarding in a few minutes.
Although airlines have a lot to learn about customer service, they do serve as a model for pricing strategy in healthcare.
I read an article in the Wall Street Journal reporting that more states are regulating Medi-Spa ownership and placing scope of practice restrictions on the procedures performed at those facilities.
It’s not just the delivery of medical care that determines the value that your medical practice or group delivers. It’s all of the “soft” stuff as well — in fact, the so-called soft stuff is a larger factor than groups generally acknowledge. Very few groups reward their physicians for it.
We usually think of nosocomial infection, one contracted from the environment or staff of a healthcare facility, in terms of the impact on patients.
Obamacare provides health insurance coverage, but coverage is not access to care. For care, you need physicians and you need to be able to see a physician, the right one, when you require care.
Preparation. It doesn’t matter whether you’re grooming your practice or business for sale or grooming it to hold and grow.
Efficiency. Hospital administrators and other bureaucrats say that they want it. Medical group leaders parrot it.
I see too many deals that are hatched from the evil twins of self-inflicted human nature: fear and hope.
Yes. Sure. Of course.
How many times each day do you say one of those words? It’s as if we’ve been programmed (because we have been) to be agreeable, to want to help. It’s one of the reasons that society works: Joe says yes and cooperates with Sally. Sally says yes and cooperates with Bob. And on and on.
When my kids were small, they used to talk about their super powers. They were convinced that they were real.
Major League Baseball has an antitrust exemption. It also has a level playing field. The players, as employees, can collectively bargain.
You probably already know that it is my firm belief that hospitals, at least as we know them, are basically dead. They just don’t know it yet. What I mean is that the majority of surgery cases are going to be shifting out of hospitals.
Some leaders of hospital-based groups, and I use the term “leader” broadly, believe that their groups are a function of the hospital. If the hospital no longer wants to contract with them, then that would be it, they’d simply pull the plug on the group.
Earlier this year, a Santa Clara County, California jury awarded the insurer Aetna a $37,452,199.00 judgment in a lawsuit against Bay Area Surgical Management, LLC, a surgery center management company, a number of its managed ASCs, and three of Bay Area’s executives.
The first time that I saw a computer there were two in the room. One of them took up most of the south side of a floor of the Computer Science Building and the other took up most of the north side.
In 1919, New York hotelier Raymond Orteig announced the Orteig Prize: $25,000 to the first aviation team to fly nonstop between New York and Paris.
July 4th, Independence Day in the United States, celebrates the original 13 colonies’ declaration, in 1776, of their independence from Great Britain.
It’s about 1 pm on Sunday and I’m thinking of getting a cheeseburger for lunch. But if I don’t, it won’t make any difference to me.
At a time when telemedicine and telehealth are poised for rapid expansion, many state medical boards are doubling down on what appears to be their true purpose: enacting and enforcing anti-competitive measures to protect those already licensed in the jurisdiction.
Medical groups, especially first generation medical groups, often suffer from a common management error: Their leaders or board members manage from the perspective of their individual personal success, not from the perspective of the group’s, that is, the business’, success and of its long-term future.
Properly done, medical group management is neither a collaborative nor a unanimous process. It is a leadership decision.
Office-based specialists, from ENT’s to urologists, often enter into suite sharing arrangements. No problem! That is, until they make it one.
Hospitals that use RFPs and others fool’s tools in respect of physician relationships will surely suffer as fools in the end.
Let’s listen in to a series of calls from a potential deal partner to the office of the Smith and Jones Medical Group.
I recently heard of a consumer survey done at a hotel in which it was found that the guests’ impressions of every factor tested for, the quality of the service, the attractiveness of the rooms, the cleanliness of the common areas, etc., depended upon their satisfaction with the hotel check-in experience.
I pushed the wiring instructions over to him.
A few minutes later, I confirmed that close to $10 million was in the account of my client, the sole shareholder.
“…don’t worry, we’ll have your blog back up by 1:00 p.m. Pacific time on the 28th.” -Network Solutions Employee
Yet, as I’m writing this post on the morning of the 30th, our blog is still down.
Somehow, someplace within Network Solutions, which provides our webhosting, they disconnected our blog from the rest of our website. Oh, I mean from the entire internet.
We can all apply this lesson in our businesses.
Letting each partner write his or her terms of partnership is not a long term strategy for success.
Legend has it that it was a bottomless basket. As much tribute to the master as could be piled into it, the basket took more and more and more.
I recently read an article about a physician who had sold his practice to a hospital. The physician was quoted as having stated that he had grown disenchanted with running the business end of his own practice, thus his agreement to “have my practice managed by” the hospital.
“When you have time to gripe, you have time to wipe. When you have time to lean, you have time to clean.”
Strategic planning is the cornerstone of all businesses footed with longevity in mind. Are you skillfully navigating an ever changing world?
Are you planning for your ideal future reality, or focusing on slight incremental improvements?
RFPs can wear many faces, is it an organic, fictitious or fulcrum RFP? Find out which type you’re facing, and strategize your response.
Compliance – it’s the multi-zillion dollar reason why your medical group’s or healthcare business venture’s efforts must constantly be tested, reviewed, and returned.
Rebroadcast: How medical groups can use surveys as tools in negotiations with hospitals.
Robert Collier, one of the fathers of direct mail advertising, famously advised copywriters to enter the conversation already going on within the customer’s mind.
Will today’s physicians soon be referred to as “human physicians” or “carbon-based docs” as opposed to the silicon-based kind? Paging Dr. Robot?
Opportunity is a funny thing because it’s always there but isn’t usually seen. That’s because it’s hiding in the camouflage of everyday problems.
“I can’t put it in the agreement, but trust me on this. You have my word.” Those are famous words from a hospital CEO. And, maybe you can trust him. But can you trust his successor?
Many medical group leaders bemoan their group’s circumstances: caught in the hard place between increasing commoditization, what they believe to be the limitations of independent structure, and the pressure of national group competition.
Medical group leaders are busy focusing on day to day activities: Most are deeply involved in direct patient care. Some, yes, some, also devote some time to working on their business. But there’s a pressing need to engage in strategy. And you have to address the tough issues, like governance, succession planning, compliance, expansion of your business, and many more.
Learn to protect negotiating positions and to use “informal” communication with administration proactively.
You keep your medical skills up. It’s time that you focus on your sales skills as well.
Running a hospital based group as “service” for the hospital, functioning as a sort of clearinghouse for income and expenses, severely limits your group’s future.
What if you’re sued for an event that one of your own members didn’t cause? To your dismay, you find out that you’re not covered for that.
You can use a red team strategy to discover your medical group’s weaknesses and to correct them before someone else takes advantage of them.
I see a tremendous amount of tension, especially when it comes to the relationship between administration and hospital based groups.
Has your medical group put themselves in a position where they can be easily taken over legally and cheaply?
You must be extremely careful when entering into any physician compensation arrangement, whether you are the payor or the recipient in order to steer clear of possible AKS violations.
Across the county in nearly every industry, large companies are laying off full time workers and are turning to staffing companies which, in turn hire what amount to temps, many on a part time basis.
Once again, this case demonstrates that simple, facial reliance on safe harbors under the Federal Anti-Kickback Statute and Stark do not guaranty safety for either hospitals or their physician employees and subcontractors.
The federal Anti-Kickback statute makes it illegal to receive anything of value for the referral of federal health care program patients. How are you managing this potential pitfall?
Leaders must lead. They cannot bog themselves down in the morass of consensus building.
Modern office machines, from copiers to printers to maybe even label makers have memory devices, and those devices may be chock full of protected health information.
Sure, unlike immigration love, less than heartfelt medical group merger isn’t a federal crime.
Criminal and, at least, serious civil, liability lurks in many neat neighborhoods. Create your own neighborhood watch to make sure that it’s not lurking behind your medical group’s otherwise metaphorical neat lawn.
Disruptive physicians. But what if the physician isn’t actually disruptive, but simply nonconformist or challenging?
I’m going to share a secret with you today. There’s no such thing as value. At least not in the fixed sense. In fact, value is as malleable as clay.
You might skip over indemnification provisions when negotiating a contract. You understand what they are. They’re just boilerplate, right? Wrong.
All medical groups have a culture, whether or not it’s been purposefully created. It exists.
Many say that the world is a tough place. Maybe it is, because it’s not just dog-eat-dog. It’s flea-kills-dog as well.
From down the street I could see the fortune teller’s shop.
Did she know that I was coming?
The medical group that I was going to see was under pressure. One of its former members had jumped ship and aligned with a competitor. The hospital issued an RFP. The competitor became the golden haired group.
Could you smell it in Cleveland, Carson City or Cape Cod? The stench filled the air in Paris, as taxi drivers burned tires to protest Uber.
The right question regarding the uncertain future, is to ask is what underlies your profession, your specialty, or its role. What’s the motivating desire or overriding function?
What are you doing to get attention for your practice or business? Attention from your referral sources, from your patients, from hospitals?
Just as no vote was required for a dictator like Casto to take over Cuba, no medical staff vote, no survey by Press Ganey, no long and drawn out process among “stakeholders,” is required to topple the status quo.
If I can make you a dollar by cutting your costs, can I keep 50 cents?
That, in a nutshell, is what’s described as “gainsharing” in the context of arrangements between medical groups and hospitals.
How many times and for how long do you think a Broadway actor prepares for his first performance, or even for subsequent performances?
In many medical specialties, both hospital and office based, national groups have become significant competitors.
Each negotiation has its own timing, not one set by a standard recipe or by a clock on the wall or on the calendar, but one that can be, and should be, set by you.
What are you incentivizing your employees or independent contractors to do? And what if those incentives are driving them to not do other things that are far more essential for your business? What if those incentives are driving them to do things that are clearly detrimental to your business?
If your mindset is that spending money on your future is a cost, you don’t have a future.
Suppose people who want to sell us driverless cars, or to force us into driverless cars, are right and that we’ll all be driving in them. What’s the impact on healthcare? What’s the impact on your practice?
In a recent set of go-rounds with the Department of Justice, the so-called company model of anesthesia services took a major hit: Jonathan Daitch, M.D., just agreed to a $1.718 million civil settlement and Michael Frey, M.D., plead guilty in a criminal prosecution.
When physicians think about allegations of kickbacks in the context of large insurers, it’s generally related to how a carrier’s internal “claims cops” have alleged that some physician or other provider engaged in a kickback scheme, obviating the payor’s need to pay claims, or, even worse, supporting their demand for repayment.
Yes, 4.89 billion reasons for you, if you are a physician who owns or is thinking about owning a surgery center (“ASC”). And, yes, each of them is green. Green as in a dollar bill.
A little bit more than 15 minutes of fame, just cost three Boston area hospitals, Boston Medical Center, Brigham and Women’s Hospital, and Massachusetts General Hospital, a collective $999,000.
When most medical group leaders think about incentives, it’s usually in the context of structuring performance incentives for the group’s physicians, or in the context of incentives that flow to the group; itself pursuant to contracts with payors or facilities.
Has your medical group put themselves in a position where they can be easily taken over legally and cheaply?
Patient satisfaction surveys are becoming a real part of reimbursement, driving a significant percentage of money.
According to a recent article in the Wall Street Journal, starting now in January 2019, Walmart is requiring employees needing spine surgery to travel to certain contracted hospitals for their surgery.
As horrible as a fire is — the danger involved, the risk of loss to the home or business owner — there’s also an inherent opportunity: an opportunity to rebuild, to renovate, and to renew. The stories of the phoenix or of Noah and the flood.
Creative destruction is taking aim directly at community hospitals. You can fight to save them. But if they’ve failed, you can, á la Shumpeter (and Weiss), take part in creating, phoenix-like, far more appropriate healthcare solutions for your community and for your profit.
If you're a physician, it's all too likely that you're uncertain about the future, feel the pressure of an all too real governmentally imposed ceiling on your income, and have even less control than ever over your time.
Like a bear emerging from its long winter nap, the Federal Trade Commission is hungry to enforce antitrust law in the healthcare sector.
You may have seen their websites: Anesthesia "practice management companies" that advertise "no stipends!" to obtain facility contracts.
How many compliance related crimes have you or your colleagues or employees committed today, whether purposefully or, completely inadvertently?
In one fell swoop, CMS pulled the rug out from under hospital control of physician practice, rendering many, if not almost all, hospital outpatient clinics unprofitable.
Chasing down HIPAA violations isn’t just about enforcing compliance, it’s about the government collecting big bucks. Listen in as we discuss a recent settlement of an actual HIPAA violation. And even more troubling, learn about another HIPAA breach settlement that didn’t even involve am actual HIPAA breach . . . only a potential one. Scared? […]
Former physician Dr. Greenspan, at 80 years old, will conceivably spend the rest of his life behind bars due to his connection with the Biodiagnostic Laboratory Services, LLC scam. Listen in and learn to be a smarter practitioner. Here are some of the major takeaways: 1. Fitting a deal within one of the AKS safe […]
Yes, that’s what they told me. My PHI would be safe because they would be entered into their system. It that’s the case, then pigs can fly. Listen in to the story of the “safety” of PHI at Holland Eye Surgery and Laser Center, which discovered that a hacker began accessing their electronic records in […]
Considering forming a Medicare certified ASC? Be careful not to destroy all of your Medicare claims by turning them into false claims. Tune in this week as we go over different ways that ASC organizers and operators cause the fatal explosion of their businesses. Comment or contact me if you’d like to discuss this post. Mark F. […]
I found an old lock in the garage. Now, what’s the combination? Comment or contact me if you’d like to discuss this post. Mark F. Weiss
The limo driver said that he’d made some bad choices in life. Some things hadn’t worked out as planned.
You know that I strongly believe that the future of hospitals isn’t hospitals, it’s outpatient facilities. I’m not sure whether the folks at Banner Health read my book and (1) didn’t believe it, or (2) decided to prove me wrong, but either way it just cost them $18.3 million.
Back in the dark ages of medicine, I mean, in 2014, I wrote about competition from Dr. Nurses and Assistant Physicians. A new player has entered the race.
There’s an expression in carpentry, “measure twice, cut once.” We should have the same expression in terms of healthcare deals…
This podcast is the second in a series on direct contracting by physicians and medical groups. See Direct Contracting By Physicians and Medical Groups for the first post in the series. Before we get too deep into the subject, let’s ask an epistemological question: If you saw one dead raccoon, does that mean that all raccoons […]
Ebay and Craigslist have disintermediated the classified section in the newspaper, which used to be the largest moneymaker in that business. The newspaper as middleman has been put to bed for the last time. But in healthcare, middlemen abound. Hospital systems are middlemen for their controlled/employed physicians. Insurance companies, and even more so on steroids, […]
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We often mentally create roadblocks and boogeymen big and small (e.g., the “competition,” “that’s the way it’s done,” “the hospital controls us”) and throw them up in front of us as if they were real, when the truth is that they’re simply self-created, imagined limitations.
Should non-taxpaying hospitals, the facilities that prefer to be known by the misnomer “not for profit,” be able to gamble their tax free funds on venture capital investments?
Someone at a conference asked me what’s the biggest mistake medical group leaders make. That’s easy, I told him, it’s not engaging me to represent them.
The hospital CFO was hooked on heroin. The heroin of big data. Big data. Gotta have it.
Like a dry cleaner, healthcare providers have to screw up to lose a customer’s loyalty.
Finders keepers, losers weepers.Except in connection with overpayments by federal health care programs — then it’s a crime.
As you know, it’s hard to make a decision when you might have to pay a large price for it. It’s much easier to make decisions when there’s only an upside, that is, when there’s an upside if it succeeds and an upside if it fails.
What does partnership mean in a medical group? What does it mean to you? What does it mean for your group? What does it mean if you are setting up a medical group?
The Wall Street Journal portrays it as causing panic in the streets. I’m taking about the pending acquisition of Aetna by CVS Healthcare. It’s stoking fear of the combination of a ubiquitous retail delivery platform, CVS, with the health insurance, managed care, and huge patient database of Aetna.
Corporations exist to make a profit. There’s nothing wrong with that. It’s a fact of life.
How many times and for how long do you think a Broadway actor prepares for his first performance, or even for subsequent performances?
Just as no vote was required for a dictator like Casto to take over Cuba, no medical staff vote, no survey by Press Ganey, no long and drawn out process among “stakeholders,” is required to topple the status quo.
What are you doing to get attention for your practice or business? Attention from your referral sources, from your patients, from hospitals?
The right question regarding the uncertain future, is to ask is what underlies your profession, your specialty, or its role. What’s the motivating desire or overriding function?