Aug 01

A Different Way To Think About Your Goals – Success In Motion Series

Ride along with Mark as he talks about a “backwards” thinking method that helps you get your business forward, fast.

 

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Jul 31

How Not Letting Go Leads To Medical Group Management Messes

A few weeks ago on the blog, I wrote about The Medical Group Governance Matrix™. If you haven’t read that post, read it now, and then come back here to keep learning.

I have a good friend who says, in the context of a physical skill, that prehistoric humans initially developed the strong, instinctual dominant-hand grip to be able to grab onto tree limbs and quickly climb in order to escape predators like saber-toothed cats. (I didn’t tell him that saber-toothed cats could climb trees, but (i) he reads this blog, so now I have, and (ii) that’s really besides the point.)

The ensuing millennia have honed this instinct, so much so, that we instinctively grab tightly with our dominant hand even when the specific application calls for a much lighter touch.

So, too, goes the vice-like grip that causes many medical group members to hang on to their personal power. They are so unable to let go of their instinctual need to personally control almost all aspects of their financial affairs, that they dash the ability of their medical group to function as a true business. The result is a club. (A club of a different sort would have helped with saber-toothed cats. A physicians’ club does not equal a physicians’ business.)

In order for a medical group to succeed, governance power must shift within the matrix from the lower evolved quadrants toward the upper right:

To do so, each member must let go of the individual control instinctually believed to be required to save him or her from the metaphorical saber-toothed cat.

The reality is that one’s future isn’t protected by completely individual control. In fact, in the business context, it’s almost always hampered in the organizational setting of a medical group of more than a small handful of members.

When the modern saber-toothed tiger, the reality of business, is charging at you, it’s absolutely no time for a vote. It’s absolutely no time for “consensus-getting.” It’s absolutely no time for an “any-member-may-veto.”

Deep down inside, we all have fears, some irrational for sure, but many completely rational. But prehistoric man survived by forming groups. That’s what saved them from the tigers, saber-toothed and otherwise.

The shift required begins inside the mind. It then moves on to your medical group’s governance documents. And finally, because those governance provisions are useless if they’re not followed, it moves from concept to practice.

So, get a grip on reality and loosen your personal grip on your medical group. Show how evolved you’ve become.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

 

Jul 27

You Can Plan On This! – A Podcast

Strategic planning is the cornerstone of all businesses footed with longevity in mind. Are you skillfully navigating an ever changing world?

Play

Jul 26

Why You Must Control the Context to Influence the Outcome – Medical Group Minute

Oftentimes the value of something relates to the environment in which it is presented.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Jul 25

How Would An Antitrust Attack On A Hospital Impact Your Practice? – Success In Motion Series

Join Mark as he ponders the impact on your practice of antitrust enforcement against growing hospitals and chains.

 

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Jul 24

Payor Agreements And Hidden False Claims Act And Criminal Traps

It was a neighborhood like many others.

Neat, but not too neat front yards. Newspapers brought in by 8:00 a.m. and maybe by 10:00 a.m. on weekends.

And, all was within the bounds of normal, giving, of course, wide birth to the meaning of the word, for this is nonfiction, not fiction. But with one outlier, of course.

They assembled just before daybreak, approximately a dozen SWAT-clothed FBI agents accompanied by the local police and, of course, a reporter with a camera. Then, they raided the gray house with a just as neat front yard but, to the well-eyed, just a tad too many security cameras.

Later that day, the reporter wrote that the man living in the house ran a 7 to 8 figure financial scam out of his, I suppose, just as neat den.

Ah, crime lurking in the “normal” neighborhood.

Unfortunately, crime and other misdeeds lurk in other neighborhoods, too. For example, inside of a provider agreement between a medical group and a payor.

Standard form provider agreements often closely and specifically define who, by classification, may be considered within the group for purposes of billing the payor. Many such define group physicians as the group’s employed physicians, thereby excluding subcontractors.

Yet, at the same time, it’s equally common for many medical groups to either regularly or from time to time staff using subcontracted physicians.

Although a set of concerns (breach of contract, fraud, and so on) is present in any such situation, the potential for trouble explodes when the provider agreement covers federal healthcare program patients. For example, many provider agreements cover both commercial and Medicare Advantage patients.

In that case, when the group submits a claim for a procedure on a covered Medicare patient performed by a subcontracted physician, the claim is potentially a false claim, triggering liability under the federal False Claims Act. And, although the FCA is a civil statute, it has a criminal cousin, 18 U.S.C. 287, commonly referred to as the criminal false claims act.

As if that weren’t enough, the same lurking billing violation can trigger liability under a host of federal criminal statutes, from mail and wire fraud, to the Travel Act, to federal health care fraud.

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.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

 

Jul 20

Are All Hospitals Really Price Buyers?

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?

What about hospitals you do business with? Are they value or price buyers?

Play

Jul 19

They’ll Bail GM Out But Will They Bail You Out? – Medical Group Minute

GM drove its business into the ground by focusing on everything except building cars geared towards their customer base’s wants.

In the healthcare industry, there is a similar argument and comparison to be made. Will there be a physician payout anytime soon?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Jul 18

How You Can Apply The 80-20 Rule – Success In Motion Series

Ride along with Mark and learn about how you can apply the 80-20 rule, also known as the Pareto principle, in your medical group, practice, or business.

 

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Jul 17

Putting A Limit On Your Obligation To Indemnify

I promised to indemnify you. Here’s a quarter.

You might skip over indemnification provisions when negotiating a contract. You understand what they are. They’re just boilerplate, right? Wrong.

First, boilerplate isn’t “extra stuff.” It’s the opposite. Like the strong metal plate around a boiler designed to contain it and prevent an explosion, boilerplate in an agreement is there to protect the agreement, to help make sure that the deal you think you have is indeed the enforceable deal.

Indemnification provisions are one of the types of risk-shifting provisions generally found in important agreements. For example, in exclusive contracts between medical groups and facilities. Or, even in provider agreements between a medical group and its physicians.

Indemnification provisions can take many forms. Some sophisticated agreements often contain multiple indemnification provisions, each dealing with a different sort of situation.

At its essence, an indemnification provision requires one party, the “indemnitor,” to hold the other party, the “indemnitee,” harmless (i.e., to pay for any damages caused and, perhaps, to defend it and/or to pay its attorneys’ fees) in the event of the indemnitor’s breach of whatever obligation or set of facts is the subject of the provision.

But there’s another, related issue that many parties don’t think to negotiate: What’s the limit of indemnification? Without a specified limit, well, there is no limit.

Although the notion of insurance is similar to indemnification, it is different, certainly in respect of the fact that the insurer isn’t “indemnifying” as to its own acts. Yet, insurance policies have limits to the carrier’s liability. For example, a medical malpractice insurance policy might have a per claim limit of $1 million and an aggregate annual limit of $3 million.

When you’re next negotiating an indemnification provision, at least think about whether you should, and whether you can, think more like an insurer and cap the limits of your liability.

Depending on the type of agreement, the type of indemnification provision, the parties, their relative positions, and whether the indemnification is one-way or mutual, it may or may not be in your interests to pursue a cap.

Just don’t let your decision be made by default, that is, by not thinking about it.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

 

Older posts «

» Newer posts