Another Medical Staff Moves to Fire the Hospital CEO – Podcast

What you think is permanent is only temporary. How temporary is the question.

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Mark F. Weiss

www.advisorylawgroup.com

Cooking Time = Negotiating Time – Medical Group Minute

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.

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Mark F. Weiss

www.advisorylawgroup.com

Why You Want or Don’t Want An Arbitration Provision in Your Contract – Rebroadcast – Success in Motion

Mark Weiss lets you know how to think about arbitration provisions in your contract. Why would you want one? How can they be used?

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Mark F. Weiss

www.advisorylawgroup.com

Why UnitedHealth Dumping TeamHealth Affects You

A few weeks ago, in August, 2019, the giant insurer UnitedHealth informed the large physician services company, TeamHealth, which fields physicians in many specialties including anesthesiology, emergency medicine, and hospitalist services, among others, that it would be dumping TeamHealth from two-thirds of their high reimbursement in-network contracts over the next 11 months.

As of this writing, nothing’s reported to have changed. Maybe they’ll kiss and make up. But maybe not. It’s been reported that TeamHealth may be ramping up to file suit.

The UnitedHealth/TeamHealth scuffle intersects with topics addressed elsewhere on the blog and presents interesting opportunities for some physicians and their medical groups.

For example, being removed from UnitedHealth plans might put Team Health’s exclusive contracts with hospitals at risk. Recall, for example, my August 19, 2019, post, Hospital Sues Medical Group. Medical Group Returns The Favor. Both Likely Lose., which reported on the fact that Trinity Health, a not-for-profit Catholic healthcare system doing business in Michigan had filed suit against the large, exclusively contracted Anesthesia Associates of Ann Arbor, also known as “A4,” claiming that A4’s becoming out-of-network with several payers violated the terms of the exclusive contract. Trinity wants to bring in its own anesthesia providers and seeks to use A4’s anesthesiologists and CRNAs, who are subject to non-competes, to do so.

Will TeamHealth lose exclusive contracts due to being forced out of network? Will this pose an opportunity for other groups to attack Team Health’s position as the exclusive provider?

Additionally, moves such as this by UnitedHealth to terminate TeamHealth from its network are likely emboldened by the increase in the number of states that have adopted so-called “surprise medical bill” legislation.

That type of legislation usually forces so-called “average contracted rates” on out-of-network physicians subject to its “fix.” By throwing higher reimbursed groups out of the network, the average, and thus the amount to be paid to non-contracted providers, falls, perhaps precipitously.

Only time will tell what happens to UnitedHealth and to TeamHealth as a result of the kerfuffle.

Other groups in competition with TeamHealth should be ready to pounce.

The situation also demonstrates that although large groups with national contracts can use their market power to cut great deals, they can also be singularly disadvantaged when great numbers of those contracts are terminated – strength turned into fragility.

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Mark F. Weiss

www.advisorylawgroup.com

But Everyone’s Doing It!! Not A Great Defense To Compliance Violations – Podcast

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.

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Mark F. Weiss

www.advisorylawgroup.com

Psst, Wanna Buy A Watch? The Myth Of Security In Hospital Employment – Rebroadcast – Medical Group Minute

The healthcare labor market shifts with time but there will always be a place for entrepreneurial physicians and other healthcare providers who seek to develop and expand their independent ventures.  This is a rebroadcast of a very relevant concept.

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Mark F. Weiss

www.advisorylawgroup.com

How Physician Alignment Destroyed Hospital-Physician Collaboration – Success In Motion

Ride along with Mark as he discusses how the short-term message underlying physician alignment has destroyed hospital-physician collaboration and contributed to the impending death of hospitals.

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Mark F. Weiss

www.advisorylawgroup.com

A Not So Love Triangle: When PE Met AKS Who Met Stark

It’s not quite when Harry Met Sally.

As you certainly know, there’s been a flood of investor money, notably private equity money, it into many medical specialties over the last decade.

Depending on what specialty you’re in, private equity investment is just beginning to ramp up.

For example, I’m seeing, both here at the law firm and at our M&A advisory firm affiliate, an uptick in deals in dermatology, ophthalmology, and orthopedic surgery. To use a sports analogy, in some medical specialties, the game is just getting started.

There many factors that make your practice an attractive candidate for private equity investment, but that’s not what this post focuses on.

Instead, it’s essential, whether or not you ever plan on doing a private equity deal, to know what makes a practice completely unattractive to any buyer: potential compliance problems, in particular, potential violations of the federal Anti-Kickback Statute or of Stark.

Too many physicians approach compliance problems from the “who’s going to know” perspective. As I’ve written many times in the past, you’d be surprised (as in one of your partners or even an employee in the billing office).

But here, in the mergers and acquisitions context, the “how” has an actual name. It’s called “due diligence,” the investigation of the quality of the to-be-acquired entity that includes a proctological look into potential compliance issues.

The presence of unresolved compliance issues can easily result in a dead deal. And, even if it doesn’t, the representations and warranties – the risk allocation provisions – of the acquisition deal will shift responsibility for undisclosed, pre-closing compliance issues back onto you, the seller. In other words, that planned trip to a faraway tourist district might be swapped for an unplanned trip to District Court.

Whether you’re interested in a potential sale of your practice now, in the future, or never, the first step is always the same and should be taken now: Commission a “red team,” a self-sponsored, deep dive into your group’s compliance risks today.

Questions? Click here for answers.

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Mark F. Weiss

www.advisorylawgroup.com

Fraud on Physicians in the ASC Setting – Podcast

As more physicians rush to invest in ASCs, unscrupulous facility promoters/managers scheme to separate physician investors from their money.

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Mark F. Weiss

www.advisorylawgroup.com

Why You Must Know About A University’s Captive Medical Group Filing Bankruptcy – Medical Group Minute

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.

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Mark F. Weiss

www.advisorylawgroup.com