Jun 05 2018

Starbucks And the Creation Of Problems Via Solutions – Success In Motion

Join Mark in a discussion of the lesson learned from Starbuck’s “solution” to its customer service problems, a solution that created bigger problems. Learn how can you avoid the same fate.

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

Mark F. Weiss

www.advisorylawgroup.com

Jun 04 2018

Direct Contracting – Part 2: Clear Your Mind of The Lies That Bind (Your Thinking)

This post 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 are dead?

Yet many have pronounced that the failure of a few early entrants into direct contracting signals the death of all direct contracting. Just as with one dead raccoon, that reasoning misses the mark; it’s a lie.

In this short post, I want to get across a basic understanding of what I mean by direct contracting and the opportunities that it presents.

The concept of direct contracting can be applied in many ways.

For example, it certainly being applied in a direct to patient model, primarily in primary care. You can view that model as somewhat akin to concierge medicine in which patients are charged a fixed amount per month and receive a standard, prix fixe menu of services and, usually, an à la carte menu of add-on services at published, fixed prices.

That model can be morphed one step removed by having the contract between the medical group and an employer for the benefit of the employer’s employees.

But there’s no stopping there.

The notion of “direct” is that there’s no intermediary entity in the chain of payment. The “premium,” if you will, is paid directly from its original source to the contracting medical group. Compare that with a traditional employer provided insurance policy: there’s at least one intermediary in the arrangement chain, the insurer. More often than not, there are 2 or 3 or more intermediaries, each taking their cut.

Of course, there’s no legal, as in mandatory, definition of “direct.”

The bottom line is that “direct” is more of a mindset — it’s the dematerialization of the payment intermediaries in connection with your design of a payment/delivery structure.

For example, an orthopedic group in a location with a large, self-insured employer might enter into a contract with the company for non-workers compensation orthopedic care (either physician side only or, if the group controls an ASC, facility side outpatient procedures). How the financial terms are structured (e.g., a negotiated price per item or episode of care, a reduced fee for service, what quality metrics apply, and so on) is open to negotiation.

And, for example, in another context, direct contracting can be used as a strategy to deflect the negotiating pressure of payors, especially down-stream middlemen such as IPAs and risk bearing medical groups.

Stay tuned. Over the next several months, we’ll continue to discuss elements of direct contracting, including compliance, potential licensing issues, deal structure, and other elements.

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

Mark F. Weiss

www.advisorylawgroup.com

May 31 2018

Why You Must Prepare For Negotiations Like Babe Ruth – Podcast

How many times and for how long do you think a Broadway actor prepares for his first performance, or even for subsequent performances?

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

Mark F. Weiss

Play

May 30 2018

Complain. Get Fired. Get $17.5 Million. – Medical Group Minute

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.

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

Mark F. Weiss

www.advisorylawgroup.com

May 29 2018

U.S. Government Intervenes in 5 Kickback Based Whistleblower Cases Against Insys – Success In Motion Series

Ride along well Mark discusses the expanding case involving Insys Therapeutics and kickbacks paid to induce prescription of its drug, Subsys.

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

Mark F. Weiss

May 28 2018

Direct Contracting By Physicians and Medical Groups

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, IPAs and risk bearing medical groups are the middlemen between, largely, employers and their employees’ medical care.

Why?

Some claim it’s because of the hassle, the administrative burden, the HIPAA this and the “coordination of care” that. So, they say, middlemen are needed. But that’s largely B.S.

Direct primary care contracting, that is, between patient and physician, is now a real thing. So real, in fact, that CMS recently sought, in their own words, “broad input on direct provider contracting (DPC) between payers and primary care or multi-specialty groups to inform potential testing of a DPC model within the Medicare fee-for-service (FFS) program (Medicare Parts A and B), Medicare Advantage program (Medicare Part C), and Medicaid.”

Over the next several months, we’ll be discussing elements of direct contracting, primarily from the angle of physician group to employer. We’ll discuss compliance, potential licensing issues, deal structure, and other elements.

For now, understand that “direct contracting” has many meanings and is certainly not “one size fits all.” It encompasses arrangements as diverse as concierge medicine, to subscription plus menu-like fixed fees for services, to sophisticated carve-out type deals directly between orthopedic surgery groups and large employers.

Thinking is constricted by the frame, the “allowed” parameters of the process. But many times, in fact, nearly all times, the concept of “allowed” is just a mental construct with no real teeth. Employers – insurers – other middlemen – providers is a frame that the large players, the CVSs of the healthcare world are breaking. You can break them, too.

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

Mark F. Weiss

www.advisorylawgroup.com

May 24 2018

What Have You Got to Gain? A Lot! – Podcast

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.

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

Mark F. Weiss

Play

May 23 2018

Medical Group Management – Medical Group Minute

Every business (yes, your medical group is a business) needs a streamlined way to make day to day management decisions. And, it cannot allow one or two or a few dissenters to hold the group back in the event of major action such as a sale or merger.

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

Mark F. Weiss

May 22 2018

Augmented Unreality – Success In Motion Series

Ride along with Mark as he discusses the need to avoid the trap of viewing the reality of the business of medicine through a tightly focused lens, as if watching a live concert through the screen of your iPhone.

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

Mark F. Weiss

May 21 2018

There’s An App For That HIPAA Violation

I recently read a post on someone’s blog in which the author addressed the question of using Amazon’s Alexa in an operating room. I used to think that there was no such thing as a stupid question, but now I have to reconsider.

On the other hand, are you already carrying a little spy into the operating room or the exam room or into listening range of other patient encounters or, for those of you in the billing business, into an office in which PHI is discussed?

No, I’m not referring to cell phones themselves as little listening devices, although I’m not 100% sure that it’s not an urban myth that your iPhone or android device always keeps its mic open.

Even if you put that notion into the category of foil hat wearing crazies, there is a related, and all too true, issue of apps on those devices maintaining open mics.

Take, for example, the 2017 report by the New York Times that more than 250 smartphone game apps utilize software from a company called Alphonso that listens to audio in TV ads and shows. The software is sophisticated enough to listen in even when the app is running in the background and the phone is in your pocket.

I’m not picking on Alphonso and the company states that it doesn’t record voice discussions, but it stretches the imagination to think that there is not a stream of data that has been backed up somewhere in order to mine it for television ad data that doesn’t also contain, and can’t be mined for, the rest of the audio information.

Smartphones (are supposed to) allow an app access to the mic only if the user permits it. But do you really know what access you’ve granted to each of your apps? Sure you do! But what about the apps of your colleagues, your partners, your employees?

Cyber criminals pay far more for health data than for credit card or banking information because it’s far more complete in terms of recreating a stolen identity. Don’t inadvertently help them out while exposing yourself to, potentially, tens of thousands of HIPAA violations.

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

Mark F. Weiss

www.advisorylawgroup.com