Aug 14 2018

Don’t Be Fooled By Healthcare Deal Arithmetic – Success In Motion Series

Ride along with Mark as he talks about the need to question numbers presented as facts in connection with healthcare investment opportunities.

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Mark F. Weiss

Aug 13 2018

Why You Must Understand the Intersection Of Incentives And Negotiation Strategy

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.

But, the issue of incentives is important in an entirely different way:  the incentives that impact the behavior and thinking of the individual or individuals on the other side of a negotiation, whether that negotiation is a major contractual negotiation, for example, for a system wide anesthesiology or radiology exclusive contract, or whether that negotiation is simply for some position in the context of an already existing relationship.

If you understand the incentive then you’ll understand the person and why he or she is acting the way they are. In a very real way, incentives are the  “super-drug” that controls human behavior.

Many mistakenly believe that preparing for negotiation, whether in the guise of a formal negotiation session or a day-to-day meeting, is restricted to boning up on the points you want to push for, to determining your “must haves” and your  “like to haves,” and so on.

But to be fully prepared, you need to spend hours and hours, sometimes even weeks, to suss out the details that underlie incentives that drive the both opposite party and the people negotiating for it.

Incentives are often at the root of what appears to be wacky positions and whacky decisions. It explains why a CEO will scuttle a favorable deal for her employer when it’s at odds with the metrics behind her bonus. It explains deals based on a short term world view versus a long term one. It explains border line (and over the border line illegal) behavior.

Understand the incentives to understand your contracting opposite and the people behind it.

Then, once you do, turn the microscope around and see whether the incentives driving your negotiating team are at odds with your own medical group’s best interests.

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Mark F. Weiss

Aug 09 2018

Should Non-Taxpaying Hospitals Be Able to Gamble With Your Funds? – Podcast

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?

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Mark F. Weiss


Aug 08 2018

Clueless and Dangerous: “Your Medical Records Are Safe Because They’re Entered Into Our System” – Medical Group Minute Series

It’s 2:45. Do you know where your medical records are?

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Mark F. Weiss

Aug 07 2018

How Safe Is Your Email? – Success In Motion Series

Ride along with Mark as he comments on Google’s revelation that they permitted app developers to access Gmail accounts. How safe is your email?

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Mark F. Weiss

Aug 06 2018

Does More Financial Pressure On Hospitals Signal The Return Of Questionable Medical Directorships?

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.

Sure, lots of those arrangements were legal. But lots weren’t.

Due largely to enforcement actions under criminal (the federal anti-kickback statute and state counterparts) and civil (the federal, i.e. Stark, and state prohibitions on self-referral) regulatory regimes, the occurrence of softball, fluff, and close-to-or-actually-completely-BS medical directorships waned considerably over the ensuing years.

But they didn’t go away.

Consider the warning shot fired by the Office of Inspector General of the U.S. Department of Health and Human Services (the “OIG”) in its June 2015 Fraud Alert: Physician Compensation Arrangements May Result in Significant Liability.

In the Fraud Alert, the OIG warned that physicians entering into medical directorships must ensure that they involve fair market value for bona fide services that the physicians actually provide. The OIG warned that a compensation arrangement may violate the anti-kickback statute if even one purpose of the arrangement is to compensate a physician for his or her past or future referrals of Federal health care program business.

The Fraud Alert cited the OIG’s settlements with 12 individual physicians who were alleged to have received improper medical director compensation. The OIG alleged that the compensation violated the anti-kickback statute for a number of reasons, including that the payments took into account the physicians’ volume or value of referrals and did not reflect fair market value for the services to be performed, and because the physicians did not actually provide the services called for under the agreements.

Today, and tomorrow, as more and more surgical procedures leave the hospital setting for ASCs and other outpatient facilities, query whether hospital administrators will revisit medical directorships with renewed fervor as they seek ties that bind.

Certainly, many medical directorships can be structured to be in compliance with applicable law and regulation. Others are simply attractive traps: they are ties that blind.

Among the many factors that physicians must consider when vetting and negotiating medical directorships are: (1) the demonstrable establishment of fair market value; (2) the actual, provable, and documented performance of duties; and (3) the relevance of duties (e.g., tasks and responsibilities that are not duplicative of hospital administrative staff roles).

Of course, for maximum assurance, directorship deals should comply with the relevant federal anti-kickback statute safe harbor. And, if the physician is in a position to refer for designated health services under Stark, the deal must fit within one of that law’s mandatory safe harbors.

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Mark F. Weiss

Aug 02 2018

How to Avoid The Second Biggest Mistake Medical Group Leaders Make – Podcast

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.

He told me to get serious. I told him that I was. So, he asked me what’s the second biggest mistake.

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Mark F. Weiss


Aug 01 2018

Alchemist Can’t Turn Outpatients into Inpatients For Less Than $18.3 Million – Medical Group Minute Series

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.

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Mark F. Weiss

Jul 31 2018

Free Consulting Services!! – Success In Motion Series

Ride along with Mark as he tells you about free consulting services. No, not from him, but the kind that you may be giving away, especially via an RFP response.

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Mark F. Weiss

Jul 30 2018

Don’t Step in Unintended Consequences

Let’s say you’re 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 doesn’t make any difference.

Here’s the point: You negotiated for some arrangement. It could be an agreement with a payor. It could be an agreement with a facility. It could be an agreement with almost anyone. And then six months or a year later, someone, whether it’s your original deal partner or a third party, approaches you with another agreement.

This could be as simple as a request for an amendment to the original deal. Or it could be as seemingly disconnected as being approached by a third party who proposes some other deal to you.

You have to ask yourself how entering into a seemingly benign amendment or how entering into a seemingly benign other arrangement, even with a third party, will impact that first deal. Which, of course, begs the question of whether you know of, and can quickly access, all of your existing agreements.

Many times, especially with the complexities of healthcare dealings and the complexities of healthcare compliance, “other” deals have a tremendous impact on your initial arrangement. You can’t look at them as stand-alone.

If you’re not careful, you can screw up years of planning. You can screw up the terms of an agreement. You can find yourself bound to terms that you had no idea you were agreeing to be bound to.

Catalog all of your agreements. Consider each new deal or arrangement in light of your existing ones as a matter of standard operating procedure.

Remember, it’s not just the (new) deal that you’re making, it’s how that deal might change, or moot, or breach what’s already in place.

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Mark F. Weiss