Articles


Read some strategies for the inevitable Hospital CEO turnover in Mark's article Hospital CEO Turnover: What You Must Know and Do to Protect Your Anesthesia Group featured in the summer edition of Communique.

Mark covers the trend of hospital based care an article entitled The Impeding Death of Hospitals: How to Help Your Clients Survive featured in the new issue of Today's CPA

Mark discusses Why Your Compliance Efforts May Be Worthless published by In the Spring 2017 volume of Communique.

Mark was quoted in the article ASC Regulatory Areas That Developers Need To Pay Attention To published on Nov. 9, 

Finders keepers, losers weepers. Except in connection with overpayments from Medicare, then it’s a violation of the federal False Claims Act leading to significant liability—that is, unless you repay the overpaid sum within 60 days. Read CMS Resets the Clock for Return Of Medicare Overpayments published on AnesthesiologyNews.com in May 2016.

Mark's article A New Strategy To Profit From Interventional Radiology, co-authored with Cecilia Kronawitter, was published on AuntMinne.com on May 23, 2016.

Three of Mark’s blog posts were republished as a column entitled Practice Challenges in the Spring 2016 issue of the Pennsylvania Society of Anesthesiologists Newsletter, the Sentinel.

Professional, business, and regulatory paradigm shifts occurring in interventional radiology present a new opportunity for interventional radiologists and their groups: Profiting from ownership of interventional radiology ambulatory surgery centers (“irASCs”). Read Is There An Interventional Radiology ASC (irASC) In Your Future? published in the April/May 2016 issue of Radiology Business Journal.

How would you like to know exactly what’s going to happen in the future so that you can prepare for and profit from it? Read Impending Death of Hospitals: Will Your Anesthesia Practice Survive? published in the winter 2016 volume of Communique.

Mark was quoted in the article Practice Patterns Change While Outcomes Remain Steady Among Older Anesthesiologists, published in the December 2015 issue of Anesthesiology News.

The debate between retaining a medical group's independence and selling to a larger entity is of growing concern for Anesthesia practices. Read Anesthesia Group Mergers, Acquisitions and (Importantly) Alternatives published in the summer 2015 volume of Communique.

Mark was quoted in the article Anesthesiology Acquisition Rate Still at Fevered Pace, published in the July 2015 issue of Anesthesiology News


There’s a tremendous cloud of uncertainty resulting from the rapidity of change in radiology and in medicine in general. Read Seeking Certainty In Radiology: Mergers, Acquisitions and Alternatives published on Imagingbiz.com in June 2015.

No one wants to work with a surgeon whose default setting is bad-mouthing or screaming at his staff, whose idea of "getting his point across" is throwing scalpels into the wall. Read Legal Update: Give Disruptive Docs the Boot published in Outpatient Surgery in April 2015.

I just read an op-ed piece in which an economist was mystified that a medical procedure cost an insurer differing amounts if performed at one facility over another. Read Do You Make This Mistake Concerning Customer Value? published in Anesthesiology News in April 2015.

Imagine! A “celebrity” economist stymied by the fact that a medical procedure, a hip replacement, for example, costs an insurer $X if performed at one facility, yet $X + $Y if done at another. Read Do You Make This Mistake Concerning Customer Value? published in General Surgery News in March 2015.

Medical groups lose contracts because they focus on what’s important to them, not on value as determined by their customers. McDonald’s and Delivering Anesthesia Group Value was published as a web exclusive in December 2014 on AnesthesiologyNews.com.

Mark was quoted in the article Top 5 financial challenges facing physicians in 2015, published in the December 2014 issue of Medical Economics. Read or download here.

Mark was quoted in the article Top 15 challenges facing physicians in 2015, published in the December 2014 issue of Medical Economics.

Bungled billing: the combination of multiple entities' fees into a single price. What could be wrong with that? A lot, depending on who is doing the budling. And, in some cases, depending on why they're doing it. Read Bungled Billing or Bungled Billing? Published in the October 2014 issue of Pain Medicine News.

What's your anesthesia group worth? There are a lot of people out there who are happy to fool you with the answer. Read What's Your Anesthesia Group Worth? And Why It Might Not Make Any Difference. Published in the summer 2014 issue of Communique.

Mark was quoted in Michael Vlessides's article Does Anesthesia Need Its Own NTSB? Published in the August issue of Anesthesiology News.

Is your anesthesia group interested in seeking shelter from uncertainty through a sale to a large regional or national group or to a private equity-backed venture? Read Anesthesia Group Acquisitions and Alternatives, published in the June issue of Anesthesiology News.

On Nov. 12, 2013, the Office of Inspector General (OIG) of the Department of Health and Human Services released Advisory Opinion 13-15 dealing with a situation closely akin to a "company model" deal. Read OIG Opinion Adds Clarity to Illegality of Company Model.

It’s a tough world out there for anesthesiologists. At least, that’s what many anesthesiologists think. Read 
The Siren Song of Hospital (Un)Employment.

Many anesthesiologists are leaving truly private practice for jobs with large national and regional groups and other anesthesia staffing companies.
 Read Doctors Rush To Corporate Employment … as Corporate America Lays off Workers

The Anti-Kickback Statute is fairly straightforward: It prohibits rewards for referrals. Read Anesthesia Profits Are Off-Limits.

The predominant relationship between anesthesiologists and hospitals has been through anesthesia groups, which more often than not hold an exclusive contract for all anesthesia services at the hospital. Read Two’s Company, Three’s a Crowd: Company Model Deals in the Hospital Setting

Kickbacks disguised as management fees and in the form of the so-called “company model." Read Company Model Kickbacks In The Hospital Setting.

Society's shift toward communal values dictates medical groups adopt coherent strategies. Read Why Society’s Shift Means Your Group Needs a New Strategy.

Just as the tides come in and out, society cycles round and round from an emphasis on and worship of rugged individualism, to an emphasis on and lauding of community and cooperation. Read The Profit Center: Part 26 -- Radiology and the 'me-we' cycle.

Like a neutron bomb, national or large regional groups wants to take over your facility contract. Read Inoculate Your Group Against A National Group Takeover.

The OIG has declined to give a free pass two popular structures to extract money from specialists.. Read OIG Disapproves Two Referral Arrangements as Kickbacks

The OIG has opined on the propriety of two popular schemes to extract profits from anesthesiologists and other specialists. Read Inspector General Weighs In on Fee Sharing

Many believe that hospital employment is the panacea: the new "safe" career option. Is it? Read The Profit Center: Part 25. How Safe is Hospital Employment?

CRNAs clear hurdle to totally independent practice in California. Read Calif. Ruling on CRNA Practice Promises Nationwide Tremors.

In an organization we tend to be judged for what we do, not for the decisions we make not to do something. Read The Error Of Measuring Success Only By Action.

If hospitals have their way, the ACO will be physicians' only real revenue source.  Read The ABCs Of ACO Economics.

Healthcare is at the Great Junction: One route leading to completely commoditized healthcare and the other, the road far less traveled, leading to high touch, high-quality care, to an Experience Monopoly. Which route is your group on?  Read Commodity Practice or Experience Monopoly?

Learn how pretending to compete with your own group drives massive improvement.  Read Shadow Your Competition. 

In these turbulent times in which the pace of creative destruction is quickening, it is more important than ever to take a strategic approach to the way in which exclusive contracting, group structure, and group functions are intertwined.  Read Strategies For Exclusive Contracting.

Currently, our society is heavily motivated by a “we” mindset, focusing on shared sacrifice, paying your fair share and giving back. Hospitals seek to take advantage of this trend to gain economic control over physicians.  Learn what you must do.  Read Protecting Traditional Practice in Today’s ‘We’ Society.

In order to thrive in the “We” society sweeping through healthcare, medical groups must adopt a different focus.  
Read Physicians: Action Required to Thrive in Today's "We" Society.

Planning is less effective than strategy and strategy is most effective when strengthened through the Scenario Survey Process. 
Read How Scenario Surveys Strengthen Strategy.

Radiology groups must engage in the Scenario Survey Process to identify potential trends and threats in order to shape a strong strategy. 
Read Scenarios Can Shape Group Strategy.

The way that fair market valuation works in connection with coverage stipends and physician work agreements is leading to lower and lower physician compensation. Read Fair Market Valuation: The Death Spiral of Physician Compensation.

The fair market valuation process is often unfair, blind to value and generally ignores the true market.  That’s the good part.  Now read about its negative impact on physician compensation.  Read The Pitfalls of Fair Market Valuation.

Your group’s held the exclusive anesthesia contract for 20 years. Instead of entering into renewal talks, the hospital issues an RFP designed to get you to undercut your position.  What to do?  Read How To Navigate the Rising Tide of Aggressive RFPs.

Hospitals are disrupting their longstanding radiology group relationships as they seek to cut stipends and get more for nothing.  The favored tool? A "weaponized" form of the request for proposal.  Read How To Shield Against “Weaponized” RFPs.

How to apply psychological pressure during your next negotiation session.  Read Harnessing the Effects of Group Pressure in Hospital Negotiations: Find Your Buddy.

The so-called “Company Model” of providing anesthesia services at an ASC presents serious kickback concerns. Read The Company Model: Is Taking Less Money To Work at a Surgicenter Worth Jail Time?

How will physicians fit within the bureaucratically envisioned healthcare system of the future?  Read The Health Care Con-Vergence?

Anesthesiologists should think twice, or even thrice, about ASC deals.  Read Will You Pay the Price for an ASC Deal Gone Wrong?

Learn how to increase your chances of a favorable negotiation by gaining leverage in countering, or harnessing, the effects of group pressure.  Read Countering Pressure in Face to Face Negotiation.

Physicians interested in controlling their own future need to steer clear of, or get hold of the steering wheel, of hospital moves to create ACOs – accountable care organizations.  Read Escape the Carnage of the ACO.

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?  Read Accountable Care Organizations: Accountable to Whom.

Are you headed to the Anesthesia Factory to deliver more commodity service, or are you creating an experience monopoly?  Read Are You Headed to the Anesthesia Factory?

Learn how political challenges to exclusive agreements impact on pain medicine practices. Read Politician Challenges Exclusive Contract and Stipend Support: Impact on Pain Practice.

If you like your exclusive anesthesia agreement, you’d better learn how to defend it from political, yes, political, attack. Learn what arguments are being made and what you have to do to counter them.  Read Exclusive Contracts and Hospital Stipends Under Attack.

Negotiation doesn’t take place in a vacuum, it takes place within a context.  So why not control the context?  Read To Control the Contract, Control the Context.

No matter what “healthcare reform” law is imposed, the steps that you need to take, right now, to thrive in the face of this looming future are the same.  Read Thriving Despite (so-called) Healthcare Reform.

If your hospital-based group is in the "medical business," why is it highly likely that it's also in the insurance business, in fact, as an insurer of the hospital's risk?  Read Taking On Risk With Dubious Reward.

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.  Read Securing Customer Satisfaction.

Maximize your group’s negotiating power by carefully choosing the message.   Read Deploy the Power of Persuasion.

Let other anesthesiologists worry about surviving the down economy:  Take these steps now in order to thrive.  Read Opportunities Knocking In Market Flux.

Physician groups can greatly increase their negotiating power by controlling context.  Read Increase Negotiating Power.

Hospital based groups need to take simple steps in defense of their business.  Read Imaging Advantage: Much ado about the same old thing? 

Many radiology groups mistake the fair market valuation process for a viable stipend negotiation strategy.  Read Negotiating Your Group's Stipend.

Hospital based physicians need to develop an experience monopoly for their referring physicians, patients and hospitals.  Read Creating an Experience Monopoly.

Anesthesiologists and other hospital based physicians can learn a valuable lesson from a False Claims Act case involving Stark law violations.  Read Anesthesiologists Should Heed Stark Law Ruling.

See my response to Letter to the Editor in connection with my article, Establish Surgeon Support Without the Monkey Business.  Read Response Letter to the Editor.

Physicians need to comply with the Red Flags Rule.  Read Readying for the Red Flags Rule.
 
Learn some of the not so obvious purposes of employment agreements.  Read Crafting Effective Employment Contracts.

Radiologists can learn how to steer clear of Stark law issues.  Read Steering Clear of Stark And False Claims Allegations.

Tough times underscore the need for a long term strategy.  Read Radiology Groups Need New Approaches to Survive in Rough Times.

It hinders your group's business if its structure makes it difficult or impossible to make quick decisions.  Yet this is what many radiology groups do through their processes of fully participatory decision making.  Read Radiology Group (un)Governance.

Anesthesiologists need to understand that the way to garner surgeon support is by tying to the surgeons' goals.  Read Establish Surgeon Support Without the Monkey Business.

What action might an anesthesia group take, both pre- and post-operatively, to boost collections?  Read Boosting Collections, A Group Effort.

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.  Read Creative Destruction.

Radiology groups must adopt business practices that will permit them to succeed in a changing and uncertain future.  If you don’t write the script for your own future, someone else will.  Read We Perform Just Like Every Other Radiology Group - So Why Are We Doing So Poorly?

Democracy is fine for government; it just doesn’t work for anesthesia groups of more than a few members, at least not on any level past the election of a leader.  Read Anesthesia Group (un)Governance.

(Part 2)  Too many practices operate as a collection of individuals whose purpose is to provide services at a hospital.  From a business and psychological perspective, they have not evolved much during the past 20 years.  Read Anesthesia Groups Must Confront the Four Fs - Part 2.

(Part 1)  Too many practices operate as a collection of individuals whose purpose is to provide services at a hospital.  From a business and psychological perspective, they have not evolved much during the past 20 years.  Read Anesthesia Groups Must Confront the Four Fs - Part 1.

We're in the process of uploading the following articles.  Until they appear here, we'd be pleased to email to you copies of any that you request:  request@advisorylawgroup.com
 
We Do Exactly What Every Other Anesthesia Group Does -- So Why Are We Doing So Poorly?
Seminars in Anesthesia Perioperative Medicine and Pain
Elsevier, Inc.
December 2005
 
Medical Directorship of Anesthesia Services:  Are You a Player or Just Being Played?
Seminars in Anesthesia Perioperative Medicine and Pain
Elsevier, Inc.
September 2005
 
The Future of Anesthesia Practice: Hedge Your Practice's Chances of Being on, Not Under, the Leading Edge of the Wave
Seminars in Anesthesia Perioperative Medicine and Pain
Elsevier, Inc.
June 2005
 
Exclusive Anesthesia Contracts:  History, Theory, Nuts and Bolts
Seminars in Anesthesia Perioperative Medicine and Pain
Elsevier, Inc.
March 2005
 
Exclusive Anesthesia Contract or Medical Directorship Pact?
Anesthesiology News
April 2004
 
Good Faith is the Key to Complying With HIPAA's Notice of Privacy Practices Requirement
Anesthesiology News
December 2002
 
Get What You Aimed For:   
How to Forge Bulletproof Employment Agreements
General Surgery News
November 2002
 
Preserve the Deal You Expect:  How to Forge Bulletproof Employment Agreements
Anesthesiology News
July 2002
 
Guest Editorial:  Liability Arising From Consultant-Prepared Compliance Plans
Orthopedic Technology Review
May/June 2002
 
Maximize Protection and Profit Through Careful Entity Planning
Radiology Business Management Association Bulletin
March -- April 2002
 
Liability Arising From Consultant-Prepared Compliance Plans
CSA Bulletin
California Society of Anesthesiologists, Inc.
January – March, 2002 Issue (Vol. 51, No. 1)
 
Structuring Practice Entities For Maximum Profit And Protection
Anesthesiology News
March 2002
 
OIG Opinion Places Legality of Common Exclusive Contract Provision
in Doubt
Anesthesiology News
January 2002
 
Lessening the Impact of the Failure of the Medical Group Model
Anesthesiology News
October 2001
 
Regulatory Compliance Plans are Key to Avoiding Legal Risk
Auntminnie.com (The Online Radiology Forum)
October 24, 2001
(http://www.auntminnie.com/index.asp?Sec=nws&sub=rad&pag=dis&ItemId=51976&d=1)
 
Physician Liability to Debtor Patients … Courtesy of Your Billing Service
Anesthesiology News
September 2001
 
High Crimes and Misdemeanors:  Avoiding Medical Group Liability as a Result of Billing Service Errors
Radiology Business Management Association Bulletin
September 2001
 
Physician Leaders Must Manage the Billing and
Collection Process ... or Suffer the Consequences
CSA Bulletin
California Society of Anesthesiologists, Inc.
April – June, 2001 Issue (Vol. 50, No. 2)
 
The Time is Now:  Providers Must Adopt Prudent
Business Practices in Anticipation of the Failure of  
the Medical Group Model
CSA Bulletin
California Society of Anesthesiologists, Inc.
January - February, 2000 Issue (Vol. 49, No. 1)
 
Are Percentage-Based Management Services Deals
Illegal?  OIG Opinion Raises Serious Concerns
Group Practice Journal
American Medical Group Association
May 1999 Issue (Vol. 48, No. 5)
 
Compliance Audits:  Save Money and (Jail) Time
LACMA Physician
Los Angeles County Medical Association
January 1998 Issue (Vol. 128, No. 1)
 
Antifraud Aspects of the Health Insurance
Portability & Accountability Act of 1996
LACMA Physician
Los Angeles County Medical Association
October 7, 1996 Issue (Vol. 126, No. 16)
Reprinted, Solano Physician,
Solano County California Medical Society,
December, 1996, Vol. 96, No. 11
Reprinted, Coastal Bend Medicine,
Nueces County Texas Medical Society,
June/July 1997, Vol. 37, No. 4
 
Physician Recruiting Packages
LACMA Physician
Los Angeles County Medical Association
June 17, 1996 Issue (Vol. 126, No. 11)
Reprinted, CSA Bulletin, California Society of Anesthesiologists, Inc., November - December, 1996 Issue (Vol. 45, No. 6) as Physician Incentives:  Consider the Impact of Federal and State Laws Before You Say “Yes!”
 
Sure I'll Agree to Arbitrate
"I Just Don't Want to Waive Any of My Rights
(and Other Fairy Tales)"
CSA Bulletin
California Society of Anesthesiologists, Inc.
January - February, 1996 Issue (Vol. 45, No. 1)
 
Beware of "Standard" Contract Provisions
LACMA Physician
Los Angeles County Medical Association
November 6, 1995 Issue (Vol. 125, No. 18)
Reprinted, Solano Physician, December, 1995,
Vol. 95, No. 1
 
Assign of the Times:  The Prohibition Against the
Reassignment of Medicare and Medi-Cal Claims
CSA Bulletin
California Society of Anesthesiologists, Inc.
September - October, 1995 Issue (Vol. 44, No. 5)
 
Does Your Hospital's MSO Owe You
a Fiduciary Duty?
LACMA Physician
Los Angeles County Medical Association
September 18, 1995 Issue (Vol. 125, No. 15)
 
Specialists and Managed Care:
Strategies for Maximizing Opportunity
Hispanic Physician
California Hispanic American Medical Association
Volume V
 
Kickbacks:  Extracting A Price For Your Right  
To Treat Patients
CSA Bulletin
California Society of Anesthesiologists, Inc.
May-June, 1994 Issue (Vol. 43, No. 3)