Videocasts


If a procedure can be performed outside of the hospital, it will be performed outside of the hospital. And, as technology and payor acceptance accelerate, more, even most, procedures will be performed outside of a hospital.
Ride along with Mark as he talks about how the Michael Cohen/Donald Trump recording story applies to preserving your attorney-client privilege.
When most medical group leaders think about incentive, 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.
Take a seat and listen as Mark warns that all money from hospitals to medical groups isn't actually "free." You may have to pay it back or go bankrupt.
You might skip over indemnification provisions when negotiating a contract. You understand what they are. They're just boilerplate, right? Wrong.
Ride along while Mark talks about the error of confusing the plan with the actual way a deal plays out.
Mark discusses the fact that trends, even those that seem modern, such as home delivery or fully prepared meals, are simply history repeating itself or, at least, rhyming. Understanding this facilitates your exploitation of trends in healthcare.
The NYC Taxi Comission is looking to force Uber, Lyft and other ridesharing businesses out of business through the imposition of a higher wage structure. Ride along s Mark discusses the fact that when businesses can't compete, they become big believers in regulation, just as in the ban on new physician-owned Medicare participating hospitals.
Mark discusses the importance of grooming your medical practice or healthcare business for sale, even if you don't intend to sell.
Meeting to meet is a bureaucrat's game, one that you don't play. Ride along as Mark discussed why you need to have a strategy, and more, in place before any meeting.
Many requests for proposal (RFPs) for physician services completely miss the point by laying out what is expected and setting out strict performance standards, such as "the contractor will cover 'X' sites from 7am to 7pm."

By doing so, they assume that they know the best way to provide the service. But by doing so, they force, or perhaps foolishly fool, potential medical groups to respond as if the requirements set forth in the RFP are actually optimal for the facility.
Ride along with Mark as he talks about the need to question numbers presented as facts in connection with healthcare investment opportunities.
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?
You know that I strongly believe that the future of hospitals isn't hospital, 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.
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.
Ride along with Mark as he tell you about free consulting services. No, not from him, but the kind that you may be giving away, especially vi an RFT response.
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.
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. 
The road for hospitals continues to head toward the cliff. Listen as Mark discusses a recent demonstration project/study revealing the patient tremendous benefits and cost savings of hospital care at home.
When I was 17 I worked at a McDonald's. The store was a franchise location. Franchise models exist in medicine as well as in hamburgers. For example, in the urgent care center market.
Ride along with Mark as he discusses how you must uncover and protect your medical practice’s or healthcare business’s hidden intellectual property.
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?
Ride along with Mark as he discusses HIPPA, naïveté, and why your digitized data probably isn't as safe as you think it is.
Modern office machines, from copiers to printers to maybe even label makers have memory devices, and those devices may be chock full of protected health information.
Take a seat and listen in as Mark discusses the beauty of making a decision.

The large red machine lumbered forward from behind, lights flashing. A fire engine heading off to a fire.
As horrible as a fire is — the danger involved, the risk of loss to the home or business owner — there’s also an inherent opportunity: an opportunity to rebuild, to renovate, and to renew. The stories of the phoenix or of Noah and the flood.

Ride along with Mark as he discusses a way to focus your mind on building your practice

Physicians (and others) considering forming a Medicare certified ASC have to be very careful about not confusing the ASC entity’s purpose. 

If they do, they may not only blow the federal Anti-Kickback Statute (“AKS”) safe harbor on which they likely rely, they may destroy all of their Medicare claims by turning them into false claims.

Ride along as Mark discusses the flip side of the cosmetologist who opens a “medi-spa:” The expansion of medical practice beyond the traditional bounds of treatment into lifestyle.
In my previous video, What You Need To Know About The Flea That (Metaphorically) Killed The Medical Center CEO, I discussed the fact that, as in a guerrilla war, change within an organization, as well as within a domain in which the organization interacts, can occur as a result of agitation by a vocal minority.
Ride along with Mark as he discusses converting a closed or failing hospital into a surgery center or other outpatient facility.
Many say that the world is a tough place. Maybe it is, because it’s not just dog-eat-dog. It’s flea-kills-dog as well.
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.
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.
Ride along well Mark discusses the expanding case involving Insys Therapeutics and kickbacks paid to induce prescription of its drug, Subsys.
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.
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
Even Warren Buffet can’t get you this return: 420% over three years.
And, it’s 100% leveraged. OPM.
Well, not OPM as in “other people’s money,” but OPM as in “our public money.”
Take a seat while Mark discusses the payment crisis adding to hospitals’ woes. Patients, payors and physician owners are pulling and pushing cases out of hospitals to independent ASCs and other outpatient facilities. And now, payors are becoming increasing parsimonious with payments for hospital inpatient care.
Disruptive physicians. But what if the physician isn’t actually disruptive, but simply nonconformist or challenging?
Ride along with Mark as he discusses the more than 420% financial return to the government that’s fueling healthcare compliance investigations . . . and convictions.

Will today’s physicians soon be referred to as “human physicians” or “carbon-based docs” as opposed to the silicon-based kind? Paging Dr. Robot?

Ride along with Mark as he discusses how competing via providing free services, such as uncompensated medical directorships, or giving into a facility’s demand for free services, is a violation of the federal anti-kickback statute.

In the real world, your practice is worth only what a buyer, if one exists, will pay for your practice at the time you want to sell it.
Take a seat while Mark discusses the cure to the “tax” of inflation, cost of living (COLA) adjustments.
Patient satisfaction surveys are becoming a real part of reimbursement, driving a significant percentage of money.
Ride along with Mark while he discusses why “the timing is never right” simply means that you should get started now. After all, the timing will never be right.
Ah, the shiny object, the more or less instant gratification. The $10 million in your pocket.
Sit back while Mark discusses the fact that you need to be careful that you aren’t creating problems with a current deal by entering into what appears to be a benign amendment or even a simple deal with a third party.
I recently attended a continuing legal education seminar. From a purely legal standpoint, the models made sense. However, from the practical standpoint, one apparently lost on the presenter, the structures were unfinanceable.
LIFO and FIFO are inventory concepts. But they apply to the quandary of which physicians would be let go if case volume drops precipitously. This is a pressing issue for hospital-based groups as hospital shrinking and close. The time to plan is well ahead of the time, if ever, to implement.
There is an unwitting lurker inside your organization. Do you have any clue what it is?
Ride along with Mark as he discusses a the issues related to a national anesthesia group’s loss of a system-wide exclusive contract.
Today’s post centers on a negotiation tip. Here’s the executive summary for you: The goal of negotiation isn’t to be liked by your negotiating opposite.
Ride along with Mark as he discusses the split of physician employment into two segments, one in which employed physicians will never become owners and the other in which a quick track to partnership is offered. Will the second segment disappear?
Make certain that you are negotiating with someone who has the power to say “yes” and not just “no.”
Sit back and listen to Mark talk about Vermont’s war on patient care, freedom, and freestanding facilities.
It’s hard enough to watch what you say when you’re speaking, but at least you’ve got inflection on your side. When you’re writing, especially in the shorthand way that many do in emails and texts (and even in blog posts!) ambiguity often slips right in.
Ride along with Mark as he discusses a key concept from his book, The Medical Group Governance Matrix: The freedom that medical group leaders must have to decide, and to decide fast.
Ride along with Mark as he discusses why physicians and medical groups must play the long game in terms of strategy.
Robby the Robot. No, not a Da Vinci, but a robot just the same. And, fully functional.
Over the past few years, 83 rural hospitals have closed. Mark discusses why, although each disrupted employees and the physicians on staff, hospital closures present opportunity for entrepreneurial physicians
Compensation plans work in conjunction with all agreements to incentivize the climate you want in your medical group.
Conflict of interest” is a lot like “greed” and “fair share:” a label used to gain the upper hand. Ride along with Mark as he discusses the potential anti-kickback statute and other legal violations inherent in conflict of interest policies.
If I can make you a dollar by cutting your costs, can I keep 50 cents?
Ride along with Mark as he discusses the danger of not knowing what’s not in the deal.
Preserve your medical group’s security and avoid lockouts and disasters when negotiating your contracts.
Ride along with Mark as he talks about the hospital that can’t keep an owner.
HIPPA violations are about one thing – the government collecting.
Kickback problems are like approaching traffic. Swerving to avoid them might lead you right into their path.
How much transparency should exist within your group?
Ride along with Mark as he discusses the dangers inherent in texts and emails in connection with business transactions.
Kickback violations are like traffic on the highway. The chances of getting caught speeding are probably only 1% or 2%. Eventually, though, someone will be pulled over.
Ride along while Mark talks about the downside of compliance “plans.” Are they actually hindering compliance?
Watch what you are negotiating over – don’t start a bidding war over nothing!
Ride along as Mark discusses how the silos in healthcare are breaking down. You may not be an Aetna or a CVS, but their deal illuminates what’s possible for you.
Bigger is sometimes better, but not always. It’s the right bigger that is better.
Take a seat while Mark discusses using fear as fuel for your future.
What is satisfaction? How do we measure it? What’s the scale? And how, like a sneaky butcher, can we put our finger on it, adding a bit more weight to the pound?
Take a seat and listen in as Mark talks about how healthcare models, such as Clinically Integrated Networks, are simply tools, not destinations, for structuring deals.
Most of us seek comfort. We want the usual. We tend to hang on too long. Like to that sweater or college T shirt. You know, the one with the frayed edges…but is that right for your future?
Ride along while Mark talks about what kind of guaranties you should think of giving.
More and more hospitals are disrupting their longstanding hospital-based group relationships as they seek to cut stipends and get more for nothing. The favored tool? A “weaponized” form of the request for proposal. There are three main types, which ones are you prepared to encounter?
Ride along with Mark as he discusses a tactic that, though used by creeps, can be employed in negotiations for good.
The right question regarding the uncertain future, is to ask is what underlies your profession, your specialty, or its role. What’s the motivating desire or overriding function?
Ride along with Mark as he discusses some interesting events on the kickback front.

Think like a virus when considering open possibilities in taking control of your future.

Join Mark as he discusses the danger of the spy in your medical group or facility.
There’s an expression in carpentry, “measure twice, cut once.” We should have the same expression in terms of healthcare deals.
Ride along with Mark as he discusses the fact that trends, even those that seem modern, such as home delivery of fully prepared meals, are simply history repeating itself or, at least, rhyming. Understanding this facilitates your exploitation of trends in healthcare.
What is your medical group or business doing to prepare for a worse than “worse” case scenario? What are you doing to hedge against it? What are you doing to benefit from it?
Ride along with Mark as he discusses the fact that, unlike deciduous trees, some hospitals won’t be springing back to life next year. As a result, opportunities abound.
Whether you’re driving or walking (especially down the center of the street) you have to scan the environment. Ride along with Mark as he discusses the need to exercise the same diligence in your career.
We usually think of nosocomial infection, one contracted from the environment or staff of a healthcare facility, in terms of the impact on patients.
Ride along with Mark as he discusses the need to understand the incentives that drive your negotiating partner’s behavior.
Medical group mergers are a lot like marriages. Some are actual mergers. The formerly separate groups really do become one. For richer, for poorer, in sickness and in health.

What Does Partnership Really Mean?

Big data. Gotta have it. Gotta manipulate it. Let’s measure everything. Whatever we can measure improves!
Ride along with Mark as he discusses a twist on Lord Acton’s famous comment. The lack of actual power corrupts as well. There are ways to beat the “powerless” people, but it is not by playing their game.
Compliance – it’s the multi-zillion dollar reason why your medical group’s or healthcare business venture’s efforts must constantly be tested, reviewed, and retuned.
Ride along with Mark as he discusses the role of policies in your business and why they must mesh with your medical group’s other governance document. Ignore at your peril!
Earlier this year, a Santa Clara County, California jury awarded the insurer Aetna a $37,452,199.00 judgment in a lawsuit against Bay Area Surgical Management, LLC, a surgery center management company, a number of its managed ASCs, and three of Bay Area’s executives.
Ride along with Mark as he discusses rightsizing your medical group. Do you have the governance structure, policies, employment agreements, and other elements required to shift resources and reduce staff as well as expand it in face of shifting needs?
Hospitals are on the decline, are you focusing your future to compete in a changing world?
It seems as if nearly everyone working in healthcare has some sort of accreditation or certification. It’s the case for individuals and for facilities. Ride along with Mark as he questions who’s accrediting the accreditors, even the biggest one of all, the Joint Commission.
The long term success of your group relies on a governance structure that enhances the strength of the entire group rather than rewarding a few individuals.
Is the beginning, the middle or the closing of negotiations the most important timeframe in your deal making process?
Why you should always ask “why” when negotiating.
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.
Ride along with Mark as he discusses why physicians and other professionals aren’t commodities.
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.
You’re driving toward contract success. But then the other party forces you off the road. Welcome to the exit marked early termination.
Two men failed to turn over more than $6 million in taxes collected from employees of an Arkansas, hospital, were convicted for the same crime they committed (and were serving time for) in Texas.
Ride along with Mark as he discusses why medical groups, like members of a species, must differentiate or die.
Hospital closures are impacting the physician employment market. Doctors are left with a choice of navigating the pitfalls of their own private practice or being part of the hospital which may lead to lower market value.
Take a seat and listen in as Mark discusses how the message sent within a medical group is like the lane lines on the road. Every once in a while, it needs to be resprayed.