Thursday, March 31, 2022

4 Mistakes to avoid when selling your medical practice

Oftentimes private practice physicians make drastic mistakes when selling their medical practice and lose thousands of dollars in the process. All their hard work and long-term investment goes down the drain. These mistakes though are often easily avoidable. As small business owners, these physicians had once dreamed of owning their own medical practice and building it to success.As times goes on, they hope to reap the rewards in the form of a successful business sale. Sounds like a great plan! But making the sale is not as easy as it may appear.

Proper planning can mean thousands of dollars in your pocket. Here are four tips to help you avoid medical practice sale pitfalls, disappointment, and lost money.

Mistake 1: Not planning ahead or waiting too long to sell


Waiting too long, or not planning in advance, can cause many physician practice owners to miss their window of opportunity. It takes a considerable amount of time to prepare for and execute a medical practice sale, therefore, long-term planning is key to any successful medical practice sale. Physicians looking to retire quickly and sell their practice within 12 months are way behind the power curve and these scenarios are often a longshot endeavor. It pays to plan ahead; you just never know when that perfect buyer may approach you and make you an offer you just can’t refuse.

Succession planning is a major consideration especially for solo physician practices as I have written about in several other articles.Again, waiting until the last minute (less than 12 months) to plan for your exit puts you at a severe disadvantage. Additionally, the physician "succeeding" you needs to be set up for success. If they see you have been planning and considering this for quite some time and that it's not a quick "I've had enough" sale, your price will be much higher. Add to that the confidence the buyer will have in a medical practice purchase if they see there was a strategy for the sale and that it's not driven out of desperation.

Mistake 2: Not finding the right person to assist you


Finding the right transactional consultant to help you with succession planning and to assist you with the sale of your medical practice is crucial to your success. Often physician practice owners go with the first person they meet just to “list their practice” and get the process going. This can cost you time and money in the long run. Within a few months, you may see no results and have to go on the search all over again. Taking time to interview professionals and looking at a realistic outcome of what is expected will get you going in the right direction. Keep in mind too, that no one is more motivated, passionate and knowledgeable about your medical practice than you.



Mistake 3: Asking too much or too little


Setting a very high or unrealistic price tag on a medical practice can lead to a dead-end street. Expecting to get top dollar for a practice that generates little or no profit is simply using bad business sense. Consider your specialty, similar practices, the current economy and your marketplace when pricing your practice to sell.I have also written several articles on medical practice valuations which can help you through that thought process. Remember it is business so don’t take it personally. Look for the most valuable opportunities for your medical practice.

Another mistake is to price the medical practice too low. Sometimes physician owners will price their practices low because they are burned out, suffer from an illness or did not get good advice. Do your homework first. Listen to your professionals such as a transactional consultant. Do research about other medical practice sales before jumping in with both feet.

Mistake 4: Selling to the wrong person


Taking the first offer may not be a wise choice as this may not necessarily be your best offer. Selling your practice for top dollar with little or no money down along with an extended contract may lead you to lose it all. Medical practice sales can go bad after the new owner takes over. The new owner may lack business experience, have a closed mind or be a poor leader . . . the list goes on and on. A successful medical practice owner makes it looks easy, but change that mix and disaster may strike. When this happens, the new owner may quickly end up in the red. This is why you want to get all or most of the money up front and leave little to escrow.

Evaluate your options and make the best selection for the long term. Ask yourself, is this the best physician to buy and run my practice? Or, can they quickly connect with my patients and referring physicians and learn how to market effectively? When the medical practice sale goes as planned, it creates a tremendous opportunity for both physician owners and the success continues.

Final thoughts


Running a medical practice is a tough business—much tougher than people realize. The more planning you put into your sale, the better the price you will be able to obtain. Keep in mind that the prospective buyer will be very suspect of your reason for selling. Have your plan and strategy in place to eliminate any fears. Just like you started your medical practice with a strong plan, sell it with a strong plan as well.


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Wednesday, March 30, 2022

Exploring the advantages of a Virtual Compliance Assistance Partner

Challenged by increasing and changing regulations, more Compliance Officers (CO) are engaging in Virtual Compliance Assistance (VCA) as an affordable option to quickly adapt to the industry’s shifting regulatory environment, while maintaining the daily functions of the compliance program. Compliance departments, like other non-revenue-producing departments, are losing resources as hospitals and physician practices of all sizes face unprecedented financial challenges. Even before the COVID-19 pandemic, compliance departments often faced hurdles in securing adequate resources to execute their compliance work plans and support their organizations’ compliance programs.


Virtual Compliance Assistance Partner (VCAP)


Some COs find they are engaged with multiple advisors of virtual compliance services in order to meet varying needs. However, engaging a VCAP provides the greatest advantage, as it fully leverages the institutional knowledge gained as the relationship grows. A VCAP can reassure the CO and the Board that the organization is continuing to assess and mitigate risks, while adapting to a fluid regulatory environment. Further, because a compliance program seldom scales at the same pace as the organization’s growth, a VCAP can bridge gaps and minimize potential vulnerabilities. A VCAP offers a cadre of compliance advisors who can provide bandwidth, as well as a deep bench of experts who can meet nuanced compliance needs.

For example, a VCAP offers both subject matter expertise and experience, derived from working with many different clients on evolving and complex regulations that may require research and evaluation to determine the potential impact on an organization. Consequently, a VCAP can advise as to how a crisis may affect current risk exposure, and how priorities should be assessed and realigned. A VCAP can also assist with routine work plan items, as well as unexpected high-risk items that require additional resources.


Scalability


A primary advantage of a VCAP is that it can scale its services to meet the specific needs of an organization and its compliance program, regardless of size. A smaller organization may engage a VCAP to support its compliance program in totality because its compliance budget cannot support a full-time position, or partially because the individual serving in the CO role is stretched too thin serving multiple roles. A mid-to-large size organization may engage a VCAP to provide additional bandwidth to complete compliance work plan items. Any size organization can enjoy a strategic advantage by engaging a VCAP to help with specific needs, or to sustain appropriate oversight of the compliance program and support annual compliance initiatives.


Financial Flexibility


VCAPs are financially attractive to COs because they are less expensive than a full-time equivalent (FTE), yet are rich in compliance knowledge. Additionally, VCAPs are agile and can simultaneously support various needs, as well as provide immediate on-call support. VCAPs offer a resource of multiple experts in markets where demand is high. Support can be tailored to meet specific requests, and thus COs reap the maximum benefit of each compliance dollar spent.
VCAP Support

Organized in alignment with the Seven Elements of an Effective Compliance Program, VCAPs partner with and support COs by providing services to meet a variety of compliance needs. Such services include:
  • Standards, Policies, and Procedures
  • Develop and/or revise the code of conduct.
  • Develop, review, or revise compliance polices.
  • Monitor regulatory updates and develop applicable policies to address operational processes or changes, as needed.


Oversight and Program Administration


  • Develop Board and oversight responsibility education, and present as needed to Board members.
  • Develop Board reports to include the compliance program update, status of compliance work plan items, potential regulatory impacts on the organization, and ad hoc audits as identified via detected deficiencies.
  • Evaluate and/or develop the Compliance Committee infrastructure, including composition, reporting structure, and charter development.
  • Provide guidance to the CO with regard to effectively administering the compliance program and obtaining appropriate oversight.


Reporting and Investigating


  • Evaluate hotline reports and conduct necessary investigations under the direction of the CO and the organization’s legal counsel.
  • Review the entity’s investigation policy and procedure and revise as necessary.
  • Assist with processes to log and investigate issues that arise from audits performed by outside parties, such as third-party payers and government auditors.
  • Develop necessary reporting structure and tools to convey monitoring and auditing findings to executive leaders, the Board, medical staff leadership, and affected departments.


Education and Training


  • Monitor regulatory updates to discern impact on the organization and develop applicable training for employees and medical staff members when needed.
  • Develop the annual compliance training plan based on needs identified in the annual risk assessment, regulatory updates, and monitoring and auditing outcomes.
  • Evaluate and/or develop compliance training curriculum and materials.
  • Develop and provide annual HIPAA training.
  • Develop and provide customized compliance training for high-risk areas, such as revenue cycle and physician contracting.
  • Develop and provide specialty coding training.
  • Develop and provide professional fee coding education for providers.
  • Provide new CO training via on-site or remote “bootcamp” offerings.
  • Develop risk-based training as identified via the annual risk assessment.
  • Provide monthly/quarterly compliance “hot topic” education.


Monitoring and Auditing


  • Conduct compliance work plan audits as identified via the annual risk assessment and detected through ongoing monitoring activities.
  • Evaluate auditing and monitoring processes and controls currently in place.
  • Develop necessary processes to identify and respond to governmental payers in a timely manner.
  • Conduct auditing of facility and professional fee billed claims, for accuracy and compliance, including “audit the auditor” claims review, and follow-up audits with corresponding action plans.
  • Complete physician analytics such as E/M Bell Curve analysis, physician time study, and procedural utilization analyses to identify potential anomalies.
  • Investigate aberrant patterns by conducting a sample review of claims.
  • Monitor CMS’ Open Payment Data to identify potential undisclosed medical staff member conflicts of interest.
  • Assess physician compensation arrangements, including but not limited to, medical directorships and real estate transactions with referral sources.


Compliance Risk Assessment and Work Plan


  • Review risk assessment methodologies and tools.
  • Evaluate and prioritize identified risk items for inclusion in the compliance work plan.
  • Identify high-level risk areas that potentially expose an organization to a substantive level of threat or loss, and develop correlated prioritized action plans.


Response and Prevention


  • Evaluate Conflict of Interest (COI) disclosure statements and assist with necessary COI management plans.
  • Assist with development of corrective action plans and monitoring of progress of those created internally, as well as those that arise from audits performed by outside parties, such as payers and government auditors.
  • Provide exit interviews and/or exit interview templates for applicable positions to determine knowledge of potential compliance exposure.
  • Assist in developing a vendor management process, including establishing safeguards for vendor selection, implementing controls for monitoring vendor contract terms, and providing vendor compliance training.


Enforcement and Discipline


  • Review/revise content of the disciplinary policy, including sanctions for non-compliance.
  • Assist with establishing compliance goals within job descriptions and annual performance evaluations.
  • Assist with the development of disciplinary action documentation in response to issues of non-compliance.


Regulatory Compliance Assistance


  • Provide assistance with and advise organizations on navigating a corporate integrity agreement (CIA), including but not limited to:
  • Providing subject matter expertise as it relates to understanding the CIA requirements and the impact on an organization.
  • Evaluating gaps in the current compliance program, and developing mitigation plans that include timelines, accountability, and internal reporting.
  • Assisting with implementation of mitigation measures and regular reporting to the monitor.
  • Conduct transactional due diligence to evaluate potential compliance risks as they relate to program infrastructure, referral relationships, and claims submission.
  • Provide post-transaction compliance assistance in transitioning entities to a corporate compliance program (e.g., implementing compliance policies and procedures at the new entity).
  • Provide regulatory expertise as it relates to COVID-19, such as the Paycheck Protection Program, Medicare Advance Payments, and Provider Relief Funds.


Virtual Compliance Assistance Models


Depending on the size and compliance needs of an organization, VCA models will vary. The most basic model may be a flat fee per month for an established set of hours, to be used at the CO’s discretion. This model is typically used for more advanced compliance programs that simply need expertise as regulations change or new ones develop.

More advanced models will build upon themselves and may include a variety of the “a la carte” assistance outlined earlier. The advantage of VCA and a VCAP is the flexible budgetary possibilities that offer customizable options maximizing the value of every dollar invested in an organization’s compliance program.


Conclusion


When effectively deployed, a VCAP is not only economically efficient in that it consolidates the role of multiple advisors, it also garners increased executive and shareholder confidence because of the expertise it offers. A VCAP provides sustainability to compliance programs that otherwise might struggle to appropriately support the organization. Working as a trusted and valued member of your team, a VCAP gains the institutional knowledge of the organization and compliance program, resulting in efficiencies and the most value for building and supporting a robust compliance program.


Take Aways


  1. VCA is an affordable option to quickly adapt to changing regulations, while maintaining a compliance program’s daily function.
  2. A VCAP can reassure the CO and Board that the organization is continuing to assess and mitigate risks while adapting to regulatory changes.
  3. A VCAP can bridge gaps and minimize potential vulnerabilities when a compliance program does not scale at the same pace of the organization’s growth.
  4. VCAPs are financially attractive to COs, offering multiple experts, and providing tailored support at a lower cost than an FTE.
  5. VCAPs can become trusted, valued team members, providing sustainability to compliance programs that otherwise might struggle to appropriately support the organization.


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Sunday, March 27, 2022

The importance of inclusion

For practicing physicians, inclusivity proves critical. Not because of HR mandates. Not because it’s a good thing to do.

Inclusivity improves your patients’ care. It enables you to be a better doctor. Rising complexity, rapid change and treating far-flung patients mean physicians need information from all angles of care.

Physicians need to know that everyone participating in your patients’ care can tell you vital information. They must feel safe and comfortable communicating with you, even if it’s bad news.

But many people won’t talk to physicians. Many don't know their observations may be important. Some don't think they have responsibility beyond their specific task. Some expect they’d be ignored. Many are afraid.

Hierarchies, tenure, specialties, functions, as well as gender, race, age, etc. have long prevented clinicians and staff from talking civilly and candidly with one another. Many withdraw or stay silent rather than risk stepping outside one’s identity.

How in the world can physicians get critical information and insights when so many people think no one wants to hear from them? When they’ve long been excluded? When they don't feel safe to speak up?

Genuine inclusivity makes you better together. Real inclusivity unlocks the information, insights and generosity of your care group. The eyes, ears and ideas of people from all angles of patient care prove essential to optimize patient outcomes.

One physician alone can no longer treat patients safely and successfully. There are far too many locations, details and possibilities for one person to know everything.

For safe, quality care now, everyone who ‘touches’ your patients’ care must feel safe from biased or hurtful treatment. They need to feel valued in your care mission.

Candid communications and everyone feeling part of the care project improve care.
  • Inclusivity improves safety.
  • It enhances patients’ experience.

True inclusivity makes the care group more efficient. It enables physicians to be the excellent clinicians they trained to be.

The two essential elements of genuine inclusivity are psychological safety and feeling one belongs.

Psychological safety means that everyone feels comfortable talking and participating. Especially when the contribution involves an error or problem. They believe they’ll be listened to and treated respectfully and fairly.



With psychological safety, your group can name difficult problems like racist, sexist or other exclusionary attitudes. They’ll step across discomfort because they believe that together they can productively discuss the problem.

Bias and exclusion deeply hurt people. For some it takes courage to simply show up at work. The fear of being belittled or ignored stops people from naming bias. For people to feel safe,
Everyone understands that unfairness, racism, sexism and bias based on unalterable characteristics prevent safe, quality care and are not acceptable.
Everyone trusts that their participation will be met with reasonable responses. They’ll be heard.
The care group knows that “nothing [happens] about me without me.”
Everyone trusts those involved in care to protect their safety and place in the care project.

When people feel they belong in the care group,
Everyone sees their connections and interdependencies with others. This collaboration requires constructive communication, particularly something goes wrong.
They understand that inclusivity creates a bigger pie. Resources are not taken from them. Inclusivity does not make anyone lesser.

Inclusivity enables everyone to feel valued, so they can be themselves.

In the midst of complexity and raging uncertainty, diversity in identity, experience and thinking improves decisions and outcomes. It’s an asset.
  • Care staff are willing to risk asking questions and speaking up.
  • They feel valued for the resources they bring.

Without it, the fears and bad feelings from entrenched exclusion and disrespect create unnecessary risks to care reliability. They introduce undesired variation that threatens safety. Physicians need prompt callbacks from specialists.

Transport staff, housekeepers, CNAs, rehab facility PTs, receptionists and staff at other facilities also know or see things that may prove critical to care.

The MD notices her patient’s tremor. Did the new medication cause it?
  • The nurse doesn’t know when the tremor started.
  • However the housekeeper noticed it when she cleaned before the new meds.
  • She didn't think it was her place to say anything.

Everyone in the care group is your lookout across time and space in unpredictable, complex care.

To persuade the care group to communicate candidly requires reducing entrenched exclusion.

Physicians prove powerful in creating inclusivity. Physicians create the expectations, decisions and communications that engage everyone in care. They model the intention and words daily.

While pre-judgment runs deep, there are many simple yet powerful ways to promote genuine inclusivity (despite daily pressures).
  • A few words, behaviors or actions can change things when consistent over time.
  • Small questions or comments can be done quickly in the hallway, around the bedside.

Foster inclusivity tomorrow by:
  • Checking in with each person in your care group, even just to ask, what’s new.
  • Call them by name.

Show them you see them. Start a relationship with them.

This goes a long way toward genuine inclusivity. It increases the chances they’ll talk to you about your patient.

You’ll unleash people’s energies and dedication. When you cultivate conditions for everyone to thrive, they suffer less. And you generate more generosity and commitment from the care group.

A bonus benefit for your patients: your care group is more willing to offer help, creating seamless care.

Genuine inclusivity improves your patients’ care and enables you to be the fine physician you trained to be.


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