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Why and How You Must Prepare Your Anesthesia Group for the Future

Ah. The future. What's it have in store for your anesthesia practice and what must you do to prepare your group for it? Some think that the future will be a continuation of the present, or, even worse, a return to an idealized past. They're both wrong.But the present does hold clues as to what the future will bring, and based on them, I'll make som...
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A Self-Diagnostic for High-Performing Anesthesia Group Leaders

Although the editor, bless her heart, steadfastly refused to let me have a sneak, pre-publication peek at the other articles that appear alongside this one, my educated guess is that each of them purports to give you answers.I know that's why you usually read Communiqué. In fact, nearly every one of the hundreds of other articles that I've written ...
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Anesthesia Services RFPs: Reality, Unicorns and Cognitive Bias

Mark F. Weiss, JD The Mark F. Weiss Law Firm, Dallas, TX, Los Angeles and Santa Barbara, CAThink back in time to a job interview. You dressed for success, put a wide smile on your face, and were on your best behavior.In the advertising world, they call them "reviews." In healthcare, we call them requests for proposal or "RFPs" for short. They're th...
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How (Others’) Stupid Compliance Mistakes Can Save Your Life

Mark F. Weiss, JD The Mark F. Weiss Law Firm, Dallas, TX, Los Angeles and Santa Barbara, CASome inner desire stronger than my willpower beckoned me to stare at them through the glass. I was nine years old. It was both titillating and embarrassing.There were 10 photographs in gritty black and white, arrayed in order behind glass on the post office w...
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Phoenix Project: Reconstructing a Local Group from the Ashes of Its Predecessor

Dateline PhoenixPhoenix. No, not the city in Arizona, but the mythical bird. The one that springs to life from the ashes of its predecessor.Anesthesia groups, like birds, have a life cycle. Birth to death. Formation to failure.The group's founders hatch the concept and bring it into existence. The group obtains business traction in its infancy and ...
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Why Your Compliance Efforts May Be Worthless

Mark F. Weiss, JD The Mark F. Weiss Law Firm, Dallas, TX, Los Angeles and Santa Barbara, CAIt's a riddle almost as inscrutable as that of the Sphinx: How can a physician or pharmacist or facility owner be convicted of a federal crime for violating a state law? The answer is, unfortunately, quite simple, quite questionable and quite dangerous. It tu...
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Hospital CEO Turnover: What You Must Know and Do to Protect Your Anesthesia Group

You and I are sitting in the hospital boardroom directly across from the hospital's CEO.We're negotiating the last few points on the renewal of your group's exclusive contract.Perhaps we're pushing for something minor in the scope of things, but it's still important to your group. For example, it could be for continuing the funding of the surgeon s...
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Why Your Compliance Efforts May Be Worthless

It's a riddle almost as inscrutable as that of the Sphinx: How can a physician or pharmacist or facility owner be convicted of a federal crime for violating a state law? The answer is, unfortunately, quite simple, quite questionable and quite dangerous. It turns what many think about federal healthcare law compliance on its head.It signals that man...
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Why Your Compliance Efforts May Be Worthless

It's a riddle almost as inscrutable as that of the Sphinx: How can a physician or pharmacist or facility owner be convicted of a federal crime for violating a state law? The answer is, unfortunately, quite simple, quite questionable and quite dangerous. It turns what many think about federal healthcare law compliance on its head.It signals that man...
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Switzerland and the Anesthesia Group Structure

Quick! Who's the president of Switzerland?Anesthesia group leaders seeking to create a larger structure out of existing groups, from an alliance among local groups, to business models for exclusive contracting, to the creation of a true regional or national player, encounter a plethora of problems from the merely difficult (e.g., due diligence) to ...
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Anesthesia Mergers and Acquisitions and Post-Termination Obligations: Have You Terminated Your Future?

I pushed the wiring instructions across the table.A few minutes later, I confirmed that close to $10 million was in the account of my client, the sole shareholder.Then we all went to lunch.Ah, the shiny object, the more or less instant gratification. The sale of your anesthesia group and the fresh $1 million in your pocket.But what comes next? And ...
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Switzerland and the Anesthesia Group Structure

Mark F. Weiss, JD The Mark F. Weiss Law Firm, Dallas, TX, Los Angeles and Santa Barbara, CAQuick! Who's the president of Switzerland?Anesthesia group leaders seeking to create a larger structure out of existing groups, from an alliance among local groups, to business models for exclusive contracting, to the creation of a true regional or national p...
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Anesthesia Mergers and Acquisitions and Post-Termination Obligations: Have You Terminated Your Future?

The Mark F. Weiss Law Firm, Dallas, TX, Los Angeles and Santa Barbara, CAI pushed the wiring instructions across the table.A few minutes later, I confirmed that close to $10 million was in the account of my client, the sole shareholder.Then we all went to lunch.Ah, the shiny object, the more or less instant gratification. The sale of your anesthesi...
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OIG Advisory Opinion Secrets and Strategies

[Author’s Note: This article is based on my presentation at the 2016 Advanced Institute for Anesthesia Practice Management.] The OIG Advisory Opinion (Advisory Opinion) process allows parties of actual or proposed transactions to obtain the opinion of the Office of Inspector General (OIG) of the U.S. Department of Health & Human Services as to whether that transaction violates the federal Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b) (AKS). There’s an official process for obtaining an OIG Advisory Opinion. Then there’s the actual way that the process works. And, then there are the secrets and strategies that can be used in connection with opinions. For decades, I considered Advisory Opinions as a set of guideposts as to how the OIG, as the primary agency charged with enforcing the federal AKS, thinks as to the application of that statute. But then I realized that there was a very different way to think of them,...
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Impending Death of Hospitals: Will Your Anesthesia Practice Survive?

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? I have a crystal ball. Here, let me share it with you. We’re going to review some of the trends currently impacting, and soon to impact, hospitals that will, I predict, lead to their destruction, at least as we know them. There is absolutely no question that these trends are going to have an impact on your anesthesia practice. Start preparing now. Trend 1: Hospitals Are Getting Bigger and That is a Weakness Government induces physician labor Obamacare favors the growth of hospitals with its incentives for aligning physicians. Think Accountable Care Organizations (ACOs) and other incentives to coordinate care, meaning coordination via hospitals. Although reports lag by several years, at least 20 percent to 30 percent of all practicing physicians are currently employed by hospitals. There...
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Anesthesia Group Mergers, Acquisitions and (Importantly) Alternatives

It’s come to the point that a good part of my work with anesthesia groups involves surgery: removing an earworm—a catchy tune that continually runs through the group’s mind. In fact, it’s always the same tune, part of The Clash’s Should I Stay or Should I Go Now: Should I stay or should I go now? Should I stay or should I go now? If I go, there will be trouble, and if I stay it will be double. So come on and let me know. This indecision’s bugging me. Stay, as in should our group remain independent? Go, as in should we sell out to someone, maybe anyone, who’ll buy us? But as is generally the case in life, the decision is not purely either/or, black or white, yes or no. There are many alternatives. And that’s what we “operate on” as part of what I call the Future FinderTM...
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Phoenix Project: Reconstructing a Local Group from the Ashes of Its Predecessor

Dateline Phoenix Phoenix. No, not the city in Arizona, but the mythical bird. The one that springs to life from the ashes of its predecessor. Anesthesia groups, like birds, have a life cycle. Birth to death. Formation to failure. The group’s founders hatch the concept and bring it into existence. The group obtains business traction in its infancy and grows until it reaches maturity. But, sooner or later and as inevitable as the sunset, the group begins to decline: the loss of contractual relationships. The unfastening of the bonds that bind the group together. Its eventual dissolution isn’t far off. The flames of death engulf the group. But unlike natural birds, many dying anesthesia groups have within them the kernel of rebirth. Enter the phoenix. Death and Praxis In today’s anesthesia market, we’re seeing two slightly different patterns of anesthesia group decline and death: the failed site of a national or...
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What’s Your Anesthesia Group Worth? And Why it Might Not Make Any Difference

[Author’s note: This article is based on a piece I wrote for Anesthesiology News.] “What’s our anesthesia group worth?” I hear that question on a frequent basis. In fact, you’re probably thinking it right now. There are a lot of people out there who are happy to fool you with their answer. They might say something like, “well, your practice is worth X times pro forma earnings before income tax depreciation and amortization, otherwise known as ‘EBITDA.’” Or, they might even have a super-complicated formula, sort of like the ones economists use to make you think that they are scientists. But that’s all BS. The real answer is that your practice is worth exactly what an actual buyer will actually pay you to acquire your practice. So, if buyer A will actually pay you $30,000,000 and buyer B will actually pay you $40,000,000, then the practice is worth $40,000,000. That’s the case...
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The Siren Song of Hospital (Un)Employment

It’s a tough world out there for anesthesiologists. At least, that’s what many anesthesiologists think. Many believe that hospital employment is the panacea: the new “safe” career option. And why not—that’s the song that hospitals are singing loud and clear, and it’s the one they’re encouraging you to sing, too, via “alignment.” Are anesthesiologists being guided into a safe harbor from the storm of uncertainty, or are they being lured by the siren song of a creature lethal to physician success? Siren Song In Greek and Roman mythology, sirens lured mariners to their deaths. Lethal creatures that they were, they didn’t kill with knives, spears, or other observable weapons; they didn’t even give rise to a threat. Instead, they used their enchanting voices in song to lure their victims’ ships aground on the rocky shore. Today, there are a number of trends creating a storm in the sea of medical practice....
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Are You Making This Mistake Concerning Competition?

“The Competition” These days I hear that term from more and more anesthesia group leaders, and I’m sure that you’re thinking about it more than you’d like. From the Latin root competitionem, its meaning originated in the sense of rivalry, of a contest for something. Since at least the 1790s, it’s been used to describe rivalry in the marketplace. Ask yourself what “the competition” means to you. What comes to mind? In working with anesthesia group leaders across the country, my regular experience is that they envision the competition as another anesthesia group, whether from across the county or across the country. These days, the image that often first comes to mind is that of the predatory staffing-service model. I certainly can’t fault these group leaders because, especially these days, there is tremendous competitive pressure from outside entities coveting your facility contracts. So, for most group leaders protecting their practice from...
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