Thursday, November 29, 2018

Interview with NY State Assemblyman Raia

Thanks so much to Assemblyman Raia for your time.

Wednesday, November 28, 2018

Monday, November 26, 2018

A discussion with a health care attorney about practice acquisition




Thanks so much to Gary Herschman of Epstein Becker Green for his terrific wisdom on private equity acquisition of medical practices. 

Saturday, November 24, 2018

An interview with Dr John Phillips



Dr John Phillips: For more information on Dr Phillips.

In this interview we discuss:

  1. prostate cancer screening
  2. advocacy
  3. medical education
  4. life

Saturday, October 14, 2017

1: Control.  One must have control of day to day, week to week and have decision making ability.  We all have constraints, but within their confines we need to be able to make meaningful decisions to be happy

2: Meaning: whether one lays brick, cleans floors, or does surgery, one must have the feeling that what they do has meaning and importance in the broader sense of life, to feel as though you will have left a positive mark, and that one's time here on Earth was not wasted.  One must feel as if their work is critical to the success of their organization's mission, whatever that role maybe.  

3: Respect: one must feel as though peers feel positively about your career and skills and that such skills are valued above and beyond a paycheck.  One must feel that their patients respect them as well.  Skills ought to cultivated and nourished.  

4: Academics: medicine demands a decades long learning process.   When a physician no longer finds learning fun, professional and personal happiness will suffer. 

5: Compensation: once basic needs are met, happiness is not increased by absolute W2 income levels.  While important, W2 is not everything.  Compensation ought to be linked to effort but without the other 4 elements to satisfaction, professional satisfaction and happiness will always remain elusive.

Tuesday, May 23, 2017

Remaining Solo: 5 Strategies

1: Go micro: go super small.  One doc.  One staff or no staff.   EHR, patient portal, no phones.  No insurance.   Good option for family doc. 

2: Go concierge: charge extra fees.  No insurance.  Good option for family doc

3: Go super special: cosmetic, anti aging, infertility.  Easier said that done. Good for plastic surgeon and derm.

4: Go non par: take no insurance.  Bill at crazy out of network rates.   Good for neurosurgery, Ortho, general surgery

5: Go stupid busy: how the rest of us do it. Take everything.  See everything.  Work everyday, everywhere.   Not sustainable. 

For option 5: rethink contracts.  Get in with IPA. 

Any other options? PM me.

Thursday, May 18, 2017

5 Threats to Independent Care

Independent practice is under inexorable assault.  Here are the 5 latest threats.


  • MACRA/MIPS  This is a very complex endeavor.  No one who I have spoken to really knows precisely how to proceed.  It is also a zero sum gain: the bonus payments from successful practices come from the deductions from the unsuccessful ones.  
  • Cyber security  If you use any electronic resources, which includes electronic claims submittal, you are at risk for malicious cyber attack.  Protection in the form of best practice IT solutions and insurance cost $$$
  • Cost sharing/deductibles  Even for patients with insurance, the dollar amounts of deductibles have risen dramatically over the past 10 years, far outpacing wage increases.  This translates to fewer patient visits and more expensive collection efforts
  • Consolidation   Health care has become consolidated over the past 15 or so years.  In some markets there is only one payer. On the provider side there has been a major shift to employed models into larger and larger entities.  This means drying up referral networks combined with declining reimbursements to offices and increased premiums for employee health insurance.
  • Income inequality  The majority of increases in wealth, income, and standard of living have gone to the top 1%.  Most doctor practices cater to the lower 99%, who struggle to pay bills and as such, put off health care as long as possible.  
Sorry for the doom and gloom but it is what it is.  Solutions in next post.

Thanks for listening.

The IU.