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Answer the phone 

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https://interimcfo.wordpress.com/2017/12/17/answer-the-phone-%EF%BB%BF/

Abstract:  This article explores how doing something as simple as disrespecting people by not returning phone calls can be career limiting.

One of the lectures I vividly remember was when the boss called the group together to absolutely shellack all of us because one of us had a very bad habit of not returning phone calls.  During the course of the lecture, we were told to ALWAYS return EVERY phone call even if it is to tell the caller to never call again.  The fact that one of us was not returning calls was described as an embarrassment for all of us.  We were told that the next time such a complaint was received, there would be no more second chances.  The person that galvanized my thinking on this topic has passed away but the influence of his powerful speech continues to resonate into the future and guide my thinking and actions.

Why would someone refuse or fail to return phone calls?  All of us are very busy and as those of us who are decision makers know, a lot of the calls we receive are cold, unsolicited sales pitches.  My assistants in several venues have been continually amused by all of my ‘long lost friends’ that drive everyone crazy with unsolicited calls that usually lead to some kind of sales pitch.  Most of these people I have never heard of.  Another reason that calls are not returned is that we are all extremely busy.  It is easy to procrastinate about returning a call until you have forgotten about it.  The next thing you know, you have disrespected someone.

I am used to not having my phone calls returned.  It is an all too common phenomena that those of us who put any effort into networking are well familiar with.  I will usually call someone three or four times and get no response before I black list them.  I recently had a very frustrating experience.  You know, the one where the administrative assistant answers the phone and says, “let me see if he’s in” only to return to the phone a few seconds later to tell me that she needs to take a message.  The probability that an Administrative Assistant will not actually know whether their principal is in or not is infatesimally small.  The last time this occurred, I told the assistant that the person I had called could use any of the last three messages I had left for him.  I am still waiting for one of those calls to be returned or better, an opportunity to return the disrespect I have been subjected to by this idiot; maybe in the form of a blind reference.  By the way what kind of narcissist would put their assistant into the position of having to lie for them in the first place but I digress.

Not only is this behavior disrespectful and unprofessional, it can be career limiting.  The very people that refuse to return your calls are frequently among your callers when they need something from you.  I have had several people that refused to accept my calls call me when they were referred to me during a career transition or job search.  I return their calls and enjoy listening to their lame excuses about how embarrassed they are that they haven’t kept up.  I indulge them while I make their call as short as possible.   What kind of arrogance and narcism is at the root of a person that would not demonstrate a whit of professional courtesy to me when they do not need me then reach out to me asking for help when they think that I might be able to do something for them?  Obviously, these morons have never heard of the golden rule.  You know, the one that admoishes us to do unto others as we would have them do unto us.

One of the many problems that can arise from this behavior is a blind reference.  Occasionally, I will receive an inquiry from someone that wants to know if I know someone.  All too frequently, the target is being considered for some type of public relations or networking opportunity like opening doors.   I ask the person wanting a reference how successful they think that someone that did not return calls would be representing their firm?

On this note, have you received requests from people that refused to return your calls or engage with you come around later and ask you to meet with them so they can try to sell you something you did not ask for and  not need?   The arrogance of this behavior is impressive to say the least.  I know people that will agree to these meetings.  They will let the idiot that disrespected them spend time and expense traveling only to limit their presentation to one hour or less.  At the end of these meetings the hapless moron is bid adieu and sent off with no intention of ever spending a cent with them or the company they now represent.

What goes around comes around.

The point of this is that when you fail or refuse to return phone calls, in my opinion you are intentionally damaging yourself.  There is an old one liner that says, “Don’t burn any more bridges that you have to because one day, you might have to re-cross one of them.”  When you fail or refuse to return phone calls, you are proactively burning bridges.  The irony of not retuning calls is that the behavior is a boomerang.  The disrespect will come back and wack you.  It is a whole lot easier to be arrogant toward those that call you when you have a gig that is when you do not have a gig.  An acquaintance that had ignored me for years finally got his ass fired.  A few months later, I got the call.  He was desparate for a job and in his opinion I held a key to him getting his next gig.  I told him that I would see what I could do and that was the last time we talked.  He never even bothered to follow up with me to see what if anything had transpired.  That conversation occured several years ago and as far as I know, his run in the helathcare industry is over.

RETURN YOUR CALLS.  FOLLOW THE GOLDEN RULE.  NEVER FORGET, WHAT GOES AROUND COMES AROUND.

A lot of people have the memories of race car drivers.  They NEVER forget.

Please feel free to contact me to discuss any questions or observations you might have about these blogs or interim executive services in general. As the only practicing Interim Executive that has done a dissertation on Interim Executive Services in healthcare in the US, I might have an idea or two that might be valuable to you. I can also help with career transitions or career planning.

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Johns Hopkins favored out-of-state patients over locals to increase revenue, lawsuit claims

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http://www.baltimoresun.com/health/bs-hs-hopkins-lawsuit-20171213-story.html

Image result for priority treatment

 

A former supervisor in the patient appointments department at the Johns Hopkins Health System Corp. has accused the medical system in a lawsuit of prioritizing out-of-state patients over Maryland residents to boost revenue.

Anthony C. Campos said in the lawsuit filed Wednesday in U.S. District Court that his department was directed with the task of “filling the plane” with patients from outside Maryland. The directive to bring in more of these patients came from the highest ranks at the medical system, the lawsuit contends.

In Maryland, hospitals are required under an agreement with the federal government to operate under global budgets assigned to them by the state that limit how much revenue they can make in a given year. The budgets were put in place as part of a broader effort to cut soaring health costs and improve care.

But the budgets only apply to patients who live in Maryland. Any money brought in by treating out-of-state patients is additional revenue for the hospital.

The lawsuit contends that Hopkins is violating a clause in its budget agreement with the state that says hospitals can’t deny services to patients for inappropriate financial reasons. The medical system is also required to provide care that focuses on the community, something the lawsuit contends can’t be done if the emphasis is on patients from elsewhere. The medical system also hid what it was doing from the Centers for Medicare and Medicaid, which oversees payments through public health programs, and the Health Services Cost Review Commission, which sets the hospital’s global budgets, according to the lawsuit.

An attorney representing Campos said he was not available for comment.

“I think Maryland residents will find it highly offensive that Hopkins is pushing out-of-state residents to the front of the treatment line while Maryland residents are forced to the back of the line all in the interest of profits,” said the attorney, Lindsey Ann Thomas, with the law firm of Conti Fenn & Lawrence LLC.

In a statement Wednesday night, Johns Hopkins said the “the complaint is without merit. Safe and high quality care for all patients, regardless of where they live, is our number one priority. Our census shows that the majority of our patients are from Maryland and that the number has steadily increased over the past several years.” ​

The medical institution began pushing for more out-of-state patients in 2015, Campos said in the lawsuit. He pushed back and told his bosses his team was getting complaints and concerns from doctors about the preference being given to out-of-state patients. Campos’ supervisors responded that they were following the orders of senior management, according to the lawsuit.

Priority was sometimes given without taking into consideration which patients were sicker, the lawsuit said.

The tactics to attract these patients became more aggressive over time, the lawsuit said. Johns Hopkins USA, a medical concierge service, was enlisted to help prioritize out-of-state appointments. The medical system began targeting the most profitable departments, including neurosurgery, oncology, otolaryngology, pediatrics and surgery. In some departments, a supervisor was ordered to intervene if an out-of-state patient could not get an appointment within 30 days, and those patients were also given priority on wait lists, the lawsuit said.

In May 2016, the Department of Patient Access was told that 250 to 350 additional out-of-state cases were needed that fiscal year to reach profit targets of $5 million to $7 million, according to the suit.

Campos is asking that the government be awarded damages and Johns Hopkins fined under the False Claims Act. He is also asking for a “percentage of any recovery allowed to him.”

California, North Carolina and New York hit hardest by 340B cuts

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http://www.modernhealthcare.com/article/20171213/NEWS/171219953

Image result for 340b drug pricing program

 

The CMS’ planned $1.6 billion in Medicare cuts to 340B hospitals across the nation will disproportionately impact providers in California, North Carolina and New York, according to a new study.

Slashing the 340B drug discount program, which is intended to lower operating costs for hospitals to give its low-income patients access to drugs, would result in large funding cuts across California, North Carolina and New York hospitals, ranging from $62 million to $126 million, researchers for consultancy Avalere found. Overall, six states will see drug payment cuts of more than $50 million next year.

About 62% of Medicaid disproportionate-share hospitals will experience less than a 5% reduction in Medicare Part B revenue due to the drug cuts, while 6% of impacted hospitals will experience cuts greater than 10%.

But the concurrent increase in non-drug payments will mean that most hospitals will have very minimal changes to their revenues, according to the study. Because the drug-related cuts will disproportionately impact 340B hospitals while the non-drug payment increases will be distributed evenly across facilities, some hospitals would see increased payments while hospitals with high 340B volumes will likely see decreases.

Still, any reduction to the already thin margins of hospitals could spell trouble for providers.

Consumers stand to benefit from the cuts, researchers said. Since Medicare beneficiaries are responsible for a portion of the total drug reimbursement, consumers in California, North Carolina and New York would save a range of $15 million to $32 million. Ten states will have aggregated Medicare beneficiary savings greater than $10 million in 2018.

“The 340B program has become a big business for hospitals,” Avalere President Dan Mendelson said. “As a result, all hospitals in the program have to think about this carefully going into next year.”

Beginning in 2018, Medicare intends to reduce 340B payments from average sales price (ASP) plus 6% to ASP minus 22.5%, which the CMS estimates to be closer to the hospitals’ acquisition cost. With the proposed changes, if a drug costs $84,000, the CMS would pay just over $65,000, instead of the current $89,000. Hospital groups have sued to prevent those cuts and litigation is ongoing.

About half of the hospitals across the country participate in the 340B program, which has been criticized because it does not restrict how hospitals spend 340B money. Critics say that some hospitals use the program to pad profits while rural and critical access hospitals maintain that it’s a vital revenue source and helps support preventive services.

In a House Energy and Commerce Committee hearing on the pharmaceutical supply chain on Wednesday, U.S. Rep. Dr. Larry Bucshon (R-Ind.) said that some hospitals manipulate the program. A financially stable hospital could acquire a physician practice in a rural community and get a 340B distinction for it, he said.

Mandating more transparency on how hospitals use 340B money would prevent abuse, Bucshon said.

“The rules allow the hospitals to pursue these mechanisms aggressively,” said Mendelson. “Some members of Congress believe the rules diverge from the original intent of the program as a way for low-income individuals to access drugs.”

 

Fracking sites may raise the risk of underweight babies, new study says

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https://www.washingtonpost.com/news/energy-environment/wp/2017/12/13/fracking-sites-raise-the-risk-of-low-birth-weight-babies-new-study-says/?utm_term=.021acebde81f

Living within half a mile of a hydraulic fracturing site carries a serious risk for pregnant women, a new study has found. The drilling technique, also known as fracking, injects high-pressure water laced with chemicals into underground rock to release natural gas.

Women who lived within that distance to fracking operations in Pennsylvania were 25 percent more likely to give birth to low-weight infants than were mothers who lived more than two miles beyond the sites.

The five-year study of more than 1.1 million births in the state between 2004 and 2013, published Wednesday in the journal Science Advances, also found lower birth weights, although not as low, in infants whose mothers lived between half a mile and two miles from a fracking site. Beyond two miles, there was no indication of any health effect to newborns, a significant drop-off, the study said.

“I think I was surprised by the magnitude of the impact within the half-mile radius,” said Michael Greenstone, a professor and director of the Energy Policy Institute at the University of Chicago, and one of three authors of the study.

There are about 4 million births per year in the United States. According to the study’s research, about 30,000 births are within half a mile of a fracking site and 100,000 are within two miles. “I don’t think that’s an insubstantial number,” Greenstone said.

Greenstone said it’s important not to read too much into the study’s conclusion. “I like to joke that there’s a little bit for everyone to hate in this paper,” he said. “There’s a big effect within one kilometer of sites, which the oil and gas industry dislikes, but the impact on the population beyond that may not be massive, which opponents of fracking won’t like.”

Reid Porter, a spokesman for the American Petroleum Institute, an advocacy group for the oil and gas industry, condemned the study, saying that while it addresses a legitimate health issue in the United States, it “fails to consider important factors like family history, parental health, lifestyle habits” and other factors that lead to low birth weight.

In his emailed statement, Porter did not address why those factors might have led to underweight babies near the sites but not farther from them.

Food and Water Watch, a nonprofit environmental group, referred to the study in calling on Pennsylvania Gov. Tom Wolf (D), who wants to expand hydraulic fracturing in the state, to reverse course.

“This study adds to existing scientific literature that tells us the serious health consequences linked to fracking,” the group’s executive director, Wenonah Hauter, said in a statement. “Unfortunately, Gov. Wolf [is] encouraging news drilling and expanding fossil fuel operations. We call on him to heed the science.”

When Greenstone and his co-authors — Janet Currie, a Princeton University economics professor, and Katherine Meckel, an assistant professor of economics at the University of California at Los Angeles — embarked on the research, he said, the aim wasn’t to condemn fracking, which is a relatively new method of drilling vertically underground, then switching to a horizontal direction to reach gas trapped in shale rock formations.

The practice has come under scrutiny because of the potentially toxic chemicals used to crack the shale and the amount of water used to force out natural gas. State health officials and residents near fracking operations have complained that wastewater from fracking taints local drinking water. Companies in some cases have been forced to provide bottled drinking water for residents who relied on underground wells. A number of states, such as Maryland and New Jersey, have banned fracking.

A U.S. Geological Survey study in 2014 said pumping wastewater into deeply buried storage wells was probably why Oklahoma was experiencing more small earthquakes than California. The sites are also known to leak methane, a gas that’s up to 100 times more harmful than carbon dioxide in causing global warming in the atmosphere.

But those drawbacks are offset by the benefits of natural gas, Greenstone said. Hydraulic fracturing for oil and natural gas “has led to a sharp increase in U.S. energy production and generated enormous benefits, including abruptly lower energy prices, stronger energy security and even lower air pollution and carbon dioxide emissions by displacing coal in electricity generation.”

The authors hope that policymakers will use the study’s finding as a talking point in a robust debate over fracking. They chose to study Pennsylvania because they got access to birth record data that identified “the exact locations of the mothers and the wells,” Greenstone said. “This was like a great success of big data.”

Most drilling operations sit in remote areas where they have little chance of harming pregnant women.

But some sites in Pennsylvania are near Pittsburgh, and others in Texas are inside heavily populated Fort Worth.

“Different communities are going to feel differently about this,” Greenstone said. “If you’re in Fort Worth, where fracturing is occurring in a dense area, you’re probably going to feel differently about it than if you’re in rural North Dakota.”

 

The GOP is getting closer to passing its tax bill. Here’s what it could mean for health insurers

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https://www.fiercehealthcare.com/payer/gop-tax-reform-bill-health-insurers-individual-mandate?mkt_tok=eyJpIjoiTTJFMk1XWm1aalV4WVRsayIsInQiOiJ2STJJYW85ZmhWc0tKakYzU2VlV05Ydk5NbVNpd1orNWt0anFYUW9GcDZkTDBMSmJlTGs0XC9tNDBIT3RmMDhzdmtFazBaTWpDYm9hMVplUjhSTElrSVgreHBJd3FLXC9YaHhzMXpPR2Y4MHVNRVJqcDVvMDVzOGdGQUNIMCtobDZtIn0%3D&mrkid=959610

man counting money

The House and Senate have agreed upon a unified tax overhaul bill, putting Republicans on the fast track to pass legislation that has significant implications for the health insurance industry.

For one, the compromise tax bill will repeal the Affordable Care Act’s individual mandate penalty, Senate Majority Leader Mitch McConnell said in a statement on Wednesday. To McConnell, axing the mandate will offer “relief to low- and middle-income Americans who have struggled under an unpopular and unworkable law.”

Health insurers and the healthcare industry at large have opposed removing the key ACA provision without a viable alternative to encourage healthy consumers to buy coverage, arguing that doing so will destabilize the individual markets. Indeed, the Congressional Budget Office has estimated that repealing the mandate would increase the number of uninsured people by 13 million over the next 10 years and hike individual market premiums by 10% during most years of that decade.

Yet while the individual mandate repeal is problematic for insurers that do business on the ACA exchanges, nearly all insurance companies stand to gain from the GOP tax bill overall, according to Leerink Partners analyst Ana Gupte, Ph.D. She estimates that insurers can capture about 10% to 15% of the potential 25% upside from the legislation, subject to regulatory constraints such as medical loss ratio rules and competitive pricing constraints.

Likely the biggest gain for insurers is the fact that, per the New York Times, the compromise bill sets the corporate tax rate at 21%—significantly lower than the current rate of 35%.

Though the House and Senate have ironed out the differences in their bills, the final version still must be approved by both chambers. GOP leaders have but two votes to spare in the Senate, and will likely have to include two bipartisan measures to shore up the ACA in Congress’ year-end spending bill to win the support of Sen. Susan Collins, R-Maine.

Collins said on Wednesday that Vice President Mike Pence assured her that those measures would make it into the spending bill, according to The Hill. Yet some House conservatives have expressed opposition to the bills, which would provide funding for cost-sharing reduction payments and state-based reinsurance programs, among other provisions.

Meanwhile, the results of the headline-grabbing Senate race in Alabama have put a major crimp in Republicans’ plans to retry repealing the ACA. Once Democrat Doug Jones officially takes his seat, the GOP will have an even slimmer majority in the Senate, where the defection of a handful of moderate Republicans was already enough to kill several repeal bills earlier this year.