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'May you live in interesting times'
By Stephen W. Earnhart, MS,
CEO, Earnhart & Associates, Austin, TX
The euphemistic statement "may you live in interesting times" is believed to be an ancient Chinese curse. There is another one that I also think is interesting: "May you come to the attention of those in authority." To me, that statement is probably just as scary as the "interesting times!" Sounds like an IRS audit doesn't it?
Speaking of mixed meanings.... everyone who reads this will be affected by the new health care reform bill signed in March. I suppose, like most, you just don't know how. But it will be interesting.
As best I can tell, no one actually has read it or fully understands all the implications, individually and career-wise. In the meantime, life goes on. For at the least the next several years, nothing is going to change for any of us. But that doesn't mean that we can put our heads in the sand. Read on!
When the government gets as intrusive in anything as it is going to get with health care, one can always expect more paperwork. While there might not be immediate changes, extra reports and data collection are always a threat. Start gearing up for that eventuality
Much of the employer/employee insurance requirements focus on the "more than 50 employees" rule, which simply put, says starting in 2014, our new boss will fine the employer for not providing health care insurance for employees if you have 50 or more employees. This means that if you are the 51st employee added to your new job, well... you might want to be careful. I predict that many small businesses will make sure they reduce to that threshold.
Clearly reimbursement is not going to increase. Paperwork and significantly higher health insurance is going to force most businesses -- us included -- to be more efficient in what we do. Strongly consider finding out just how efficient you are now, and look at ways to tighten up. (Editor's note: For a special package of cost-cutting ideas, see the January 2010 issue of Same-Day Surgery.) Reconsider keeping those employees whom you cannot figure out where they are and what they do. Be realistic; you all have them!
For hospitals, be prepared to address your surgeon issues about decreasing reimbursement for their professional fees. Since it became obvious that the health care reform bill was going to pass in mid-March, our phones have been ringing off the hook with surgeons thinking they need to become investors in existing surgery centers or develop their own. As a hospital outpatient department, you do not have the luxury of financial incentives to counter the ASC industry, so you need to really tout your efficiencies and other services. This would not be a good time to have idle employees and long turnover times between cases!
If you are an existing surgery center with surgeon investors, you really need to tighten your belts and weigh your options. Ninety-five percent of the calls we have received in the past month are from surgeons who cannot buy into an existing surgery center because there are no more shares available. This situation is forcing most of them to start a new one. A strong strategy will be to free up as much ownership opportunity as possible to new surgeons or to those who have been hounding you for more equity. Construction costs, surprisingly, are low right now due to the struggling economy, so this is a good time for many of your potential investors to develop their own center. Don't let them!
So ... an interesting time is upon all of us. Never one for the status quo, I will admit to rubbing my hands together with glee at the opportunity to make a difference in this exciting new era of health care. What was it that Forrest Gump said? "Life is like a box of chocolates...?" Open the box and enjoy the ride! [Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Contact Earnhart at 13492 Research Blvd., Suite 120-258, Austin, TX 78750-2254. E-mail: firstname.lastname@example.org. Web: www.earnhart.com. Tweet address: Earnhart_EAI.]