HealthCare Voice

Feds Probe Alleged Fraud at UT Southwestern, Parkland

Whether any real fraud was committed remains to be seen.  I certainly do not want to engage in the blog equivalent of piling on.  Nor do I want to suggest that UT or Parkland leaders knowingly ignored warnings from their internal auditors as part of a plan to maintain "revenue as usual."

Based on extensive conversations with hospital CEOs, medical educators and consultants around the country, it is clear that CMS and the Justice Department, after years of  lackadaisical enforcement, are now pursuing Medicare/Medicaid fraud cases with a vengeance.  We should not be surprised.  Medicare faces a shortfall of epic proportions.  Something must be done to narrow this deficit.  Aggressively pursuing fraud investigations, imposing significant fines, and in some more egregious cases, prosecuting and imposing actual jail time, is one way the federal government can shout out:  'Hey, pay attention.  We are serious this time.'

For years fiscal conservatives have complained -- rightly so --  that the federal government was not doing enough to protect taxpayer interests from fraudulent billing such as invoicing the government for duplicative, unnecessary, or phantom tests.  Now the government's philosophy regarding how the rules will be enforced seems to have changed amid the Great Recession and the political fear on Capitol Hill that has been created by the massive deficit crisis. 

Hopefully, this particular case as outlined in the following Dallas Morning News article, will end with limited consequences for the parties.  They are both important healthcare providers whose reputations for outstanding clinical care, medical education, and cutting edge research are above question.  But healthcare providers, including the leading organizations, can no longer claim confusion or ignorance of often complex or conflicting payment regulations.  That defense will simply will not be good enough this time around, the government lawyers seem to be saying. 

In those cases where the government can show a conspiracy to knowingly break the law or just ignore the rules, the consequences could be startling for some.  In New Jersey, physicians are beginning significant jail time as the result of guilty pleas and convictions in connection with hospital payments for physician medical director services.

Healthcare leaders and physicians who ignore this change in enforcement policy will do so at their own peril. 

I worry that this is a huge problem and that UT and Parkland are only the tip of the iceberg.  

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Feds probe alleged fraud at UT Southwestern, Parkland | News for Dallas, Texas | Dallas Morning News | Latest News 

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Lying When The Truth Would Have Worked

In her Sunday column "Lies As Wishes," New York Times columnist Maureen Dowd details the misadventures of executives and politicians, in this case primarily the latter, who enhance their accomplishments to strengthen their position with the voters.   Ms. Dowd,  paraphrasing T. S. Elliott when he wrote that memory mixes with desire, concluded,  "Politicians get into trouble when desire nixes memory."

Truth is that while politicians are the most visible offenders of this maxim, executives and managers seeking a new job are hardly immune.   Resume enhancement --exaggeration of accomplishments or credentials -- remains a growing problem in our hyper-competitive job market.  Regrettably, I believe, it will only get worse.

"These cases are never merely about words," Ms. Dowd wrote.  "They are more profoundly about identity."  She finds support for her thesis in the words of Bella DePaulo, psychology professor at the University of California, Santa Barbara:

"I think lies are like wishes," Dr. DePaulo said.  "So when you wish you were a certain kind of person that you know you are not and maybe you are not willing to do what it would take to become that kind of person, or can't go back, it becomes tempting to lie."

The tragic lesson is that far too many leaders -- in government and in business -- will lie, spin, shade the truth or whatever term you would like to employ, when the mere truth would have carried the day. 

Some people, my grandmother liked to say, will climb up a tree, hang by their heels and lie when it would have been easier -- and a lot less risky -- to stand toe-to-toe, face-to-face, and tell the truth.  

At a time when voters and employees thirst for truth -- even when it makes them uncomfortable -- we are developing a national culture based on spin and the enhancement of facts or circumstances.

I once interviewed a candidate who, up front, admitted to spending 90 days at the Betty Ford Center.  His treatment was prompted by an over abundance of caution -- to understand and control what he thought might be an emerging reliance on alcohol.   He loved his family and his profession and did not want to risk either.  After a detailed vetting process, including interviews with his counselor and an intensive review of public records, he got the job and went on to perform brilliantly in a large public hospital.

His admission of a personal  flaw made him authentic.    It was easier for him to stand face-to-face and tell the truth.  

He didn't need to embellish.  That is a practical lesson for job seekers and politicians.

Now a more interesting question:  how do you know which candidates you are recruiting are telling the truth and which ones are enhancing their hiring chances? 

Is your screening process sufficiently robust to distinguish between the two?

© John G. Self, 2010

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Mr. Self is the founder of JohnGSelf Associates, Inc., an executive search and advisory services firm in Dallas.  He has extensive experience in recruiting in Asia, Africa, the Middle East, and North America. 

 A highly rated speaker, Mr. Self has more than 30 years of healthcare experience, 16 years in executive search, and his record of talent selection is one of the best in the industry.

He is the 2010 Regent Award winner as the senior healthcare leader of the year in North Texas, an honor bestowed by the American College of Healthcare Executives.

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TRANSFORMATIONAL RECRUITING: Better Results, Lower Costs

The failings of the current transactional recruiting model used by the vast majority of internal and external recruiters are well documented.  The most recent studies show that, on average, executives and managers recruited from outside an organization are pushed out, fail, or quit within 18 months.  Given the high cost of mis-hires and turnover, this is a rate of success that corporations, particularly health systems, hospitals and other medical providers simply cannot afford.

If “people are our most important asset,” as so many healthcare annual reports proclaim, then why would a company, especially a healthcare organization, want to use a recruiting business model and process that has remained essentially unchanged for more than 50 years and produces such haphazard results?

Transformational recruiting will produce better results and value.  For clients this translates into significantly lower talent acquisition and retention costs over the long term.

What is Transformational Recruiting? 

 It is an approach that is, first and foremost, based on the principles of a Total Onboarding Program (TOP) as outlined by industry thought leader George Bradt and his talented colleagues at 
 PrimeGenesis ,  Stamford, CT. 

 The following statements characterize important elements of the transformational recruiting model that I have developed over 16 years in the search industry with wonderful insights from the aforementioned Mr. Bradt.

1.  Onboarding begins before the start of the search process.  This is when you define the job – the scope of responsibility, reporting relationships, and performance deliverables.  You identify the appropriate academic and professional credentials and the competencies necessary to achieve success.  Obtaining buy-in from the position stakeholders before the recruitment process begins is essential.
2. Transparency is critical.  Organizations must learn to be honest with themselves about themselves.  Being honest on the front end is the least embarrassing and least expensive time to make relevant disclosures to candidates.  Under the transactional model, failure to be transparent is one of the most common candidate complaints.
3. Challenge the conventional wisdom. Transformational recruiters are not “yes” consultants.  They have the experience and the courage to challenge their bosses or their clients.
4. Document the issues.  In transformational recruiting, the position description is more like a position prospectus, a detailed offering statement that covers all the essential transparency issues.  Transparency and full disclosure are absolutely necessary in a best-in-class onboarding program.  If the candidate has to wait until a site visit to find this level of detail, the search process is defective and the chances of success are greatly jeopardized.  In transactional recruiting, the average position description from external firms is eight to 12 pages.  Internal recruiters usually provide less, if anything at all.  
5. Accountability is required.  Recruiters, whether internal or from an outside firm, must be held accountable for their performance – meeting deadlines, producing a panel of acceptable recommended candidates, etc.  In transformational recruiting this is done with performance penalties and extended placement guarantees.  Documentation (#4 above) is part of the accountability process.
6. Sharing the risk is mandatory.  Consultants frequently use the terms “partnership” or “a partnering approach” to emphasize value.  However, there can be no partnership without shared risks – shared financial risks.  Transformational recruiters use best-in-class detailed candidate screening programs like Topgrading.^©  
    
7. Value innovation is a core pillar. In transformational recruiting, expense management is essential.  Transformational recruiters will manage costs to a project cap.  However, transformational recruiting never shortchanges quality for convenience, the cost of a mis-hire can be too staggeringly expensive.  If you are using a comprehensive screening/interviewing system like the highly regarded, but time consuming Topgrading^©methodology, then offering an extended placement guarantee is more about enhancing value for your client.  Transactional recruiting is more about process and saving time than drilling down to a level of certainty.  Providing clients a video summary of the final face-to-face interviews with the recruiter will ensure that they are selecting the best two or three candidates for site interviews.
8. Detailed background checks are now part of the standard operating procedure. For the C-suite, senior level executives, vice presidents, etc., transformational recruiters are reviewing public records, including criminal, civil and municipal court documents in every jurisdiction where the candidate lived or worked.  Investigators check CMS OIG records, and credit reviews are necessary to verify patterns of behavior.  For former military officers, the DD 214 is an important part of this process.  While fewer candidates are fabricating credentials, resume enhancement regarding accomplishments is still a significant issue. Transformational recruiters vet these accomplishments through follow up interviews with references or by using investigators to test the record in face-to-face interviews with former supervisors.
9. Commit to regular communications with the clients and the candidates.  While most recruiters stay close to their clients, another common candidate complaint regarding transactional recruiting is  poor to beyond horrible communications from recruiters.  Transformational recruiters respect candidates, even those who are clearly unqualified.  Ongoing and consistent communication with candidates is a sign of respect.  The search process never moves as fast as the candidates would like, but there is no excuse for poor communication, even if it is an email message.

There are many excellent recruiters in the search industry. The vast majority are transactional.   Our new economy, healthcare reform and ongoing reductions in reimbursement will produce new economic realities and performance expectations.    The time to overhaul our business and recruiting process model is long overdue. 

 My approach to transformational recruiting model has produced results that are 5 times better than the national average. 

So what will be the argument for maintaining  the status quo?

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Mr. Self is the founder of JohnGSelf Associates, Inc., an executive search and advisory services firm in Dallas.  He has extensive experience in recruiting in Asia, Africa, the Middle East, and North America. 

A highly rated speaker, Mr. Self has more than 30 years of healthcare experience, 16 years in executive search, and his record of talent selection is one of the best in the industry.

He is the 2010 Regent Award winner as the senior healthcare leader of the year in North Texas, an honor bestowed by the American College of Healthcare Executives.

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Making Hard Decisions

"I can make the hard decisions."  

So many candidates make that claim in this hyper-competitive job market.  Yet once employed and comfortable in the corner office, far too many of  these  leaders base their decisions on the defensive posture that is more about how to keep the job versus how to be successful in doing the job.

Later today I will post an article on a new approach to talent acquisition called  transformational recruiting, detailing how this approach will produce better results and value for clients by reducing long-term recruiting and retention costs. 

How does recruiting concept fit with Onboarding?

Transformational recruiting, unlike the hit-and-miss results that we see in transactional recruiting,  
 is based on the principles of Total Onboarding that George Bradt and his colleague Mary Vonnegut set out in their wonderful book Onboarding.

Making the hard decisions -- and then executing well -- is so important in defining what makes a leader successful.  In order to do these things, you must have the best people and invest in making them better.  A recruiting program that is not based on Onboarding is transactional and outdated in this new normal economy.

Read More on George's blog.

Onboarding Decisions.

Onboarding Decisions

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It Is Time To Dump The Transactional Recruiting Model

 We face three challenges in the healthcare talent management equation: 

1. A series of changes related to healthcare reform 
2. Waves of new balanced budget act-styled cuts in reimbursement that will test the ability of hospitals and physician practices to survive
3. An outdated recruiting process model that is not up to the task to find the quality of leaders necessary to successfully confront these changes

If we only had to deal with the recently passed healthcare (payment) reform legislation, that would be like a walk in the park.  We are, after all, an industry whose leadership is among the most adept adapters in any business sector.  But there will be more.  With skyrocketing budget deficits fueled in large part by high healthcare costs that stretch the Medicare program, it would be unrealistic for hospital CEOs and physicians not to expect a series of balanced budget act cuts that will squeeze out additional savings. 

 Medicare is not sustainable in its current form.  Everyone in Congress knows it, but that was conveniently not part of the healthcare reform debate.  Things are getting so bad that the US government will not have the money to pay the bills in about 10 years, according to David Walker, President of the Peter G. Peterson Foundation and former Comptroller General of the United States, unless it makes dramatic changes in the portfolio of benefits and the amount of money it pays to healthcare providers.  Absent that, the treasury department must borrow 100 percent of every dollar that is paid to hospitals and physicians, piling on the already  out-of-control national debt.  Ironically, some industry analysts believe these types of reimbursement cuts will probably lead to more structural reform than anything Congress might have the courage to attempt.  If you cut enough money out of the system, these analysts posit, hospitals and physicians will be forced to make dramatic and cost-saving changes in delivery systems in order to survive.

Only the best leaders and managers will be able to clearly anticipate the dramatic changes before they arrive at the front door of our U.S. hospitals and physician practices.  Only the best will be able to create new strategies and new solutions on the fly.  So, there is an important connection between the financial mayhem that is certain to occur over the next seven to 10 years and the strategies we use to recruit and retain the best people

 Unfortunately, the current recruiting business model used by the majority of search firms, outsourcing companies, placement agencies, and internal recruiting departments is on its last legs and cannot deliver the desired results. 

 Transactional recruiting that is in use today by the majority of search firms and internal recruiters has been around for more than 50 years.  There have been some marginal improvements in terms of technology – the introduction of web-based psychological or behavioral profiling, facsimile transmissions, computerized searchable databases, email, videoconferencing, and Skype, for example, but the basic candidate recruiting process and business model remain the same.  Recruiting is one of only two or three industries that have not experienced a business transformation.  And if clients and their  recruiters need any proof that change is needed, look at the various studies that show that the "stick rate" -- the average tenure of someone recruited from outside an organization -- is  unacceptable:  40 percent of senior level candidates leave, are pushed out, or are fired within 18 months, according to a Heidrick & Struggles internal review of 20,000 of their searches (Financial Times, March, 2009). This is not an anomaly at Heidrick.   Other surveys show similar results at all levels, in all industries.

 The time has come for the recruiting industry to seriously look at its weaknesses.  Transactional recruiting models must be replaced with more accountable, outcome-oriented processes with consequences for those who provide the service. 

 The following statements characterize the transactional model:

• Order taking orientation
• Lack of understanding of the costs of failure
• Divided responsibility (identification and selection)
• Lack of transparency
• Poor communication with candidates
• Don’t rock the boat mentality
• Marginal accountability
• No financial fear of failure
• In summary:  NO PARTNERSHIP

 There can be no partnership without shared risks, which includes financial responsibility.  This is one key element that distinguishes transactional from transformational recruiting.   While transactional recruiting is not an ideal process for the challenges we face, there will be no rush to change.  Why change?  There is currently no economic incentive to do so. 

But the storm clouds of change are forming.

On Wednesday I will introduce you to a new approach, transformational recruiting, that will produce superior results in these challenging times.

Next:  Transformational Recruiting

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Creating Time While Onboarding

Onboarding is an important tool that will help organizations improve their recruiting, reduce the opportunity for talent failure -- a significant problem for many organizations -- and to accelerate and enhance performance of new hires, or newly promoted employees.

As health care enters another period of change, the human capital component of health systems, hospitals and other providers will become very important.  Organizations who recruit and retain the best people will thrive.  Those that do not place human capital as a front-and-center priority probably will not.

Because of the importance of Onboarding, I have been "re-blogging" some of George Bradt's thoughts on the subject.  For regular HealthCare Voice readers you know that he is the father of the term "Onboarding" and his firm, PrimeGenesis, is a leader in assisting executives prepare for new positions.  

George's contributions to this subject are immense and I value his thought leadership.  

Onboarding will be an important part of my presentation to West Virginia Hospital CEOs who are meeting next week in Glade Springs, West VA because it is a key differentiator between transactional recruiting -- the most common and ineffective type of recruiting in use today -- and transformational recruiting which is based on Onboarding principles.  Transformational recruiting is the future for talent acquisition.

Read More

Creating Time While Onboarding.

Mr. Self is the founder of JohnGSelf Associates, Inc., an executive search and advisory services firm in Dallas.  He has extensive experience in recruiting in Asia, Africa, the Middle East, and North America.  A highly rated speaker, Mr. Self has more than 30 years of healthcare experience, 16 years in executive search, and his record of talent selection is one of the best in the industry. 

He is the 2010 Regent Award winner as the senior healthcare leader of the year in North Texas, an honor bestowed by the American College of Healthcare Executives.

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