Robert, Russ — Great to be on your show talking about St. Kitts and the opportunity to create a medical school and healthcare delivery system in the Caribbean. I look forward to being with you next month in Belize to check out the healthcare system there and to meeting you and your clients on St. Kitts in April 2011. The Real Estate Guys are sponsoring a cruise focused on real estate investing in April. Their last stop is in St. Kitts and we will meet the ship and personally escort his clients to see this great island nation. Check out The Real Estate Guys at www.realestateguysradio.com. My interview was broadcast on July 25th — click here to listen to the show. Thanks guys — we have a conference call in 30 minutes — look forward to speaking again. Jeff Check out the St. Kitts Project tab at the top of this page !!!!! You a doctor? At the bottom of the St. Kitts Project tab page is a link just for you, or you can Click Here. Be part of what could become the most amazing adventure in the Caribbean.
Home Healthcare — CMS Target #1
I’ve begged my friends who own home healthcare assets to get out. Sell. And all but one (way to go George) told me that they had too much upside in the business to consider selling now. Lesson #1 when running a healthcare company. Sell before major regulatory change. Sell when margins are too high to be sustainable — no one is good enough to make up for it in volume without MANY years of additional work. Sell when someone wants to buy your business — for when the day comes that CMS targets the industry, then NO ONE will be a buyer. Amedisys is the poster child for the most recent CMS and Congressional action. They have been accused of creating care plans with one eye on the reimbursement rules. Get to a certain threshold of visits, and reimbursement rises substantially. One visit less than the threshold and no bonus. Guess what? CMS thinks the industry is making sure the patient gets the one last, and arguably unnecessary, visit so the home health agency gets the higher payment. OF COURSE THEY DO. Wouldn’t you? One more treatment will help, not hurt the patient. Yet when the payment system is set …
Thank You Freedom Fest 2010
Last night was the conclusion of Freedom Fest 2010 at the Bally’s Casino in Las Vegas. The quality of this program was astounding and I congratulate all who were involved. You haven’t lived until you see Steve Forbes dressed up as George Washington in one of the skits at the closing banquet. We live in unique and dangerous times. As I’ve written to my clients on all too many occasions, the investment decisions that we make in the next couple of years will be the most decisions that we will ever make in our lifetimes. Get it wrong and we may be financially ruined, regardless of how many financial resources we have today. Get it right and even modest investors can make millions, securing the financial future for their families today and for generations to come. If you have never heard of Freedom Fest, click on this link and see what you missed. Something like 160 presenters over three days. I’ve been to lots of conferences and heard lots of speakers. The quality of the speakers at this conference was impressive. And the conclusion is unmistakable: the United States and most of the major countries around the world are on …
CMS goes after Oxygen
After quite a long time of silence, CMS weighed in with a massive 30% cut in oxygen reimbursement in 9 competitive bid markets. CMS has been trying for a couple of years to have providers compete for business based on price. After a court setback, CMS is back. The plan expands to cover 91 more MSAs in 2013 and the rest of the country in 2016. The cut was far worse than expected and again shows that oxygen services are over priced. The largest public company in oxygen, Lincare has argued, and probably correctly, that a big cut like this will allow it to gain significant market share. No argument there. Yet earnings are going to be under pressure and after a double in the stock it is quite vulnerable. Time to be very cautious in the markets. The world’s debt problems are being recognized and the result will be a no growth world economy. The expectations of a 3%+ recovery will be an illusion. World governments are cutting spending and China has a real problem in a real estate bubble that dwarfs the U.S. bubble. Time will tell, but it could get really nasty and July is historically a …
Healthcare Reform Signed – Watch Out Below
The deed is done. Obama’s version of healthcare reform is law and the details continue to trickle out. My favorite so far is that consumers will be fined $695 to not get insurance — the IRS will keep tabs, but the IRS hasn’t been given any money to enforce the bill (estimated at >$10b annually) — and the IRS has been given no enforcement ability. People who don’t get insurance will be billed $695, but if they don’t pay, then the IRS can’t take the offender to court, doesn’t charge interest or penalties — in essence, the IRS has no power to collect. While stupidity like this kept the cost of the bill down for the CBO, ultimately money will need to be added and the deficit will grow larger. With the deficit in mind, last week’s US government bond offering went poorly and interest rates ticked up 10-20 basis points. Increases in interest rates has begun and the market, not the Fed, will push rates higher and ultimately the Fed will be pulled along. If someone needs to pay $150/month for insurance, it seems to me that paying $695 in a fine (assuming the fine actually needs to be …