Telemedicine. It’s the future and it’s arrived no matter what the Medical Board rules or the courts do in any particular case.

Having fallen for the fallacy that there’s profit in market share, hospitals have gorged on acquisitions and on employment and alignment of physicians.

They may look like boilerplate, but your feet might be in the boiler’s fire if you haven't properly thought through the impact and interplay of the indemnification and insurance provisions in your contracts with hospitals and with providers.

In an increasingly competitive, increasingly hospital-centric world, the saying "money likes speed" is truer than ever. Yet many medical groups have doomed themselves to stasis, or worse, as a result of their defective governance structure.

Your practice is arriving at what I call the Great Junction, the fork in the road, one route leading to further commoditization of radiology services with fungible providers, and the other route leading to high quality, high touch medical care: to a unique experience delivered by a Strategic Group. How will you navigate this perilous reality?

More and more hospitals are disrupting their relationships with physicians. As to hospital-based groups, they seek to cut stipends and get more for nothing. The favored tool? The request for proposal, commonly known as an "RFP." How can an RFP be avoided? Do you respond? How do you respond? How can the rules be bent?

With increasing financial pressure from flat or decreasing reimbursement and rising costs, surgeons and other referring physicians are beginning to look for ways to generate additional income. A prime example: the use of so-called "company model" entities to capture the profits of anesthesia providers at ASCs. But that is just the beginning.

Success. Even more success. It’s what you want. Welcome to the club, which appears to be getting more exclusive every day, not due to evolution but to self-selection. Of course, sometimes we get stuck, or at least delayed by problems that pop up, blocking the way. But for many, the problem is that they don’t know what the problem is.

Some days, it seems as if everyone, from anesthesia groups to vascular surgery practices, is talking about selling their practice to a larger group, private equity investors, or to a hospital.

Believing that the future of the business of healthcare will be a projection of, or incremental improvement over, today's reality is a fool's game. There are only two sides to the healthcare coin: figure out a way to disrupt the current practice model or figure out how to deal with someone else's disruption.

Just as the tides come in and out and as ties get wider, narrower, then wider again, society cycles round and round from an emphasis on, and worship of, rugged individualism, to an emphasis on, and lauding of, community and cooperation.

Long ago, physicians ceded control of the healthcare market only to have a healthcare “system” rise, a system controlled by bean counters and policy wonks. Obamacare. Accountable Care Organizations. ASC owners seeking to capture anesthesia billings.

If surgeons can use so-called “company model” entities to capture the profits of anesthesia providers at their ASCs, they’ll soon be demanding their “cut” of anesthesia at the hospital.