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Curbside Consult with Dr. Jayne 6/25/18

June 25, 2018 Dr. Jayne 6 Comments

I’m gritting my teeth after the recent CareSync debacle, especially as it comes hot on the heels of so many other closings, layoffs, restructuring, and “right sizing” maneuvers across the industry. I realize that CareSync, like so many other companies that find themselves at the end of the line, was a start-up, but that doesn’t make its closure any more palatable for its customers or its employees. One of my clients had done business with them, and although the integration with the product moved at a snail’s pace, they seemed to be on the up-and-up and eventually did deliver what was promised.

When billing for Medicare Chronic Care Management services, there are specific rules that must be followed in order for the billings to be valid. For primary care practices caught in the “chicken or egg” phenomenon, where you have to collect more money to hire care coordinators to perform care management to make more money, a vendor like CareSync seemed like it was sent from above. They were willing to take on the care management functions for a share of the Medicare reimbursement, allowing the practice to provide the services without having to increase head count.

I know there were some bumps at the beginning, where patients in the practice were less-than-willing to talk to perceived “outsiders” who had access to their medical information. However, I had heard that after a while, CareSync had begun to virtually embed care coordinators within particular practices, so that patients became familiar with the personnel and it seemed less like an outsource function. I only had a couple of connections with them through my clients, and don’t know a lot of the details, but I can imagine the practices are wringing their hands about what to do next and how to get their data, even though CareSync is assuring everyone that the data will remain accessible. It’s not clear for how long it will remain that way, and the one practice I reached out to hasn’t heard anything from the company (not surprising, given the way it shuttered itself).

It’s surprising that the sale that was supposed to save it unraveled so quickly, with the potential buyer visiting with employees on Monday and the company closing down on Thursday. When things fall through in deals like this, you usually see the wheels come off during the due diligence phase or during the negotiations, not while the bride and groom are at the altar but just haven’t signed the wedding license yet. There have been comments about the company “running out of time,” but what exactly that means just isn’t clear.

In any of these layoff or closure situations, my first thought is with the people who were just let go. This case is particularly bad because the company has simply closed, with no severance packages offered, no provisions for insurance coverage under COBRA, and possibly not even a last paycheck or settling of other benefits such as flexible spending accounts. For people higher in the company who fully understood what it means to be part of a start-up, they are likely prepared for such a scenario. For lower-wage workers on the front lines, especially for those living paycheck to paycheck in a relatively tough economy, it’s devastating. According to surveys, as many as three quarters of full-time workers fall into that category. A full 40 percent of us can’t cover a $400 emergency expense, and it’s especially challenging for workers who are paying off student loans or have other challenging circumstances.

I have several good friends who have entered the ranks of the jobless this year, from three different companies and from different segments of healthcare IT. Most are in their mid-to-late 40s, but one is in his late 50s and has some family issues that make working a traditional nine-to-five job challenging. The odds of him finding a new full-time position with an employer willing to allow him to work flex time right out of the gate are very slim, especially in his part of the country. It’s hard to know what to say to a friend who has just lost his job, especially when you work together and you know it might be you the next time. There is a certain level of survivor’s guilt while you’re still trying to understand what you can do to be helpful. My friend said the hardest thing for him was having people tell him things like, “Now you can spend more time with your family member who needs you,” when they don’t understand that without income, a very delicate stack of spinning plates is going to crash down on them. Sometimes it’s better to just say, “I’m sorry, how can I help?”

I have another friend who now refers to herself as a “layoff magnet” since she has been “made available to the workforce” three times in the last five years. It’s not like she’s picking sketchy employers, but has been with several big players in the EHR space, only to have her project canceled, her division sold off, or her entire team downsized. She’s not even sure she wants to continue in the healthcare space, which really is a loss to the industry, but I don’t blame her. Other friends have gone to the automotive industry or financial sectors, with at least theoretically more stability. Another one got his real estate license, and although isn’t making as much money as he did in healthcare, feels like he has better quality of life. One is teaching middle school. I think he’s the gutsiest of them all.

For those of us who are fortunate enough to remain employed, it’s a good time to re-evaluate priorities and spend a few minutes thinking of how you would fare if they showed up at your desk with the proverbial cardboard box. Do you have an emergency fund? Do you have life insurance or disability coverage separate from what your employer offers? What would it take to get health insurance on your spouse’s plan or in the marketplace? Is your resume up to date? I hate to be doom and gloom, but given recent movement in the industry, it’s worth your while to get a plan in order, even if you never need it.

Have you been impacted by a layoff, reorganization, restructuring, or other synonyms? Leave a comment or email me.

Email Dr. Jayne.

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Currently there are "6 comments" on this Article:

  1. Dr. Jayne,

    As unfortunate as this is, I think what goes unmentioned is the inherent risk that comes with working at a startup. Having worked for three, I can tell you that nothing, and I mean NOTHING that happens regarding financing, strategic partnerships, or anything related to funding is guaranteed when you are working for a startup. Is it ok to be optimistic? Absolutely. Is it ok to get excited about your prospects when, you hope, the company is bought out or sold in the future and you have the options to cash in your chips? 100%.

    My point is that it’s easy to become complacent, and as the CareSync case points out, the proverbial rug can be yanked at any time no matter how rosy things may seem. The point is, have a plan B ready at a moment’s notice if you work for a startup and be prepared to deploy it in cases like this.

    It’s a shock but truthfully, anyone who has worked for multiple startups knows that things can take a positive or negative turn at a moment’s notice.

    • Agree. My spouse has worked at several start ups (non-HIT) – it’s amazing how quickly you turn from invaluable employee with critical deadlines to “sorry, you have an hour to clean out desk”. And how easy it is to put your head down to do all the work demanded of you – and then forget to poke your head up often to get the lay of the land. I would always ask “do you see lots of suits crawling around the office?”. And before every hatchet…yup…sudden infux of suits in C-level area. It became the most obvious writing on the wall, and luckily it’s always been a quick rebound into something new and positive. Good reason to never burn a bridge in your industry…it’s quite a small world after all.

  2. It is disheartening to see the impact on Caresync employees due to the company’s rapid decline, but it is refreshingly encouraging to see how the Tampa business community has come together to provide a lifeline to those employees in its wake. Dozens of Health IT (and other) companies, including ours, have arranged job fairs and reached out through social media and other avenues to let the Caresync employees know that they are not abandoned, but in fact treasured resources very much in demand. This response happened quickly and with overwhelming force, causing at least one ex-Caresync employee to post: “Wow! What a difference 24 hours makes.” I’m sure there are many other communities around the country that would react similarly, but this time was Tampa’s opportunity to step up, and the community did not disappoint. Unanticipated significant life changes are always difficult, but it warms my heart knowing that many, if not all, of the Caresync employees will quickly find a new place to call home. We are looking forward to welcoming many of them into ours with open arms.

  3. a “layoff magnet” since she has been “made available to the workforce” three times in the last five years.”

    …only to have her project canceled, her division sold off, or her entire team downsized.”

    What?!!! You mean that people aren’t always laid off because they are ‘sub-par performers?

    Sometimes following the HISTalk talk is like following Ricochet Rabbit: Bing. Bing. Bing! All over the place.

    • “All over the place” is correct as long as it means (a) me describing my personal health system experience with layoffs in an IT leadership role, while also offering Dr. Jayne the chance to (b) tell a personal story from a vendor -employed friend. Those are two vastly different environments when it comes to layoffs, project termination, and closures.

  4. Having found myself in a situation post-sale of my company where I was “no longer a fit” earlier this year was challenging at best. Even in non-start up environments it’s good to have a back up plan and a network to draw from. Truth be told, the only reason I was hanging on in my former role was my team – high performing, smart and a pleasure to work with. The leadership, the tech stack, process and role confusion … not so much. I ended up landing a role with a former employer where I’m being encouraged to be strategic, be a leader and influence change. I feel valued for the first time in a long time. I love the post by David, that a community can come together to embrace those in unfortunate circumstances. While not a literal community, I had a village of contacts – both those who know me personally and those who know me afar – who came together, kept me positive and literally helped wherever they could. It truly makes the concept of paying it forward a valuable one. I wish all of the CareSync employees the best of luck, and though they may not know it yet, they are likely going to find something bigger and better to grow their talents with.







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