Confronting the Future Boldly

The rising tide of decreasing reimbursements and increasing overhead costs triggered by the implementation of the Affordable Care Act puts private practitioners at a distinct disadvantage. Thankfully, we all had the foresight to come together to preserve our patient-focused model and level the playing field through strength in numbers.

At our inception, I thought this rising tide of change would crest over a three to five year period, allowing for a gradual integration of our divisions into The Centers’ brand. However, the medical landscape is more volatile than anticipated and incremental change is no longer realistic. Bolder initiatives to spur integration are now required.

Payors are getting stronger through consolidation, a major paradigm shift in reimbursement – pivoting from fee-for-service to value-based care – is requiring the need to invest in data solutions to mine and prove the quality of our care, and patient expectations are increasing by the day.  As Mike McCaslin, principal at Somerset CPAs, highlighted in his keynote speech at our recent Annual Meeting, the time to move forward as a truly unified organization – singular in branding and internal processes – is not a few years down the road, it is right now.

As we complete our second year of integration, we have been successful creating structurally a large company deriving improved financial and clinical benefits. Nonetheless, I believe, our vision for the future is too narrow. The change in the delivery of medicine is accelerating at light speed. CAO must take charge of the change! Our organization must be recognized as the most highly regarded provider of personalized health care, with concrete data confirming we produce quality outcomes at the lowest possible costs. This is exactly aligned with what payors are looking for and will place The Centers in a stronger position as we approach the next round of negotiations in 2017.

How do we do this? True integration, not just lip service, must occur.

Now is the time for bold new initiatives. We have already proven our model works, saving enormous amounts of money through increased purchasing power and leverage, and enjoying an uptick in patient visits simply through being able to accept a wider range of insurance carriers. Our accomplishments were attained not as 33 separate divisions, but as one integrated corporation called CAO. To truly maximize the opportunities our size and strength present, I propose that we take audacious steps as an organization to accelerate our integration process over the next two years.

We need to take transformative action, collectively embracing the idea that our own divisional identities may no longer serve the greater good. It is hard to give up individual brands developed over decades. Yet, the future of medicine is very clear. We must be one company with one common vision and one standard of clinical practice, not 33 small, uniquely regarded separate practices. Our myriad of divisions confuse our consumers and referral sources, which in the future more likely will be commercial businesses and other health care companies, not the traditional single practicing internist.

It is now time to permit the brand of CAO to be the predominant representative of our practices. To promote this change, I would suggest current divisional logos for 2016 be placed below the CAO brand. In 2017, if we are to truly embrace integration, all divisional logos should be abandoned to allow CAO to realize its complete corporate strength and authority. We need to speak as one voice to take charge of change.

As someone who has spent more than three decades in one location, I take great pride in the brand my division has tirelessly built among patients, hospitals and physician peers. However, I’m the first to admit that my practice, Orthopaedic Medicine and Surgery, no longer has the clinical and financial gravitas to compete in today’s health care environment. That’s why I’m prepared to take strong action immediately, eliminating my local branding to wholly embrace The Centers in all that we do.

Our struggles to futilely cling to our local identities are quickly rendering us irrelevant, while we have at our fingertips the power to integrate and take our rightful place as one of the biggest forces in the orthopaedic industry. This will allow us to be on equal footing with other large members of OrthoForum.

Bold measures should include consistent business practices across all divisions. Offices should look and feel the same to provide a consistent quality patient experience. Savings from a common practice management system, a common EHR system, a common billing system, and a common answering service could help offset yearly capital contributions by the partners. These changes won’t be easily achieved, but they cannot wait three to five years. 

As an integrated company, The Centers has a distinct competitive advantage. As patients continue to become more savvy and treat health care purchasing decisions the same way they would any other purchase, large hospital institutions, in their current forms, will not be able to compete on price, convenience or quality outcomes.

We must move forward as one unified group, formidable in size and mission, or we will squander the fruits of our past efforts. We can no longer passively sit back and let integration happen slowly. External factors are accelerating at such a rapid clip that we must keep pace, forging a new path for CAO as a singular and powerful group with a uniquely patient-focused message.

Change and progress only come with sacrifice. Let’s be bold, let’s be leaders, let’s be great.