Group Integration; The Future is Here!
The benefit of more than 30 years of experience working in the business side of medicine has allowed me to watch, and participate in, a myriad of changes. Consider the merger mania of the late 80s and 90s, the movement away from inpatient services toward ambulatory care facilities, the consolidation of payer groups, changes in the reimbursement structure and the latest round of health system acquisitions of private practices, just to name a few. These, and other changes, have brought about a major shift in the culture and nature of medical practice management. It brings to mind an analogy about the weather in Maryland: “if you do not like the weather in Maryland, stay there, because it will change.” The practice and business of medicine is changing before our eyes. It is an exciting time to work in this field; we have the opportunity to help craft our health care system and positively affect the lives of those who come behind us.
Two of the most important changes in the past few years are those in the payment structure and the role of the patient in health care. As a young administrator, I was responsible for managing relationships with our payer community. Developing relationships with private, public, local, regional and national payers that underwrote multiple lines of coverage was a challenging and fun part of my job. Since no payer controlled the dominant share of business, negotiations were simpler. Walking away from a payer relationship rarely put the medical practice in a difficult position due to their relatively limited market share.
Patients were NOT seen as customers, rather people who visited our office to be cared for, and were often dictated to and directed. The doctor always knew best. Early in my career in 1983, I suggested our group implement a system of patient surveys so we could better understand our strengths and weaknesses as a medical practice. Our medical director, a seasoned surgeon, didn’t believe patients knew enough about medicine to comment on quality of care, and thus passed on the idea of patient surveys.
How things have changed. Now, in our region, a few large payers dominate the market. Walking away from the negotiation table is not as simple as it once was. Patients are now seen as customers who have a choice in where they seek medical care. While our physicians manage their medical problems, we expect and need patients to actively participate in their recovery. And of course, the patient’s perception of quality is key to any serious assessment of care, from the moment they step into our office waiting room to the end of their care. We will not mention the increasing role of social media – sometimes good, sometimes not particularly helpful! Our business has changed, and will continue to change, and it is happening rapidly.
These changes, among others, prompt serious self reflection at every level of the medical practice. As our division assessed the environment, we decided that an affiliation with a larger entity was necessary to survive the ever changing and competitive medical landscape. We faced immense pressures to increase our purchasing power, improve recruiting efficiency, better manage our payer relationships, and extend our market presence and footprint, and needed to gain greater access to clinical and administrative talent. All of these needs resulted in joining CAO.
The movement to an integrated group has allowed us to achieve all of these goals and many more. The access to a broad range of clinical specialists and talent is amazing. Recently, one of our physicians needed to refer a patient for a hip scope. Rather than looking to a local academic medical facility, and condemning the patient to the morass of dealing with interns and residents, with little time spent with the experienced surgeon, we were able to tap our resources within CAO. After one telephone call and email to CAO partners, our patient was scheduled to see a physician with that area of expertise promptly.
I have been able to consult with fellow administrators from other divisions who are experts in information technology, billing and collections, human resources, ancillary services, purchasing, developing an ASC and numerous other areas of practice management with amazing ease and efficiency. It is incredibly beneficial to have access to such bright minds within the group.
CAO’s sheer size and market presence has positioned us to partner with payers, taking risk, as reimbursement structures change. This is an essential benefit of being a part of CAO. However, medicine is, at its core, a people business. People delivering services to people. Therefore, the real magic of CAO lies in the strength and diversity of its clinical and administrative talent. The group integration has brought together an amazing collection of health care providers and ancillary staff. We are positioned as the dominant orthopaedic provider of care in the Maryland, Washington, D.C. and Northern Virginia area. We are a shining example of how group integration can benefit individual physicians, each division, our patients and the communities we serve. The future is truly bright for the stars of CAO.