Why Clinical Integration is Essential for the Future of Independent Physicians

med networkBy: Ben Humphrey, MD, CPE, MGO Healthcare Consulting – Guest Contributor

We’re past the tipping point and are proceeding headlong into new market-driven accountability for quality, cost and value.  As these large-scale changes progress, physicians who want to thrive and be positioned for long-term success will have to embrace new ideas and approaches in their practices.

A few years ago physicians in Ohio created their own physician-owned company to assist themselves with success in the changing world of healthcare.  Via their company, The Medical Group of Ohio (MGO), they created a clinically integrated physician network comprised of nearly 2,100 physicians.  The vast majority of these physicians are in small independent practices.  Being clinically integrated means the physicians are working together, using proven physician-created protocols and measures, to demonstrably improve patient care, decrease cost, and deliver value. Continue reading

Healthcare Reform Doesn’t Have to be All or Nothing

By: Jeff Cohen

pulling hairHealthcare professionals today are constantly faced with views of what’s changing in healthcare, and all of them seem equally convincing.  “One day, everyone will be employed by a hospital” is one of the favorites.  Not surprisingly, the proponents of that perspective tend to be….hospitals.  “Everyone has to merge their practices” is another favorite.  The proponents?  Large super practices, of course.

How does one sort through this?  Who’s right?  The truth is that everyone is seeing part of the whole and is “right.”  But being “right” doesn’t mean right for you.  My opinion? Continue reading

Discounted Fee Organizations Have Surprising Regulation

percentageThe idea of an organization which provides discounted fees to patients is not a new concept.  Organizations like independent physician associations (IPAs), even accountable care organizations (ACOs) and simpler discounted fee plans will be surprised to know that Florida may require them to be licensed by the  Office of Insurance Regulation (OIR), even though they do not handle pre payments and do not collect premiums.  That’s perhaps the most startling aspect of the regulations—there is no financial risk involved, and yet Florida law seems to require regulation.

Pursuant to Fla. Stat. 636.202(2), a “discounted medical plan organization” means an entity which, in exchange for fees, dues, charges, or other consideration, provides access for plan members to providers of medical services and the right to receive medical services from those providers at a discount.  A “discount medical plan” means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other consideration, provides access for plan members to providers of medical services and the right to receive medical services from those providers at a discount.  Fla. Stat. 636.202(1).  A discount medical plan does not include any product regulated under chapter 627, chapter 641, or part I of chapter 636 (governing Prepaid Limited Health Service Organization).  Fla. Stat. 636.202(1), which of course is no comfort to providers looking to garner or protect market share by discounting services or by creating a collection of discount services providers, which is typical of IPAs and “networks.”

Before doing business in Florida as a DMPO, an entity must be legally organized in a compliant way and must be licensed by the OIR as a discount medical plan organization or be licensed by the office pursuant to chapter 624 [Florida Insurance Code], part I of this chapter [Prepaid Limited Health Service Organization], or chapter 641 [HMO, Prepaid Health Clinic]. Fla. Stat. 636.204(1) emphasis added.  Each discount medical plan organization must at all times maintain a net worth of at least $150,000.

Providers looking to provide discounted fee arrangements in a simple and effective manner many be surprised to know how complex that endeavor in fact is.  Moreover, the discounts will likely (and ironically) have to be reduced in order to bear the state licensure and financial viability fees.  Go figure!

Marketing: Boldly Going Where No Practice Has Gone Before

By now, every physician has learned about ACOs, Super Groups, IPAs and the like. Virtually every “new” acronym and idea has revealed itself as a retread old one, so at least physicians are getting more comfortable with the new language of healthcare reform. And they are accepting that no one really knows what’s going to happen and how medical practice will ultimately be years from now.
Nearly every physician has asked in the past year or so “What do I do now?” And they have heard responses from every vendor which translates into “Buy my stuff.” Ask an IT person what to do…”Buy my stuff.” Ask an EMR person what to do…”Buy my stuff.” Ask a lawyer….ok enough.

What to do and when to do it in light of feared changes in healthcare is anyone’s guess. There is, however, one remarkably overlooked area of business which physicians have traditionally neglected and which they must focus on now more than ever—marketing.

Do you have a website? Do you know what SEO is and how it works? Do you believe that patients buy what you do and not just who you are? In the internet age when people buy mattresses online, sight unseen, physicians have to begin to learn about marketing.

Though years ago, practicing medicine was clearly a profession, it is now big business. And physicians who thrive will be those who embrace business practices, including marketing. This takes a huge shift in perception since most physicians look at marketing as an expense, not as a good investment.

If you were told that every dollar invested in marketing will yield five dollars in new business would you spend the money? If you were told that buying a stock will result in a five-fold yield over twelve months, would you invest? Physicians have to look as marketing as a good investment rather than simply as a cost. And those that do will likely grow and thrive.


ACOwatch: Kathleen Sebelius: Keynote Speech From 2nd Annual ACO Summit

6/28/2011: ACOwatch.com 
Remarks as prepared for delivery by Secretary Sebelius on June 27th, 2011, Washington, DC.

“Improving care is clearly the best approach to addressing rising costs – especially compared to recent proposals that would simply cut Medicare and Medicaid, without doing anything to address underlying growth in health care spending.  But it’s also clear that we are not improving fast enough.  So our challenge is to speed it up.”

Read more here: http://acowatch.com/

Jeff Cohen and Florida Healthcare Law Firm featured ACO interview on Medsider

Thank you @scottnelsonlive for featuring us on #Medsider today! Hear the interview here: #ACO http://medsider.com/interviews/accountable-care-orgnizations-interview-jeffrey-cohen-florida-healthcare-law-firm/


ACOs: The Interview We Want to See

http://www.xtranormal.com/site_media/players/jw_player_v54/player.swf


Odd Little Facts about ACOs


  • The Medicare patients will be invisible to the providers for one year so as to discourage lowering costs improperly. How will this affect the providers’ ability to design cost-lowering programs?
  • ACOs are not closed networks;
  • When ACO beneficiaries go outside the ACO, and healthcare cost savings or excess is passed onto the ACO, even though the ACO had no control over such things. Imagine how seasonal residence plays into this;
  • Demonstration projects show a lot of patient “churn,” further challenging the ability of an ACO to control costs;
  • It looks like the two sided model will put 25% of reimbursement at risk;
  • Even Mayo, Geisinger and Cleveland are saying they won’t participate in ACOs.


ACOs are S.T.U.P.I.D

We have probably never seen so much enthusiasm and spending on anything in our history as we are on healthcare reform. The point is to slow spending and improve quality by incentivizing cost-saving, quality-enhancing behavior. And the Accountable Care Organization is the new healthcare delivery model designed to save us from our greedy, over-utilizing selves. Here’s how it works:

First, you take a lot of primary care physicians and tell them they will get more money by (1) taking an expanded role in taking care of patients, and (2) reducing the expenses associated with that care. Then you tell them two really special things: first, you tell them “Uh, since we’re afraid that you will improperly reduce the amount of care the patients need, we won’t tell you which patients are in an ACO and which are not.” Second, you tell them “We really mean it when we tell you that we intend for you to make more money, but we won’t tell you exactly how we’re gonna do that. Trust us, ok?”

Second, you empower physicians to lead the charge. After all, they’re the only participants in ACOs that smart people think can control costs and quality. And you do this by telling them to (1) shell out about $26 Million to form an ACO, (2) go to Wharton and get an MBA, (3) educate themselves about all the intricacies of information technology and work out the kinks involved in implementing electronic medical records, and (4) keep taking care of those patients while you do all this. Finally, you keep the identity of patients secret from the physicians so there is no way to prepare care plans that take into account the diseases faced by the patients. No problem.

Third, you let patients run amok. They can go into an ACO…or not. They can go in and out of ACOs. They’re like kids that way, but they’re responsible for reading the 397 pages of ACO regs and then deciding whether they like the idea of not. Oh, and they have absolutely no incentive to sign up for ACO care. And why would they? “Hey, how about you go with this ACO, which will get more money if they spend less on you. How’s that sound?” How could this possibly be sold to Medicare patients? “This ACO will get paid for getting you well! Your primary care doctor that you’ve trusted for 20 years and who helps you get and stay healthy…that person doesn’t have the same incentive to get you well.” NOT.

Simplicity. There is none. Never before in our history have we seen something so simple (patient rationing) become so complicated (rationing = less expensive care). And so many acronyms and governmental departments and positions too! There are one sided models, two sided models and now a Pioneer model, for those who are especially adventurous. And did I mention that the basis for healthcare reform, the one that only the state of Washington has the courage to articulate, is really just rationing?

Troubling to pretty much everyone. Yes. Except for policy makers, there has yet to be any significant support for anything other than the IDEA that healthcare should cost less and be more outcome oriented. Even the Mayo, Geisinger and Cleveland systems have all politely declined at this point.

Unlimited flexibility. Yes, this is true, especially as it relates to patients. See, patients can be in a cost saving ACO or not. They can go in and out of them and the ACO will bear the cost. That’s right: patients can go in and out of them—ACO, non-ACO, and yet only the ACO will be penalized for cost increases. Let’s see, the ACO model is the cost saving model. And the plan is to allow patients to choose for society to save money or not. And the patients have zero incentives for participating in an ACO. And who is responsible for the behavior of these patients? Uh, well, we all are.

Patient accountability. This is completely lacking in the ACO model. There is absolutely nothing to incentivize patients for making healthy decisions and to punish them for making unhealthy ones. Also primary care driven. Not really. There aren’t enough to go around, but some guy who knows a doctor is free to see you now. Oh, also pro competitive, meaning everyone will wanna be an ACO, so that will create competition in the market and a tremendous drive to drive costs down and quality up. Ok, not really, but wouldn’t it be nice if that COULD happen. In fact, healthcare reform is functioning to do one sure thing—reduce competition, since only the biggest, strongest organizations can afford to compete or to be one.

Inexpensive. Nah. While the initial cost projections suggested about a $2 Million price tag for forming one, they are now up in the $12 to 26 Million range.

Direct and demonstrative. NOT. The entire healthcare reform delivery plan is like pushing a mouse through a maze by its tail.

Healthcare reform is like Alice in Wonderland at its best. It only makes sense on mind-altering drugs. Moreover, the shizo message from our policymakers on the whole issue is dumbfounding. “We are committed to lowering healthcare costs. ACOs will do this. Patients can be in them…or not.” Some legislators think they’ve created a panacea with ACOs, but then don’t want to compel them. It’s just political nonsense.

Look, slowing healthcare cost creep and quality enhancement are good things. We all (patients included) ought to be outcome driven and focused so that the end result is actually healthcare. ACOs just don’t and won’t do that, which may have something to do with the recent announcement by Mayo, Cleveland and Geisinger that they’re really not that interested in playing with them.


IPAs Again

Independent practice associations (“IPAs”) are gaining momentum in response to healthcare reform and market changes responding to healthcare reform.  In an era when consultants are selling one-size-fits-all solutions, physicians have to consider IPAs as a viable option once again, but they have to fine tune their expectation to recent changes.

            In the thunderous noise wrought by talk about accountable care organizations (ACOs), physicians are scrambling to see where they might fit in the future of healthcare.  While we think those changes will be neither as severe or as pervasive as feared, we do see huge opportunities for ANY organization which can (1) reduce healthcare expenditures, and (2) improve quality.  Healthcare businesses of the future will view utilization skeptically.  Hospitals of the future will look like medical practices with beds.  Medical practices of the future will have a stake in the cost and quality of care being delivered and will view utilization skeptically. 

Continue reading