News
What Physicians Want
Courtesy of HealthLeaders Media
Philip Betbeze, for HealthLeaders Magazine, June 9, 2010
A group practice offers benefits of hospital employment, but in a physician-owned model.
Physicians just don't want to work in private practice anymore. Or so the prevailing wisdom would have us believe. Instead, says this line of thinking, with few exceptions, new doctors just want steady employment, preferably in the hospital environment, where all they have to do is take care of patients instead of dealing with the billing and staffing challenges, and all the other headaches that a physician in private practice is expected to take care of.
The problem with this theory is that it's only partly true. It's true that, generally, as bureaucratic and paperwork nightmares of the private practice physician mount, it is more difficult for such so-called "mom and pop" operations to compete for talent. Even larger multispecialty practices are seen losing out to hospital-owned practices and hospitals themselves, as inpatient facilities ramp up hospitalist hiring.
Still, contrary to the prevailing wisdom, new physicians don't necessarily want to work in the hospital. Yes, they want a flexible work environment and they want to spend their time taking care of patients. But that doesn't mean those activities have to take place within a hospital's four walls. Instead, innovative private practices are structuring their offerings to new physicians around a stable, entrepreneurial work environment in which all the extraneous details that don't involve patient care are done by administrative staff.
An example can be found in Community Care Physicians PC, a 35-office, physician-owned group practice based in Latham, NY, where founder, chairman, and CEO Shirish Parikh, MD, says satisfaction in their jobs—particularly interacting with patients—is the main driver motivating physicians. His challenge is to offer as much flexibility as possible to physicians. What's good about that approach is that it's exactly what patients want as well.
"Compensation, and perhaps surprisingly, security, are important," says Parikh, "because it seems like hospitals don't fail as frequently as groups."
Every physician at Community Care, which was founded in 1985, has an opportunity to become a shareholder. To begin, each is employed, but at the end of his or her second year, shareholders can nominate the physician to become a shareholder, after which he or she can decide to remain employed or buy shares. About 100 of the 180 physicians it employs are shareholders. The practice's strategy has been successful precisely because Parikh and Bob Kleinbauer, the practice's chief operating officer, look for myriad ways to expand the practice's footprint. They want Community Care to be available to patients for almost everything for which they don't need an inpatient stay, and that starts with being the patient's keeper of information.
"What we're trying to do is tier the primary care activity," Parikh says.
Other group practices are looking to develop ancillary services that complement their specialties, says Jon-David Deeson, a shareholder at Pershing Yoakley & Associates, PC, in Knoxville, TN. Those services used to be focused on reimbursed activities, like diagnostic imaging, but after reimbursement was dialed back recently, discretionary services—in other words, cash-based—are rising in importance.
"For most practices over the past several years, there's a downward trend in reimbursement relative to their services. Real estate is another good example as groups look to create and control other sources of revenue."
Many access points
Access is critical to executing this type of strategy, and means big investments in facilities and types of care that widen the practice's footprint, says Parikh.
To that end, access to the practice's physicians is available electronically, by phone, or through traditional visits. In addition to the traditional practice, Community Care is experimenting with walk-in clinics staffed by physician extenders for common ailments, for which all visits represent a pure cash transaction (Community Care also has a network of urgent care clinics, which do accept insurance). Care coordinators and "health coaches" help patients navigate the group practice's 30 office locations and ancillary services as well as assist in obtaining referrals and continuing care with medical professionals outside the practice.
"Care coordinators are the new type of glue we can use in healthcare to help patients become more engaged in their health status," Kleinbauer says.
Being entrepreneurial
Community Care looks to exploit opportunities. It noticed hospitals in the area were struggling with scheduling radiology services and hospitalist services. So it created a hospitalist program for local hospitals to use and now takes referrals for outpatient radiology services.
It developed its two urgent care centers for the same reason. "Our patients were using the emergency room a lot so we established an urgent visit center through one of our acquisitions, which was so successful we rolled another one out in our service areas," Kleinbauer says. The centers don't compete with the day practices, but rather, "become an extension of our offices," he says. "I'd like to say we had a grand plan, but we saw opportunities, and as they came along we implemented a response to a community need."
"We're living in exciting times," Parikh says of Community Care's entrepreneurial spirit. "You can wring your hands or seize the moment and move forward aggressively, knowing more people will be seeking care outside the ERs. Further, you can make sure people can access primary care without physically going. Those are areas that represent tremendous opportunities."
Not Afraid to Try New Things
Community Care Physicians engages in a number of innovative efforts.
- CCP has had a systemwide, full-function EHR for five years, and several of its physicians have access to patient EMR data through their mobile phones. It also implemented a patient portal (Relay Health) and is exploring the role e-visits might play as reimbursable events with its local managed care organization (MVP Health Care).
- The practice began utilizing kiosk technology for registration functions in several of its primary care offices and is upgrading to Web 2.0 functionality. In the near future, the kiosk technology will be expanded to its medical imaging services.
- Two CCP practices are participating in a pilot for a patient-centered medical home in conjunction with a local managed care organization.
- The practice added new urgent care services to help with access to primary care. It's also opening a "walk-in" care center for patients who want to access lower-level healthcare needs via nurse practitioners.
- CCP is partnering with several large employers who want worksite clinics to help reduce healthcare expenditures.
- It's partnered with the local medical school and runs three of its residency programs with CCP physicians as faculty: family medicine, urology, and medical imaging.
It was the first physician practice in the region to develop a "medical mall."
Philip Betbeze is senior leadership editor for HealthLeaders Media. He may be contacted at pbetbeze@healthleadersmedia.com.
