The Future of the LTC Physician Practice

We’re at a crossroad in PAC physician practice management and picking the right direction appears to be the biggest challenge. I personally don’t think any direction is wrong at this point. The only wrong thing to do right now is to think you don’t need to go in a different direction.

As we’ve all learned from Hem and Haw change is difficult, but we’ve all held our ground for too long. The idea of a LTC physician practice being able to maintain independence has become irrelevant. It’s increasingly important for us all to work together as scale appears to be what is relevant in today’s healthcare arena.

Last week I got my batteries recharged for another year while attending AMDAAMDA is the only time of the year that I don’t feel like AHA is on an island. It’s a week that most of the LTC practices in the nation take flight off of their remote islands and create a continent of ideas. From the sessions, hallway peer to peer discussions, and even the wee hour talks – its nice to know others are at the same crossroad as AHA. One common thread is we all know that change is inevitable, but we all have different thoughts on the direction to take.

My thought, at least for today, was formed during an ACO session discussing Clinically Integrated Networks. These are networks of physicians that don’t require Health System employment to kickoff. These Networks of physicians are aligned by common goals, clear incentives, and communication. Seems easy enough right? Well, up until just recently in talks about expanding the ACO’s and bundled payments these simple concepts have been relegated to those wearing the same logo on their name badges. For the 1st time hospital systems have the opportunity to be rewarded by gaining a better understanding of what goes on in the areas outside their umbrella. Having to employ the physician in order to gain ground has finally lost it’s appeal.

As it turns out the most important and subsequently expensive patient population in America today resides in our country’s nursing homes. Most only calling the nursing home a rehab center for 40 days or preferably less. The space AHA occupies has only become important to the area hospitals in the past couple of years. This shift has occurred as a direct result of actuaries realizing the gravity of the cost outlay for these patients. During my presentation about ACO’s we reveled that an average MCR benefit’s spending is 3x that of a traditional beneficiary the second they admit to the nursing home. This bares it’s own opportunities for cost savings as well as it’s own challenges. The important takeaway is to realize that this is a population of patients that in large part are outside of the health system’s umbrella. This could lead to health systems scrambling to acquire nursing homes, but they’ve tried that before and failed miserably. Reference hospital TCU’s demise and mismanagement. If hospital admins think running a hospital is challenging try nursing home management in today’s survey rich world.

So that leads me back to Clinically Integrated Networks(CIN). This is the area that seems to be the most appealing. A true Win-Win-Win-Win for all involved. The expansion of hospital networks via nursing homes, home health, hospice, and physician practices. And guess what…they don’t have to employ you to benefit. After all, it’s not about employing more doctors and increasing their productivity…it’s about the highest quality at the lowest cost and sharing the savings. So employment isn’t the way to go as they’ll never be able to acquire enough scale in the time frame needed to save themselves. So it’s through Clinical Integration that will give them the necessary scale and the much needed boost to make a true difference. So if you’re a physician working in PAC now is the time to be having the discussion with your local health systems about forming a CIN.

Just remember its a CIN if you do it and a SIN if you don’t :)

That’s at least my thoughts for today’s plan for tomorrow…

Tom Haithcoat can be reached via email attom.haithcoat@advancedhealthcareassociates.com

 

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