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“The difference between a vision and hallucination is how many people see it.”

In the November issue of Memphis Medical News I said I would provide some “take
aways” from the board of directors meeting at the annual meeting of the Medical Group Management Association held in New Orleans, in October. Since I am limited by space, please feel free to contact me if you have any follow up questions concerning these issues.

As you would expect, it was one of the most engaging board of director meetings and annual conferences I can recall in my 20 plus year involvement with the MGMA. I thought the beginning quote for this article was very fitting and I must give credit to my friend and colleague, Mickey Smith, CEO of Oakhill Hospital in Brooksville, Florida, also on the MGMA Board of Directors.
Last year when healthcare reform was being debated, the board engaged a consultant to work with us on a session envisioning the future.

The rationale was: until we stop defending the present structure, how can we envision the future? We recognized that most people are reluctant to embrace change, which is why we invested so much time and energy in this plan. I look forward to sharing how we are using this ‘visioning plan’ to embrace change in upcoming articles, but the upshot is that we plan to be proactively engaged to insure that the patient-physician experience is not compromised at the expense of patient safety and quality.

On the legislative front, there was much discussion of the upcoming physician Medicare payment cuts that will take place Dec. 1 and Jan. 1, assuming no action is taken by Congress. (This article is being submitted mid-November to be published in December). A survey was conducted by the attendees in New Orleans. Here are a few of the results, again, if these cuts stand:
• clinics will have to lay-off nearly 30 percent of the non-clinical personnel and 19-21 percent of their clinical personnel;
• capital outlays or expansions will be delayed;
• as many as 37 percent will delay implementation of any EHRs.

Many groups have already frozen their Medicare panels, and if this cut occurs, most groups will have to make further freezes or, with regard to some medical specialties, terminate participation in the Medicare program. One attendee asked a panelist if the federal government could require a physician to see a Medicare patient. (I believe this was attempted in the Massachusetts Universal program).

In response, another attendee expressed his belief that, if this were to be upheld, it would be the same as treating a physician as an indentured servant, deemed unlawful under Article 4 of the United Nations Declaration of Human Rights which was passed in 1948. And for those who do not recognize some laws or articles under the United Nations, the Trafficking Victims Act (TVPA) of 2000 extended Servitude to cover peonage. (Wikipedia)

Accountable Care Organizations were thrown out similarly as akin to “do you want fries with that burger.” In fact, toward the end of one of our long board meetings (you know the ones that start at 7 a.m. breakfast, include a working lunch and by afternoon you are brain dead), we decided that after all the presentations and discussions on ACOs, we had a new definition: ANY CONSULTANT’S OPPORTUNITY. Following the presentations and breakout sessions, there was one point that the board and attendees were very much in agreement on - HEALTHCARE IS STILL LOCAL. And local means physicians, hospitals, other providers with patients being the drivers. Healthcare providers and healthcare administrators should be the ones working hand in hand with the payers and not the other way around. Be suspect of organizations who misrepresent themselves as ACOs or groups which do not have medical providers represented heavily at the table drafting and participating in the process; most likely they are acting in their own self interest.

And, yes, we left without a clear definition of a ‘patient centered medical home’ except for defining it as patient centered. There was some very convincing dialogue that medical homes could be primary care centered and some specialty centered (particularly for chronic care patients). It would be difficult if not impossible to have a patient centered medical home completely primary care driven given the extreme and dangerous shortage of primary care physicians.

A lot of discussion and various presentations from hospital groups all over the country shared their experiences with hospital/physician arrangements. There were still a lot of independent physician groups. Many groups had consolidation with other groups high on their due diligence evaluation lists. Some were in various discussions with hospitals and other interesting partnerships. Again, the common phrase was ‘if you have seen one, you have seen one.’ Some of the more successful hospital/ physician arrangements had both a combination of physician employment and hospital/physician joint ventures.

The groups that shared the most success stories used hybrid models such as employment and JVs, but had a very well laid out shared governance structure of physicians and administrators (hospital executives and clinic executives). The major ‘take away’ from these group discussions can be summed up in one sentence whether they were physicians looking toward potential consolidations with other physicians or with hospitals.

Communicating a commitment to the future success of the organizations and individuals involved entails the following: a continuous dialogue and engagement; a corporate culture that works well together; planning the future with open discussion, and demonstrating mutual trust in meshing the different styles of leadership.

Bill Appling, MBA, FACMPE, is president of Watkins Uiberall Health Care Consulting. He has faculty appointments at the University of Memphis in the Fogelman College of Economics and Business, where he teaches in the Masters of Health Care Administration program.

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