CONSPIRACY THEORY

The Patient Protection and Affordable Care Act of 2010, affectionately known as “ObamaCare”, is picking up steam.  As mandated, legislation has been filed in the Texas House of Representatives to establish a Texas Insurance Exchange.  This exchange is intended to be a public forum including a website for comparing “qualified plans” with regard to pricing, enrollee satisfaction, and HEDIS criteria. The most interesting aspect is that “qualified plans” must offer no financial disincentive to patients with pre-existing conditions.  In return, enrollees will be eligible for premium tax credits and cost-sharing considerations.
 
The concern is that a two-tier insurance system will be created.  Old style insurance with rates structured according to the risk in the covered population will be forced to compete with “qualified plans” subsidized by the government.  We may be moving one step closer to a single-payer government-sponsored insurance system.  For the sake of brevity, we’ll call this the Conspiracy Theory.
 
A website comparing insurance policies could be helpful if done properly and with good intentions.  We at the PDA central offices have little confidence in the government’s ability to fulfill this hope.  The Conspiracy Theory seems to be a more credible scenario.
 
Remember, with change comes opportunity.  PDA will keep you informed as we discover ways to take advantage of these opportunities.  Please share your thoughts and ideas with us in return. 
 
Today would be a good time to take advantage of our membership drive.  For every new member you refer to us, your 2011 PDA annual expense will be decreased by 25%.
 
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PDA is an independent physicians association that strives to generate new revenues for its practitioners, eliminate hassles, and not require any more time. The organization contracts with commercial managed care payers, Medicare Advantage Programs, and Medicaid opportunities. Current new business development is directed at Employee Retirement Income Security Act (ERISA) contracts, i.e., Direct Contracts to employers and Department of Defense healthcare programs. Day-to-day operations issues at the physicians’ offices relating managed care are supported by PDA resources. PDA colleagues provide medical marketing to grow practice revenues and profitability, full service insurance benefits including medical malpractice, and interim healthcare operations management. The Chairman and board of directors are independent physicians. Bylaws equally include nurse practitioners, physician assistants, nurse anesthetists, podiatrists, and other allied health professionals. Through various marketing and contractual means, PDA is engaged with 780 practitioners in seventeen counties.


Dallas Hospitals and Physicians

Practitioners and their staffs should be concerned about quickly improving their financial picture. An awakening concern would begin with a revisiting of the hospital-doctor relationships. If a physician practices at a Tenet facility, for example, there should be major concern about the quid pro quo between the physician offices in the surrounding medical office buildings and Tenet.  We think we know the “satisfaction score” of PDA physicians with Tenet. However, the reality is that Tenet and PDA need to support each other with genuine commitment to deal with marketplace competition and external governmental forces. We should be on the same team or find a better team.

Tenet has two DFW facilities that are impacted by PDA. These facilities are acute care hospitals: (1) Lake Point and (2) Doctors. Alas, RHD and Trinity Carrollton have moved on to be controlled by competitive hospital businesses.  Tenet has cared very little about PDA, the historically passive messenger-model IPA. It now makes sense to project the potential benefits of a strategic association that is committed to the achieving of mutual goals and benefits.

After the 2010 total overhaul of the PDA management services organization, Dr. Dwight Lee and a group of motivated physician leaders of PDA have sought to develop specific strategies with Tenet. This initiative is continuing at an increased pace. There are other forces at work. Rival hospital system Community Health has made an offer for Tenet valued at $7.3 billion. Soon, PDA will determine where it fits within the future plans of Tenet and where Tenet perceives the best value of PDA. We do hear that “Medical Homes” are the announced goal of Texas Health Resources (THR), and “Accountable Healthcare Organizations (ACOs)”, are reported strategies for THR, the Baylor System, and Hospital Corporation of America (HCA).  During this period of change, we have new opportunities calling to us. PDA is positioned to help our practitioners seize these opportunities.  Your thoughts are important to us. Let us hear from you.


What do the Patients Think About “ObamaCare”?

What do the patients in your waiting room think about government-directed healthcare programs?  This is an interesting question that harkens back to the time of tort reform campaigning. Some physicians said nothing, others said a lot, and many told their patients it was time to make a choice:  they could choose to support tort reform at the polls or they should consider selecting another physician.  Whether that is the right response or not, those patients received a clear understanding of how their physicians needed them to respond to the risk of gratuitous litigation. The ObamaCare program is now a reality. Physicians should consider taking the leading role in educating their patients. Whatever your stance or beliefs, it is worth a minute to make sure your patients see your profession as you do.

The Harris Interactive/HealthDay poll released in early December said that the nation’s citizens are divided over the healthcare reform package: 40% of adults in the poll feel the legislation should be repealed; 31% favor keeping all or most of the reforms; 29% are undecided.  But this sampling does NOT necessarily represent the opinions in your waiting room.  The 31% in favor of keeping the reforms are those who have high expectations of what will be given to society.  Of our patient population, we can only speculate how the patients feel; you know your own patients better than anybody else does.

 There always will be a strong push for government control of medical services and physician compensation.  You have to ask yourself how you, the physician and your staff, can be more persuasive and helpful in shaping public support of free-enterprise medicine.

We at PDA are advocates for independent physicians.  Our goals are to generate more physician income, limit hassle and require no more physician time. We work for these goals while keeping the core PDA mission of assisting our members in providing high quality, cost effective healthcare.

Happy New Year from Buddy Miers….Blogging on a Monday, January 3rd as 2011 begins.


Hospitals and Independent Physician Organizations (IPAs) Are Now “Same Team” Stakeholders

Hospital operators and physicians have a multi-faceted relationship. The practitioner sees the hospital as an important part of the underpinning of his practice, and the hospital cannot exist without the attending medical staff.  

This obvious synergy is diminished by an underlying current of opposition. The hospital administrator must focus on the need to protect existing revenue streams while supporting new concepts that may be crucial to future success. He is tasked with managing invested capital and with growing an efficient enterprise.  Against the backdrop of multiple stakeholders, i.e., board, community, corporate management, regulators, payors, etc., the hospital president sees the medical staff as an unruly, diverse gathering of absolutely necessary talent and skills.

Meanwhile, the physician staff views the hospital administrator as a political watchdog and more recently, as a direct competitor through the physician aggregation process. Harvard Business School professor Rosabeth Moss Kanter and other behavioral scientists have reflected on the conflict between innovation and cost saving efforts.  Physicians are inclined to maximize medical service, no matter the cost. They are put off by a perceived lack of administration responsiveness, by bureaucracy and by a perceived unwillingness to let physicians participate in decision-making.  The horns of the healthcare dilemma are clearly delineated as it relates to this complicated delivery system.

There have been periods of cooperation, particularly when hospitals and physicians are faced with a perceived common “enemy” such as third party payers and oppressive government regulations. One of the most successful cooperative efforts was the JVE (Joint Venture Enterprise/one of the first three physician-hospital-organizations). The JVE was orchestrated by Presbyterian Hospital of Dallas (PHD) in the 1980’s. Events brought physicians together with hospital administrators as a response to the managed-care wave which was appearing on the west coast.  Twenty five PHD physician leaders flew to the west coast to personally observe the threat of destruction of their prosperous practices and culture.  With first–hand knowledge, they returned and forcefully teamed with administration. This organization quickly demonstrated the level of cooperation and mutual benefit that can be generated when divergent groups work toward a common goal. 

Relationships in the managed care environment needed rapid and effective restructuring.  The JVE provided the framework so that the hospital benefited, the physicians benefited, and their patients benefited. A successful independent physician association (IPA) hybrid model was developed, and JVE hybrids were created across the country.  For an extended period of time, JVE remained highly successful in negotiating both direct employer contracts and managed care contracts from a hospital-physician organization format.  Eventually, the government modified regulations in a determined political attempt to block the IPAs and physician-hospital hybrids from bargaining unless capable of meeting difficult new regulations.

Now, there is a new wave of change sweeping the country:  ObamaCare.  This change certainly represents a threat to both hospitals and physicians, but every change brings opportunity.  ObamaCare is still a ill-defined threat on the horizon, but changes are definitely coming.  Physicians and hospitals again need to fashion a cooperative effort if they are to flourish when the new regulations suddenly crystallize.  The medical delivery system in America is about to endure another expensive and complicated process of change. 

Hospitals have a choice.  They can affiliate with groups of independent physicians, or they can attempt to directly control the physicians through aggregation and ownership.  Corporate ownership, however, has historically struggled to avoid transforming a hard-working, dedicated physician to a clock-puncher mentality.  A laundry list of productivity quotas cannot substitute for the motivation and entrepreneurial excitement of an independent physician.  The motto “If it ain’t broke, don’t fix it” was never more appropriate.  The independent physician has been the power and driving force behind America’s medical excellence.  As history shows, those hospitals experimenting with the aggregation model are doomed to experience a major disenchantment. Aggregators are now the uneasy owners of a herd of cats, and that is an expensive and very unstable position.  They move ever deeper into the morass they’ve created because they are alienating the most productive elements of their physician staffs. 

Hospitals oriented toward cooperation, on the other hand, are preparing for change by forging alliances with independent physician associations such as PDA of Texas, making themselves ever more attractive to the most productive physicians.  PDA is ready to join forces with these hospitals to meet the approaching challenges.  Without continuing innovative leadership, the successful IPAs of two decades ago were eventually enveloped by new regulations and were suppressed into mere credentialing vehicles and “messenger model” organizations.  But an experienced management team which originated the JVE model has now taken the helm of PDA.  This IPA is not content with only providing a menu of messenger model contracting services and managed care plan credentialing. New opportunities and timing have made possible a new era of cooperation, innovation, and success for our physicians and hospital partners.

Here are the compelling reasons to create a business alliance with PDA of Texas:

  • PDA’s mantra for the future is for enlightened physician-hospital integration
  • The IPA has a critical mass of one hundred seventy-five physicians with a major development program of enlistment  
  • An IPA structure that inclusively seeks high quality nurse practitioners, physician assistants, and other allied health practitioners.
  • PDA is managed is by experienced healthcare executives and physicians that have successful time in the managed care arena
  • Contracting experience includes ERISA self-funded plans, defined benefit models, and niche specialty contracts
  • The IPA moves in synergy with a full service property and casualty/general lines insurance agency.