Here We Come!

Independent physician associations (IPAs) were originally designed to help individual physicians unify their voices against the threats of big government and big insurance companies.  Arguably, the most successful IPA in the nation was the original JVE at Presbyterian Hospital of Dallas under the guidance of Harris Miers.  The founders of JVE created a powerful negotiating force that represented both physicians’ interests and hospital alike.  Later, the politics of “system integration” intervened, and the Federal Trade Commission changed the rules.  At that point, the JVE and all IPAs were demoted to the “messenger model” and could no longer negotiate effectively for independent physicians.

IPAs spent the next 20 years mired in the “messenger model”.  They became simple vehicles for communication between physicians and insurance carriers.  Once stripped of negotiating power, their primary functions became: (1) credentialing, (2) contract administration and (3) issue resolution.  The contracts available from any given IPA became virtually indistinguishable from those of competing IPAs. 

Physicians sometimes have membership in multiple IPAs.  With contracts “commoditized”, multiple IPA membership had diminishing advantage. Practitioners find themselves simply going with the flow.

PDA is challenging the past, the present and the future.  The new “IPA” must become synonymous with making more money for the practitioner, eliminating hassle and not asking for more work effort. Our vision is to become an independent multi-specialty group practice that is a for-profit powerhouse, clinically and financially integrated. Together, we must break through the messenger model limitations and the pressures to sell out to the aggregators. 

We are about building independent negotiating power, accountable care organization (ACO) access, and medical home participation. The rules of the game have changed once again, and we are ready to seize the opportunity. This is a movement…”Made in America by independent physicians”.

Independent Practitioners and ACO’s

This week’s blog is being used to bring you a major notice.  PDA would like to announce what we believe to be our ultimate destination in the “new normal” of ObamaCare.

The regulations for accountable care organizations (ACOs) and for medical homes have not yet been spelled out. Nevertheless, it is becoming clear that physician groups must become “clinically and financially integrated”.  The major aggregators have recognized this, and they are feverishly purchasing physicians to create appropriately integrated multispecialty groups.  In order to survive, the independent physicians must also move in the direction of integrated multispecialty groups.  We must make this happen if we are to successfully compete for the healthcare dollar, and PDA will be the vehicle.

PDA intends to provide a framework for that portion of our membership which desires clinical and financial integration into a multispecialty group practice.  We anticipate that there may be two levels of participation.  At our core will be the multi-specialty group practice, perhaps along the lines of Scott & White.  Surrounding that will be physicians who don’t wish to integrate, but who can still refer patients to, receive referrals from, and earn incentives from the central core.

We extend an invitation to PDA members with multispecialty group experience to come forward and contribute to the planning. To be sure, we are not going to reinvent the wheel. Our leadership is committed to designing a cutting edge model. We look forward to building a meaningful dialogue with all independent physicians.

Please feel free to forward this announcement to any practitioner who may be interested in joining our cause.  The future is racing toward us like a locomotive. This is looking like a movement rather than a simple IPA.

Here Comes the Accountable Care Organization (ACO)

We are rapidly learning about ACOs. We have been to seminars, worked the internet, scheduled meetings with a number of hospitals in this regard, and discussed the concept among our team.
To share our growing knowledge with our membership, we need to begin with a simple definition for a complex system:
“An ACO is a related set of providers and facilities that can be held accountable for cost and quality of care provided to a defined subset of Medicare, Medicaid or commercial health plan subscribers.”
If that sounds like an integrated delivery system to you, congratulations; you win the prize!  Such a system could definitely communicate with outside agencies, deal with utilization review, and accept bundled payments.  This model has major potential to change the status quo.
If an ACO can develop attention-getting volume, the sometimes uncoordinated fee-for-service payment system can in theory be replaced.  Regardless of the structure, who owns what and who gets paid what, the ACO is held responsible for total spending and quality for a defined population. There are definite similarities to an HMO type structure. It is not necessarily a good or bad thing.  It’s just “what goes around comes around”.
PDA is looking at ACOs from the point of view of the independent physicians. We are seeking ways to make the physician more revenue, limit hassle, and require no additional time on the job.  We just want you to learn with us and stay shoulder-to-shoulder as we together face change.

Projects Update

We would like to bring you up to date on PDA projects and strategies:

  1. We now have an agreement-in-principle for a direct ERISA contract with a local 50-employee group.  Final papers have not yet been signed, but we are excited about the potential income for a significant segment of our association.  We expect this to be a small first step toward unlimited potential.  This is the way JVE, the predecessor of what is now called Genesis, started to grow.
  2. The Chairman and the CEO of PDA will meet with a major hospital management company this week to discuss an enhanced working relationship and ACO possibilities.  We are going to establish such a relationship with a “like interested” company.
  3. PDA is currently undergoing audits of credentialing and contracting activity.  Like any audit, they are necessary, but not fun.

News Update for those who have been too busy to look up:

  • A Florida judge has declared the entire Accountable Care Act (ObamaCare) to be unconstitutional.  This makes two states which have approved the ACA and two which have nixed it.  This debate will be settled by the Supreme Court.

 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%.

ERISA Contract – ATTN: Physician Office Managers!

This is the PDA mantra that you’ve become familiar with if you’ve been reading these blogs.

 “More Money!” receives the emphasis today.  The PDA central office is working on our first ERISA direct contract.  The Employee Retirement Income Security Act provides a mechanism for employers to self-insure their employees.  We are negotiating a contract which will directly link a local 50-employee company to PDA physicians for their healthcare. 

Technically speaking, this is not our first ERISA direct contract.  Our management team, when leading the Managed Care Joint Venture of the Presbyterian Healthcare System (JVE), has negotiated direct contracts with municipalities, school districts and major Dallas employers. In fact, the JVE’s first direct contract was with the employees of Presbyterian Hospital of Dallas. This is not our first rodeo.

 As we speak, we are looking for new hospital relationships and physician colleagues. This specific contract isn’t signed yet, and we all know “the job isn’t finished until the paperwork is done.”  Maybe this deal will close and maybe not.  Either way, we want our physicians to know that we are aggressively working on your behalf.  This is the new PDA!

 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%.