As a Physicians Direct Access IPA (PDA) member, you are an independent practitioner who has resisted the pressure of becoming a clinical employee with a performance quota. It is accepted that the 501(a)model…the one which houses most employed physicians…is economically worthwhile and in step with the needs of the healthcare industry. In fact, we support one local 501(a) and have referred physicians that need a salaried position to this organization. But, the over-riding reality is that PDA is part of the “Independent Practitioner Culture”. We focus on those who identify with independent free market capitalism.
Once again, here is what PDA is based on:
· Professional, nationally recognized credentialing
· Individual office problem-solving specifically related to managed care snafus
· First class managed care contracts with competitive commercial reimbursement (37)
· An exclusive Medicare Advantage collegial relationship
· An evolving relationship with the Tenet Healthcare Corporation
· A unique workers compensation agreement
· And the crown gem of PDA…The Flagship Physician Network (FPN) as a nationally positioned and locally based delivery system for direct contracting with self-insured clients
The Flagship is the independent practitioner’s chance at financial success and enhanced quality of care vs. piece work or salary. This product is not about the big insurance company or mega hospital system HMO, ACO or exchange. FPN is a concentric group of motivated providers banding together with their IPA to do good service and protect individuality of practice. To do this, there must a direct sales function. Such a sales resource is the Flagship.
This community healthcare program can be successfully sold in the local markets as a delivery system which has physician direction and favorable reimbursement. The ownership is now open to physician participation. Current development discussions range from private placement funding for sales development to funding based on a public securities offering. Significant funding from a physician group has been respectfully declined while another option of practitioner investment is being currently positively considered. It is a “crawl, walk and then run like a racer” business plan. This message is one of many to assist the IPA member’s understanding of what is going on with their independent strategy. PLUS: it is designed to hammer home the power of referral!
In future blogs, the Flagship methodology of impacting rehabilitation, restoration, disease management, outpatient surgery, home care and wellness will be discussed. The power of referral is the engine that needs to be balanced, bored and stroked to create horsepower that also equates to making practitioners more money and time vs. bureaucratic process.
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The Flagship Physician Network is in the agent-broker recruiting mode. This a very important time as few links in the healthcare chain have been so stressed as the health insurance agent-broker. In the past, each agent was “appointed” by several insurance companies and sent forward to sell employee benefits on a commission basis. There were many insurance companies to consider. Small to medium size businesses (2-200 workers) were primarily “relationship” clients of their agent. The agent would annually shop the benefit plan for what seemed to be the best deal. The agent’s service also included many other areas such as COBRA benefits, workers compensation, solving claims problems, presentation of Health Savings Accounts, etc. The system had a good run while the insurers paid the agent a commission based on the premiums generated.
It was a good run until cost and access to care issues boiled over from the political pot of healthcare. Now, the Patient Protection and Affordable Care Act (PPACA) is a reality and the changes are unbelievable. One such change really impacts the insurance agent. Eighty to 85% of all premium dollars must go to patient care. A noble idea, but the commissions of the agent broker are directly hit by this rule. And, agents are being required to be transparent with their charges and to seek a justifiable fee from their customers. On top of this, there is a potential loss of up to 30% of small businesses that even offer benefits insurance. Indeed, there is turmoil in the insurance marketplace.
Agents are troubled and confused. They have fewer companies to represent, commissions are reduced or non-existent, the PPACA law is a confusing puzzle, and the healthcare providers are frustrated and resentful. Being an agent is not as much fun as it was yesterday.
The Flagship Network is a great solution available for the agents to offer a self-insured benefit product to the American worker. Agents need to understand and embrace this exciting program. On the 24th of April, the Flagship message will be presented to a large meeting of outstanding agents and brokers hosted by the Dallas Association of Health Underwriters. From such presentations, the agent and broker forces are enlisted to market the Flagship and its physician practices. Hard work and tenacity have gone into this program, and the future of direct contracting is very promising. We invite agents to consider the Flagship solution.
PDA is an IPA, but the traditional IPA functions (credentialing, maintaining managed care contracts, and assisting when physician offices must interface with insurers) are only a small part of the PDA mission. As an Independent Physician Association, PDA is committed to helping its member physicians make more money with no added hassle and without greater time commitments. As physicians, we have been subjected to a ratcheting-down process that puts us near and sometimes below the break-even point for our practices. New revenue sources are essential to physicians who wish to remain independent practitioners.
To make this goal a reality, PDA has created the “Company Store”, with ready-to-use revenue sources to fit almost any practice style. All the items on the shelves of the PDA Company Store have three qualities in common: 1) they provide needed services to patients, 2) they generate physician revenue without adding hassle or time commitments, and (3) they are fully vetted by the PDA ancillary products committee. Many of the services have been mandated by the Center for Medicare and Medicaid Services (CMS) and many are being monitored as part of HEDIS standards. The primary care physicians of PDA will be prescribing these services. That’s a given. Each physician must decide if his prescriptions will generate income for himself or for someone else. The default easy answer is to write a prescription and hope the patient complies with your instructions to be tested. The proactive answer for both the patient and you, the physician, is to see the test completed in your office to 1) guarantee compliance and 2) directly utilize the generated revenue.
There is a productivity driven financial model for each of these products. A quick work-up of the numbers and a view of possible new incremental income can be a positive experience. Every contribution to profit after covering fixed practice cost and only requiring variable cost is new incremental income that is associated with a larger margin.
The following items are available on the shelves of the PDA Company Store for use in your office:
Cognitive Testing for Early Alzheimer’s
Audio Testing / Audiometry
Nerve Conduction Testing
Biometric Testing and CLIA Testing
Bone Density (Mobile Dexa Scan)
Company Doctor Program
Electronic Medical Record
Fundus Photography and Glaucoma Testing
Insurance Products: Medicare Advantage marketing
Stress Testing and Spirometry
Ultrasound: Echocardiography and Vascular Ultrasound
Spring is here, and summer is coming. That means it’s time for vacations, days off, while at the same time being asked for file reviews and reporting from the various MA plans you participate in. Help is here! In our continuing effort to bring value and income to our membership, while reducing your workload and bureaucracy, PDA is offering a new opportunity to our members. We have been working to establish relationships with the area vocational training facilities that help to bring young people into the medical office field. They have been trained, and aspire to be Medical Office Assistants, Medical Assistants, and Patient Care Technicians.
The students are working to better their economic situations, and come from the entire Dallas area. Once they complete their classroom experience, they are required to complete 200 hours of externship in order to graduate from their programs. They are seeking real world experience, in a professional office environment such as that offered by our PDA membership. These students are mostly in their early 20’s and are entry level to the professional arena, but are working hard to break into the field. We are bringing these students to the offices here at PDA for pre-interviews, on-site work trials, and then would like when it is appropriate to make the connection to PDA members that are interested in participating. This can be a great situation for both your practice and the students. You get the opportunity to really evaluate the skills of the student. If you are thinking about hiring a new person, this is a no risk extended interview. This is also a win for these kids that are trying to get a leg up into the field, and will never break in without real office experience.
The process is simple, let us know you are interested, and we will work to make the connections to make it happen. There are weekly timesheets and evaluations that are part of the process, they are one page long and all but two lines are filled out by the student. PDA is acting as the facilitator in this program, and the actual participation will be between your practice and the applicable training facility. This will be an ongoing process with the goal of placing externs in offices that are somewhat close to home. With graduations on a monthly basis, there is no guarantee of a placement right away, but we will continue to expand the program based on your input, interest, and assistance in evaluating the efficacy of the program. This really is about reducing your workload, while offering the opportunity of experience to someone who may very well turn into a long term employee.
Please e-mail or call to express your interest or thoughts on this program, and once again, Thank you for your membership with PDA!