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Case Study: Struggling Practice Finds Success Through an Innovative Consortium

Case Study: Struggling Practice Finds Success Through an Innovative Consortium. Presented by Kyle Matthews CardioVascular Associates of Mesa, P.C. Objectives. Explore a unique perspective on physician and practice cooperation to maintain independence

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Case Study: Struggling Practice Finds Success Through an Innovative Consortium

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  1. Case Study: Struggling Practice Finds Success Through an Innovative Consortium Presented by Kyle Matthews CardioVascular Associates of Mesa, P.C.

  2. Objectives • Explore a unique perspective on physician and practice cooperation to maintain independence • Identify a new way of doing business beyond integration or an accountable care organization model • Evaluate whether your organization can succeed using an innovative business model

  3. About Your Speaker • Kentucky Native • Early Volunteer • Western Kentucky University • Freed-Hardeman University • Accounting • Finance • AmSurg Corporation • CardioVascular Associates of Mesa

  4. About Your Speaker • Arizona MGMA President • National MGMA Committees • National/State Task Force • Annual Conference Abstract Review • MGMA 4Corners Conference Co-Chair

  5. Disclaimer This presentation is a case study based on actual events as experienced by a practice administrator. Before beginning any work on any form of cooperative entity, please seek legal, accounting and other professional advice. Your presenter is not a legal nor accounting expert and is not making any recommendations on how to form new entities since all practices are unique.

  6. Interact @KMattCHD KMatt35@gmail.com

  7. Do It Yourself • Recognize the Problem • Find the Solution

  8. Practice Background • Located in Mesa, Arizona • Phoenix Suburb • 38th Largest City • 8 Physicians • 5 NPs/PAs • 2 Offices • 15,000 Unique Patients Per Year

  9. Service Area • Intense Competition • “Guys Next Door” • Influx of New Physicians • Hospitals/Systems • Lack of Integration • Snowbirds • Housing Market

  10. Same Story, Different Place • Billing Problems • Low Morale • Sacred Cows • Unfavorable Contracts • Operational/Financial Inefficiencies • Mounting Debt • Embedded Consultant

  11. Change Begins • New Management Team • New Compensation Model • New Team Focus • Financial-Based Decisions • Revamped Committee Structure • Restructuring of Existing Contracts

  12. New Challenges Arise • Reimbursement • Economy • Competition • Hospitals • PCP Consolidation Traditional Solutions Were Not Enough

  13. Our Future Partners • Different Philosophies • Different Culture • Number 1 vs. Number 2 • Heart Hospital • Partner Transfer • Virtually No Interaction

  14. Small Problem -> Huge Opportunity • Banner System • “Rural” Hospital • No CV Services • No Cardiology Presence • 30 Minutes Each Way • Projected Consults < 5 Per Week

  15. It Begins • One Phone Call • Cheesecake Factory • Similar Strategies • Similar Issues • Common “Foes”

  16. Intent • Competitors • Maintain Independence • Exclude Revenue • Save Money • Exchange Ideas • Expand Strategy

  17. The Basics • Structure • Separate Entity • Low Overhead • Physician Leadership • Legal • Operating Agreement • Purchasing Agreement • Master Agreements

  18. Priorities • Medical Supplies • Nuclear Supplies • IT

  19. Medical/Nuclear • RFP • Presentations • Required Participation • Existing Contracts • On-boarding • Tiered Savings • Partnerships

  20. Medical/Nuclear Benefits • Protection against Supply Issues • Generics • Suggested Uniformity • Exchange Ideas • $$$

  21. IT • Optional • RFP • Local • National • Presentations • On-boarding • Group Governance

  22. IT Benefits • Reliability • HIPAA/Regulations Compliance • Shared Resources • Techs • Network Administration • CIO • Shared Purchasing • $$$

  23. Data Center • I/O • Agility • Reliability • Sustainability • Security • Ideal for Medical Practices • Unaffordable as Individuals

  24. Data Center Benefits • Financial • Shared Physical Space • Shared Data Storage • Shared Connections • Common Maintenance • Physical • Electric • A/C • Water Damage • Lightning

  25. Data Center Benefits • Operational • Uptime • Speed • Equipment Health • Security • Sleep Better • Mitigated Additional Costs

  26. Twitter Challenge @KMattCHD

  27. Health Insurance • Optional • Partially Self-Funded • TPA • Stop-Loss • Reserves • Individual Plan Documents • Individual Loss Ratios • Centrally Administered

  28. Health Insurance Benefits • Wellness Plan • Narrow Networks • Plan Design • ACA Protection • Premium Protection • Group Governance • Group Strategy • Shared Consulting • $$$

  29. Other Projects • Office Supplies • Statements • Shredding • Echo Reading • Answering Service • Collections • Phone Maintenance • Venous Ablation Packs • ICD-10

  30. How It Works • Physician Led • Physician Owned • Practice Administrator Executive • Physician Meetings • Administrator Meetings • Health Plan • Wellness • IT • Vendor-Partners • Superior Communication

  31. Operating Parameters • Management Fees • Low Overhead • Reimbursements for Services • Budget • Approval Levels • Check Signatures • Buy-In • K-1

  32. Challenges • Legal Restrictions • Individual Practice Buy-In • “What Have You Done For Me Lately” • Varying Needs • All Groups; All Sizes • Vendor Compliance

  33. What Is Next • HR • Credentialing • Compliance • Shared Personnel • Nuc/Echo Maintenance • Billing

  34. Possible Destinations • One Tax ID – Financial Integration • Clinical Integration • Internal Consolidation • Maintain Current Structure

  35. Lessons Learned • Share the Work • Talk, Talk, Talk • Establish A Team • Administrator Relationships • Ideas • Problem-Solving • Best Practices • Sanity

  36. Why It Works • Cost-Savings • Options • Independence • Harmony • Intelligent Decisions • Survival

  37. Practice Today • Line of Credit Repaid/No Short-Term Debt • Strong Financial Health • Competitive Staff Compensation • Morale High; Turnover Low • Excellent Patient Satisfaction • Firm Partnerships • Enhanced Operational Efficiencies

  38. Questions

  39. Kyle Matthews @KMattCHD KMatt35@gmail.com

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