Spine surgeons across the country are facing a tough decision: how do they make changes to adapt their private practice to the changing healthcare climate or do they join an established system as an employed surgeon."I've noticed that a lot of surgeons in private practice have joined foundations or are now being employed by hospitals in anticipation of pending changes," says Ty Thaiyananthan, MD, founder and head neurosurgeon of BASIC Spine in Orange, Calif. "I believe though that there are other options for surgeons who want to continue on their own and practice medicine without the constraints of being employed by a hospital or medical group. A lot of surgeons have decided to partner with a practice management companies to help them adapt and thrive in healthcare's changing environment. It's has been a win-win model for our practice. Our association with our practice partners have lowered our overhead, increased our patient volume, allowed us to track our outcomes, and added ancillary services. They've focused on the business of running our practice and we focus on the medicine:
Dr. Thaiyananthan discusses his experience with a practice management company, Incubus Practice Partners, and where he sees his group growing in the future.
Q: What are the biggest challenges facing spine groups today?
Dr. Ty Thaiyananthan: I think one of the biggest challenges facing spine group practices is that spine and pain care is adapting to the accountable care models and in this model surgeons are being employed by hospitals and foundations to have access to patients. There is a growing concern that the days of individual and small practices aren't going to happen anymore. The larger groups will still be available for spine care, but smaller groups are having trouble protecting themselves. It boils down to whether or not patients are regulated and how small groups can optimize ancillary services to provide a high level of care.
Q: What has your practice done to address these challenges?
TT: We sat down and looked at a few different business models and we found a practice management company that can provide a host of services including aggressive marketing, management, accounts receivable, regulatory compliance, ancillary service revenue and contract negotiations. They also provide a process for staff provisions and human resources. This is a total practice management solution, but also a solution for creative marketing to attract de novo patients and monitor the quality of care and outcomes.
It's a business model around a small or solo group practice that allows them to compete with hospitals or foundations without having to join and give up their practice. Now we are working on further lowering our overhead and increasing reimbursement and tracking our outcomes in a way that's meaningful to our practice to the plans that we cover.
Q: What factors were most important when you were considering which practice management company to partner with?
TT: We shopped around and found a few other companies as well. We chose Incubus Practice Partners (www.incpp.com) because we wanted a total package; the others offered services to make sure your HR forms were filled out and taking over the billing functions, but we wanted something more. What was different about Incubus was that they helped build our practice by showing us a strategy to bring in new patients and by building an ancillary revenue stream. They also honed our ability to set up our entity as a self sustained ACO.
They developed a business plan for us to hire more surgeons and develop our program. It was truly a business partnership instead of having someone take over services we were already doing. They went back and negotiated our contracts. As we expanded, they showed us at one site that it was more beneficial for us to buy than rent. They took it from a business perspective, which most physicians fail to recognize. They had us define our goals and worked it out from there.
Q: How quickly did you see a return on investment from working with a practice management company?
TT: In the span of a few months, we were able to improve the payments on our patients. They came in and revamped our website, implemented targeted search engine optimization and generated a system to bring in new patients. They helped us think about an ambulatory surgery center and other ancillary services. They helped us plan for a bigger group. We increased our baseline revenue and now we can compete in the local area with a more established presence.
Our clinics have grown over 600 percent by association with the practice management company. With the addition of more physicians and services we've been able to provide a cheaper rate and provide data to payors. One contract gives us a bonus for the outcomes we were able to achieve.
We are in Orange County California, which is a very competitive environment, and we grew from a one-man practice to six physicians in a short amount of time.
Q: What tactics do you use to stay competitive in your environment? Are you partnering with other providers?
TT: The practice management company actually leveraged a partnership with one of the local hospitals for us. We work as a cohesive team with multiple operating rooms and preferred block time. As a result, the hospital got certified as a three-star hospital by one of the insurance plans, and there is only one other hospital at that level in the state.
They were able to leverage our hospital resources as well to help build a comprehensive program. They used the hospital to get salary recruitment packages for the surgeons and brought in a vendor to help lower costs that would make the spine program more profitable. Our practice sees this as a very positive relationship.
Q: What are your plans for success in the future?
TT: We are working with Incubus Practice Partners to build an ASC that makes sense for our center. Our practice can own and run it in its entirety, and we brought in ancillary services such as MRI. We have partnered with a physical therapy facility as well. It's good business to produce a multidisciplinary practice today and provide a single source for patient care.
As doctors, we don't have time to deal with the business aspects of our practice. We split our time between patient care and business, but with a management company I can focus on patient care during the week — which is what I do best — and there is another entity to finish everything on the business side.
Dr. "Ty" Thaiyananthan is the founder of BASIC Spine in Southern California. BASIC specializes in complex and minimally invasive spine surgery and is at the forefront of pioneering new surgical techniques using stem cells and minimally invasive surgery to treat chronic neck pain.
Dr. Ty earned his medical degree from UCSF, did a general surgery internship and neurosurgery residency at Yale and completed a surgery fellowship at Cedars-Sinai Medical Center in Los Angeles.