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Best Practices
What about Me? Print E-mail
Written by Lawrence Schimmel, M.D., FACS   
Tuesday, 03 January 2012 00:00

As 2012 begins the independent physician practice is under attack from a number of directions and to survive it must be smart enough to understand what is taking place and how to work around it. In the past few years, large single specialty groups have formed with the philosophy that there is strength in numbers. If you are part of this type of organization you have been protected to a degree. Those that are not part of these large single specialty groups have been left to fend for themselves. The independent physician has no strength in numbers, no economy of scale as it relates to purchasing power, and does not control enough market share to demand a higher level of reimbursement from managed care organizations. Understanding the problem is critical for you to make the necessary adjustments in your practice to compete in this environment.
A new threat is just around the corner. It is called the hospital and its physician owned groups. Hospital owned physician groups are a major threat to both independent physicians as well as those in smaller single specialty groups. How did this happen? In the 90s, the emphasis of the new healthcare world was going to be the family practitioner. The primary care doctor was going to be the manager of patient care.  Under the assumption that primary care doctors would provide care, managed care organizations attempted to capitate them to reduce the cost of care. Unfortunately, the result in many instances was that the primary care giver became a triage officer and handed out referral slips rather than caring for their patients.  Additionally, many primary care doctors stopped going to the hospital to admit or coordinate care for their patients. Historically, this shift is important because as primary care physicians went less and less to the hospital the question arose:  Who was going to coordinate the care of there hospitalized patients? A new specialty was born out of the capitation of primary care physicians, the Hospitalist. Initially some entrepreneurial physicians created hosptialist companies, but it was only a matter of time before the hospital saw the benefit of owning their own hospital-based caregivers. Now hospitals are acquiring specialty care physicians and we are faced with the growing reality that it is likely that hospital owned hospitalists will refer consultations to hospital owned specialists. 
The hospital has closed the loop on the delivery of care with its approach to owning and managing the urgent care center, the outpatient center, the hospital, the primary care physician, the hospitalist, and now the specialist. There are those who will say that this integrated delivery system is the best way to provide care to the patients surrounding hospital campuses.  However, this creates a dilemma for the independent physician in our community. Whether a planned strategy or something that just happened, many feel that the hospital is just a license away from being a managed care organization or under the new health care reform act very close to forming an ACO.
This is the new reality in many locations throughout Florida, so what is the majority of physicians who remain independent going to do about it to survive? Perhaps this will be the impetus for multi-specialty groups to organize? Perhaps this will force more specialists into larger single specialty groups? Perhaps the small independent needs to adjust their practice to the new realities and make more out of less?  Every business needs to adjust to market conditions and a medical practice is no exception. This is a very fluid environment and the decisions that are made by independent physician groups in the next year will have long-term consequences on their specific practice.
Dr. Schimmel is a Principal at Marcum Healthcare.  You may contact the author at or 305.995.9801.
Last Updated on Friday, 27 January 2012 13:19
Baptist Medical Group Adds 3 New Docs Print E-mail
Written by Jeffrey Herschler   
Wednesday, 07 December 2011 13:06

Baptist Health Medical Group, an organization of more than 80 physicians in multiple specialties closely aligned with Baptist Health South Florida, welcomes three new physicians:
  • Ronald Tolchin, D.O
  • Dionne Casthely, D.O
  • Francisco Borja, M.D 

Dr. Tolchin is medical director of the Baptist Center for Spine Care, part of Baptist Hospital's Neuroscience Center. He specializes in physical medicine & rehabilitation, low back pain and spine disorders. Dr. Casthely specializes in spine disorders and musculoskeletal rehabilitation and fluoroscopic guided injections. Dr. Borja specializes in adult orthopedic hip and knee joint replacement and arthroscopic knee surgery.

Last Updated on Wednesday, 07 December 2011 13:13
The Money is in the Management Print E-mail
Written by Jeffrey Cohen, Esq.   
Wednesday, 26 October 2011 16:29

Conversation regarding ACOs and even healthcare reform itself is misplaced.  The well established facts are (1) more people will receive health care, and (2) the cost of healthcare will come down.  It does not matter whether the stimulus is a new law or just marketplace reaction.  The fact is that a healthcare system whose players are incentivized to do more with more expensive stuff is not economically sustainable or socially tolerable.

Take a look at our evolving marketplace.  What's the single most distinctive feature in healthcare, aside from inactivity?  Integration.  Larger hospital systems and larger medical practices, typically single specialty.  Good adaptation?  Maybe.  It is in the short run.  Single specialty aggregation is purely defensive though.  It allows groups to maintain market share and to resist price compression better.  But how will that allow providers to do more with less?  How will that stimulate more outcome based, financial risk based care?  It doesn't.  It is well established that cost and quality management demands broad spectrum system awareness....ummmm primary care physicians.  The adaptation of single specialty group integration is short term.  How short?  Who knows?  But it is clearly not as sustainable as one whose preparation for change includes primary care capabilities.

And how do hospital-based physician alliances help physicians survive and thrive?  They don't unless they have a strong primary care base, and even then it is very questionable whether hospitals will be able to utilize their PCPs and specialists in a way that rewards outcomes based, financially smart behavior.  Hospitals have always been sink holes in the landscape of healthcare costs, so why jump in?  Physicians need to make sure that their affiliated hospital systems have clear plans and abilities (e.g. management and good physician billing and collection experience) to deliver outcomes at the right price.  Studies, however, that indicate over sixty percent of Florida hospital admissions are unnecessary are consoling in a fee for service environment, but devastating in a capitated (or other risk based) one.  Physicians have to make sure the ship they book passage on can sail a long way.

And they have to make sure they are part of the right team.  What expertise is there in things like IT, financial management, clinical outcomes management, and risk based contracting?  You're gonna need that!

If one believes that healthcare costs are unsustainable (this guy does) and that our entire payment system is driving that result, then the need for new payment systems is clear.  And the challenge, just in terms of thinking about healthcare differently, is enormous!  How do you go to work and not think "I gotta do a lot, test a lot, do lots of procedures."  How do you begin to shift?  Do you shift?

The compelling answer is "YES."  Why not act now, before any law (even one dumber than the one that passed a year ago) gets passed, before our society calls the issue a failure and politicians and our neighbors demand a single payer-type system?  Isn't there a huge opportunity RIGHT NOW?  You betcha.

So where is it?  It's in management.  The money is in the management.  The data collectors, crunchers and implementers are the new gods in healthcare.  Anyone who can collect data, show what makes clinical and financial sense and then implement it will be more sought after than conflict diamonds.  Show one hospital how to live in that new system, where there are more patients, but less money available, and you retire rich.  Show physicians and other healthcare business people the same thing and lead change.  And since physicians are busy being physicians, except for a handful of physician entrepreneurs, they're best bet is gonna be to find good partners in "business" who embrace change and see opportunity.

With over 20 years of healthcare law experience following his position as legal counsel for the Florida Medical Association, Mr. Cohen is board certified by The Florida Bar as a specialist in healthcare law. His practice immerses him in regulatory, contract, corporate, compliance and employment related matters.  Mr. Cohen is the founder of The Florida Healthcare Law Firm. | 888-455-7702

Last Updated on Thursday, 03 November 2011 08:31
Florida's Top Group Practices Print E-mail
Written by Jeffrey Herschler   
Tuesday, 13 September 2011 15:59

According to the South Florida Business Journal, the Top Five Group Practices in the region are Holy Cross Medical Group, Cleveland Clinic Florida, Phoenix Physicians LLC, University of Miami Health System - UHealth and University of Miami Hospital.   The Top 25 list, was published in their annual Guide To Health Care on Aug. 19 and is ranked by number of physicians.  Holy Cross Medical Group (at #5) boasts 135 docs while University of Miami Hospital (at #1) employs a whopping 1300. 

By comparison, Florida Physicians Medical Group (FPMG) claims to be the Orlando area's largest multi-specialty medical group practice with 252 board-certified physicians and surgeons. In Tampa that honor goes to the USF Physicians Group with more than 350 physicians.  Meanwhile,  the University of Florida Physicians (operating in Gainesville and Jacksonville) is a medical group practice comprised of more than 640 doctors.

The South Florida region has long held a reputation for smaller groups, duo's and solo's.  Any Detail Man (or Detail Woman) can tell you that. Often S Florida docs "pose" as groups but are really separate P/A's or LLC's sharing office space.  That said, SFBJ's latest list provides fresh evidence that economic forces, accelerated by HCR, appear to be changing this traditionally small group market. Click to view:  SFBJ's Top Five South Florida Group Practices.

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Every Picture Tells a Story:   Highest Paying Job in U.S.

You guessed it.  Doctors and Surgeons occupy the number one spot in 2011.  

Presented by MF Healthcare Solutions via CNBC (photo by Getty Images)

Last Updated on Tuesday, 13 September 2011 16:10
Many cheap Med Mal offers are coming my way. How can I go wrong when I am saving so much? Print E-mail
Written by Matt Gracey   
Tuesday, 13 September 2011 15:47


Florida doctors are now enjoying a very "soft" buyer-centered market cycle, although I believe this is close to ending.  Back in 2000 we were in a similar market cycle, which led to many insurers pulling out of the state and the others dramatically increasing their malpractice-insurance rates a year or two later.  My advice as we enter the end of this soft market is to find a stable, well-funded, Florida-committed malpractice insurer so that you will lessen the chances of your coverage being canceled by your insurer when the going gets tough soon. 

When deciding which insurer will handle your coverage, remember that not all malpractice insurers are created equal, by any stretch of the imagination.  This is contrary to what you might read and hear from slick marketing folks and what you might like to believe so you feel can feel more comfortable and secure just price shopping. As with every important purchase decision, a risk/reward calculation is useful.  If a new, unrated insurer is promising great coverage and superb defense against claims, all for a price much below the rest of the marketplace, then there is a very high probability that they are just luring you in with unsustainable marketing promises.  In the last malpractice-insurance crisis of the early 2000s, over 50 insurers stopped insuring Florida doctors and left many facing expensive "tail" purchases, so choose very carefully as we come to the end of this buyers'-market part of the never-ending cycle.

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Matt Gracey is a Medical Malpractice Insurance Specialist in Delray Beach with Danna-Gracey, Inc. He actively lectures and writes educational material to help doctors and legislators around the state understand the malpractice insurance issues facing doctors today. You can reach him at (800) 966-2120 or

Last Updated on Thursday, 22 September 2011 09:47
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