“Children are Special” (CARES) is a newly formed physician-owned entity that will join some of the best pediatricians in North Texas under one umbrella into a financially and clinically integrated pediatric network to create one of the largest private pediatric practices in Texas. The mission is to preserve the private practice of pediatricians and allow pediatricians to chart their own destiny rather than relying on a hospital system or ACO. We believe that keeping the private pediatrician in control of the delivery of care is best for the children, the pediatrician, and best for healthcare in North Texas. View Our VIDEO About the Future of Private Practice
Maintain an Independent Practice
Conceptually, a super group will be formed that will be capable of competing in the new healthcare paradigm while continuing to value the independence of private practice. In this practice without walls, pediatricians will operate under a new tax identification number but continue to provide care without changing the name, location or culture of their individual practices.
Pediatrician Co-owned Management Company
CARES will contract with ParkHill Medical to provide management services that may include HR management, payroll services, employee benefit administration, revenue cycle management, EMR data management and negotiated payer contracts. The management company will be the backbone of the clinically integrated group and will have permanent representation of CARES pediatrician members on the board of managers. ParkHill Medical is a newly formed practice management entity that will provide optional investment opportunities to the physicians in the CARES practice group, as pediatricians will have the opportunity to own up to 50% of the management company. The management company may have third party investors, provided that the non-physicians do not have managerial control of the company. ParkHill Medical will provide these comprehensive management services on a percentage of revenue basis that will be unique to each practice.
The Goals of the New Venture CARES are as follow:
- Improve managed care reimbursement rates by leveraging a large number of pediatricians under one tax ID number.
- Determine best practices that improve quality and lower costs.
- Collect quality management data to deliver to managed care companies in the new pay for performance model of reimbursement.
- Negotiate on behalf of pediatricians, vaccine reimbursement that is commensurate with the cost of providing these necessary services.
- Create a Care Coordination Model with the use of an EMR that allows the pediatricians to control the cost of care and to seamlessly refer patients to sub-specialists and facilities in a value based system.
- Provide a sound revenue cycle management platform that collects all revenue that can be captured for the pediatricians.
- Decrease operating costs by creating operational efficiencies and purchasing power and provide HR services that historically have not been available to small groups or solo pediatricians.
- Expand the types of services that children need in North Texas, but are unavailable to access at this time.
- Create investment opportunities, that to date, have not been offered to private practice pediatricians.
Pediatricians Control Their Destiny with Economies of Scale
The goal of the transaction is to redefine the leadership role of pediatricians in the practice of medicine forever. Changes in the law and outside economic pressures are constricting the pediatrician’s ability to maintain practice revenue and provide excellent medical care in an efficient manner. Continued market consolidation and the shift toward value based reimbursement will make survival increasingly difficult for independent pediatric practices. By changing the legal corporate structure and combining a large number of doctors under one financially and clinically integrated practice, pediatricians will no longer simply provide medical care to children in a manner dictated by outsiders. Instead, they will provide the most efficient medical care possible to children and have the opportunity to direct the entire continuum of care for their patients, while minimizing the revenue lost to outside vendors and third parties.
CARES Pediatric Network, a Platform for Success
Managed Care contracting in a large clinically integrated practice, such as CARES, will provide distinct advantages when compared to the current IPA model for contracting. The IPA model is vulnerable to continued downward pressures on physician reimbursement because it is unable to participate in newer models for reimbursement. As a messenger model, IPAs cannot provide meaningful care coordination, which is the foundation of Value Based Reimbursement. The CARES network provides a platform that will allow its physician members to secure top tier contracts under any reimbursement model and provides the leverage of numbers in negotiating such contracts. Robust information management with athenahealth and the expansion of the Network for care coordination will position CARES to participate in ACO type bundled payments and Population Health Management contracts. By negotiating as a large group, CARES can address problems specific to pediatricians such as the shortfalls of immunization reimbursements that lag behind vaccine cost increases. As a physician owned entity, CARES will always look out for the interest of physicians first as opposed to hospital based networks that tend to look out for the interest of the hospital at the expense of the physician.
Alone we beg, together we bargain.
EMR/EHR & Revenue Cycle Management with athenahealth
Central to the enterprise is the necessity for uniformity for revenue cycle management and the electronic medical record. athenahealth has been selected as the strategic technology partner to provide these services. athenahealth has been historically been noted for excellence in revenue cycle management and EMR, but has been considered an expensive product. Organizing into a larger group and partnering with the newly formed management company have reduced the cost significantly. athenahealth’s, athenaOne has the ability to provide an integrated platform that allows for revenue cycle management, EMR, information management, and meaningful care coordination in seamless environment. athenaOne will maintain financial integrity and separation of each pediatrician or practice as a cost center so that there is no loss of revenue within the CARES network. The fee for the EMR and revenue cycle management will be embedded in the management fee.
Human Resources with ParkHill Management
ParkHill Management will be able to provide HR services to the CARES physician group that are typically not available to small or solo practices. Electronic payroll service, benefits administration, employer compliance and liability review as well as employee handbooks are some of the services available. ParkHill Management will also be able to provide annual diversity and sexual harassment training as well as practice manager training. By pooling a large number of employees, leverage is obtained in every area of overhead so that employee costs can be substantially reduced. The cost of a benefits package through a large group can substantially reduce existing costs to the individual practices. ParkHill will also provide employee training upon for all practices when needed as well as a work flow optimization evaluation. Best practices can be shared within the group and adopted by the individual practices.
Purchasing Power with PedsPal
ParkHill Management has secured a relationship with PedsPal, a larger purchasing group that will allow group purchasing in every facet of the pediatrician’s practice.
Why Do Pediatrician Incomes Continue to Decrease?
For many years, outside agencies have evaluated the medical arena and determined that there were opportunities for the non-physicians to profit off of the physicians by installing sound business practices and economic fundamentals into the physicians’ world. Some physicians profited, but many did not. A significant reason is that the size of the economic pie available for providing medical services has not increased. Under most analysis, the slice of pie that continues to be reduced is the physicians’ piece. This entity intends to maximize the slice of pie traditionally given to physicians by fully participating in new reimbursement paradigms, contracting on more favorable terms due to size and quality, and reducing physician overhead by installing best medical and administrative practices. Additionally, this transaction intends to participate in other slices of the pie not currently available by minimizing revenue lost to outside vendors and third parties and through physician investment in the management company. The pie is not growing. The slice attributed to physicians is constantly under attack and the only way to protect the current slice of pie and/or receive more pie is to change the thinking about the way to practice medicine.
With Change Comes Great Opportunity
Horizons must be expanded to avoid contraction of the status quo. Status quo is not an option, because the status quo is changing. The changes do not appear favorable for individual pediatricians or group practices. The options are to either batten the hatches while outside agencies attack the piece of pie available to pediatricians for providing medical services or to lead the revolution that changes the way pediatricians define practicing medicine. Change is coming, in one way or the other. History tells us that those who innovate, lead, and take chances are rewarded. We intend to be rewarded while finding better and more efficient ways to provide the best medical care available to our patients.
Pediatrician Leadership and Ownership is the Answer to the Problem
By joining together, pediatricians can leverage their collective resources to provide the best care for their patients in the most efficient manner and receive the maximum reimbursement available for their services. Additionally, the physicians will be offered the opportunity to invest in operations outside of their practices. From investing in the management company, imaging centers, urgent care centers, ambulatory surgery centers, and possibly a joint venture in a women’s and children’s hospital, physicians will broaden the arena in which they practice medicine in ways that have never been done before by pediatricians in Texas.
Children Are Special Symposium
February 22, 2014
Time: 8:00 AM – 3:00 PM
Location: Omni Hotel, 555 S Lamar, Dallas, Texas 75202
Followup Meeting Scheduled for March 5th for physicians who could not attend and those who would like additional information.