Children Are Special (CARES) Symposium
View the CARES Symposium Videos
Date: February 22, 2014
Time: 8:00 AM – 3:00 PM
Location: Omni Hotel, 555 S Lamar, Dallas, Texas 75202
Meeting Agenda: Informative sessions that accurately describe the threats facing your practice and provide a model that gives pediatricians control of their own destiny.
Attendees: Pediatricians (limit 100)
Children Are Special Video Text
The American doctor. Few people are held in such high regard as these caregivers – they tend to the sick, they keep us well, they fight against disease, they produce breakthrough cures, and they provide the most innovative and effective care in the world.
Those that care for our children, our pediatricians, are held in special esteem as they tend to our youngest, most beloved, and most innocent members of society. Indeed, pediatricians care for the future of our country.
In the past, pediatricians have been able to make the important decisions about how best to care for each patient, largely independent from outside pressures.
With the advent of the Affordable Care Act or the ACA, regardless of the degree of the Act’s implementation now and in the future, the practice of medicine in the U.S. has been forever changed. The change is due in large measure to the reimbursement and reporting ramifications of the ACA that will aversely impact the independent physician’s ability to remain in private practice.
As a result of the changing healthcare environment, decreased reimbursement under the IPA messenger model is anticipated since the IPA cannot actively negotiate contract rates on behalf of physicians unless the physicians are part of a large ACO designated IPA. The private practice physician that depends on the IPA to obtain market contract rates will be vulnerable. Simple fee-for-service contracts are being replaced with Value Based Reimbursement or Pay for Performance models. Under these new models, physicians are not reimbursed on the traditional fee-for-service basis and are instead reimbursed on the perceived quality of care.
These new reimbursement models favor large scale data reporting and the demonstration of meaningful care coordination. IPA messenger models cannot provide direct contract negotiations or meaningful care coordination, which is the foundation of Pay for Performance or Value Based Reimbursement.
What do these changes mean for independent private practice pediatricians?
Unfortunately, it means that these doctor’s practices are in jeopardy. In most cases, a private practitioner will not be able to demonstrate meaningful care coordination or conduct large-scale data reporting given that they are not a part of a larger organization that can achieve these efforts through economies of scale. The Value Based Reimbursement model requires a highly sophisticated level of care coordination that it is not achievable by individual practices.
Given that independent pediatricians are unable to capture maximum reimbursements under the new models, they are moving away from private practices in record numbers.
In fact, many pediatricians are concluding that their sole option is to either be employed by a hospital or accountable care organization or with an affiliate of a hospital system where it is a virtual certainty that a physician’s independence will be lost.
The good news is that there is another option. Children are Special or CARES is a newly formed, physician-owned super group that will bring together a number of the best pediatricians in Texas under one tax identification number to form a financially and clinically integrated pediatric network.
The goal of CARES is to preserve the private practice of pediatricians and allow them to chart their own destiny rather than relying on a hospital system or ACO. CARES will preserve private practice by providing the infrastructure and resources to allow pediatricians to organize into a group to achieve economies of scale while maintaining the autonomy and unique culture of their private practices. The network will be one of the largest private pediatric practices in Texas.
Here’s how it works. Pediatricians join the CARES organization and provide care for their patients without changing the name, location or culture of their individual practices. The platform allows the pediatrician to control care coordination from start to finish since the CARES network includes not just pediatricians, but also a wide variety of sub-specialists and surgeons. In addition, CARES physicians will own imaging, urgent care, and ambulatory surgery centers, and will seek to develop women and children’s hospitals.
The CARES platform will also consist of a management company that will provide EMR data management, revenue cycle management, payor contracts as well as human resource and employee benefits. Pediatricians from the CARES pediatrician group will serve on the Board of Managers of the management company.
The management company will provide the uniformity necessary to achieve revenue cycle management, economies of scale, and the electronic medical record. Athenahealth has been selected as the technology partner to provide this integrated platform of software and services. Athenahealth’s EMR will power a care coordination model that will allow the pediatricians to control the cost of care and seamlessly refer patients to subspecialists and facilities in a value based system.
The management company will also provide human resource 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 just some of the services available.
Due to the pooling of such a large number of employees, leverage is obtained in every area of overhead so that employee benefits and purchasing costs can be substantially reduced.
The management company will provide these services on a percentage of revenue basis that will be unique to each practice.
All of these different components of the platform work together to provide the patient with high-quality care at a cost-efficient price to the network. This closed loop system also permits CARES to capture the maximum number of incentives from the Pay for Performance programs given that virtually all of the patient’s services will be within the network that the physicians own.
In addition, not only does the CARES platform create more revenues for physicians through the reduction in overhead and administrative costs as well as greater reimbursement rates, but CARES pediatricians will have the opportunity to own up to 50% of the management company.
Additionally, physicians will be offered the opportunity to invest in the imaging, urgent care, and ambulatory surgery centers that will allow for additional revenue streams outside of their practice areas.
Because CARES is physician owned and directed, its pediatricians will have control of the medical care provided to children in a manner that is not dictated by outsiders. Instead, they will be able to provide personalized medical care for their patients and will have the opportunity to participate in the entire spectrum of medical services provided.
These benefits, coupled with the fact that CARES minimizes the revenue lost to outside vendors and third parties, makes joining the CARES organization a distinct and favorable alternative to hospital systems
CARES. Proud to provide the personalized quality health care for the children of Texas. To learn more about the CARES organization, please contact us at www.childrenarespecial.com .