Network gives specialists negotiating leverage
Physicians seek greater voice in care decisions
In order to deal with the unique challenges that specialists face in today’s managed care environment, a group of Boston area surgical and medical specialists have formed a physician organization to give its members a greater voice in patient care and to enable them to work more effectively with hospitals and other tertiary care providers.
Specialty Care, LLC, based in Scituate, MA, is made up of more than 80 surgical and medical specialists who are on staff at six hospitals in communities on Boston’s south shore. Members are specialists in four areas: cardiothoracic surgery, general and vascular surgery, orthopedic surgery, and gastroenterology.
"We’re doing a lot more networking and working harder in ways we are not accustomed to, but we’re getting good at it," says Robert Driscoll, MD, a general and vascular surgeon who is president of Specialty Care.
A leverage booster
The organization has brought together specialists who previously didn’t know each other but who realized the benefits of joining together in today’s health care environment. "We were surprised to find that many of us across different hospitals in our region were having the same problems with managed care organizations and primary care groups," Driscoll says.
The organization is the state’s first surgical/ medical specialty care organization. The physicians in Specialty Care say having an organization will strengthen their position in the managed care market and give them greater leverage in the process of making decisions about patient care.
"Patients are looking for us, the specialists, to assume a more active and upfront role in the management of patient care. There is genuine concern and anxiety about the direction that managed care is taking. Patients are concerned that nonphysicians or employees of managed care organizations are making decisions about their care," Driscoll says.
The organization expects to be able to negotiate risk contracts with other physician networks and health care organizations as well as save money on malpractice insurance rates and other expenses by purchasing as a group. The organization is structured so members share information on best practices and communicate regularly with the patients’ primary care physicians.
"Very smart and experienced specialists are talking about the best way to manage care. There is real value added for the patients as well as for the HMOs because they know what to expect and they don’t always have the resources or the expertise to manage diseases," he says.
Improving care by sharing information
One benefit of the organization is that it brings together groups of specialists who can share information and come up with the best practice models, Driscoll says.
"We can discuss how we can best manage patients with a certain disease and share information on the best techniques and the newest innovations that will allow us to get the patients through our offices quickly and efficiently, to the operating room, through the operating experience, and to educate them," he says.
The specialists share their experiences on techniques that have worked well for them. "There is a comprehensive series of things that need to be done on the patient’s behalf. One member might do one thing particularly well and share the information with the others," he adds.
The specialists also sit down and review cases weekly with the primary care physicians at each hospital where they practice. "It has opened the lines of communications," Driscoll says. "We talk regularly rather than having to wait several days for a referral letter to be generated."
The face-to-face contact benefits both the physicians and the patients, he says.
"The primary care physicians can tell me directly what the patient needs. It gives me a better understanding of which patients have more critical problems, and I am able to see the patients with more acute needs more quickly," he says.
Having a comprehensive discussion with the primary care physicians helps the specialists establish patterns of treatment and makes it easier to treat the next group of patients, he adds.
"We discuss patients who are going to have surgery, those who have had surgery. We talk about how they are doing, their expected length of stay, and how we might improve them with therapy or alternative care, such as discharging them to transitional care or home with a visiting nurse service," Driscoll says.
The specialists intend to pool their knowledge and experience to develop their own best practices and critical pathways. Each of the hospitals where the specialists practice have critical pathways and patient outcomes plans, but the specialists want to write their own.
"The best practices change on an ever-present basis. We want to make sure that we are able to introduce innovations that are better for patients, such as minimally invasive technique," he says.
For instance, some innovations, such as laparoscopic surgery, are better for the patients but raise eyebrows with insurers because initially they seem more expensive, he adds.
"We want to look at our experience and be able to freely discuss those operations with our patients and with the insurance companies," he says.
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