Jay Lieberman, DPM, FACFAS

Genie Lieberman, MS, MBA,OTR/L

When President Obama declared the Cleveland Clinic to be a model US hospital, was he saying that US hospitals would be centralized locations for all medical care?  Many hospitals and health care systems seem to be ramping up in that direction.  There is no question in my mind that the Cleveland Clinic an excellent hospital and medical center.  I also believe that their model is a difficult one to replicate.  As we all know, one significant reason the Cleveland Clinic delivers high-quality care less expensively than other hospitals is that its doctors are paid a salary only.

Those of us who are independent practitioners have to ask ourselves if we are ready to blend our practices with a hospital or health system. 

Remember that you have made or are going to make a sizable investment to develop your practice.  The downturn in the economy has made some of us feel as though our overhead is insurmountable.  So let’s say the local hospital offers to buy your office now for an amount equaling the accounts receivable and the value of the depreciated equipment.  The deal also includes a salary that equals a percentage of what you were making in years past.  You may feel that if you don’t take the deal they will find someone else.  Some very fine practices have already made this transition and each year there will be a pool of newly minted doctors to fill the slots in those big organizations.  Should you make the move? 

We can all be sure,…. one way or another,…. change is inevitable.  To have a viable practice in the future will require becoming as efficient and connected as possible.  We all know what’s involved in achieving those goals.  It means using high technology (voice recognition software, paperless charts, digital x-rays, interconnected communications with other healthcare professionals) and employing lean management principles.  At this point, we are all wondering if the individual practitioner will be able to find a way to make these changes.  Alternatively, maybe it does make sense to become part of a bigger organization.

We all need to ask ourselves … What value do we bring to the table … to organizations and individuals in our communities? 

One aspect of our value to organizations is economic. Although President Obama wants to transition to a coordinated and interrelated system, it looks like the basic fee for service structure is here to stay for a while longer.  So let’s break it down.  Most elective surgery is being directed to surgery centers and diagnostic procedures are going to diagnostic centers.  Freestanding facilities can provide these services at lower costs than hospitals with large administrative superstructures.  However, it must be noted that some large health care organizations have found ways to separate ambulatory and inpatient divisions to leverage economies of scale.  For all these organizations, the same basic payment structure that we use now still applies; each encounter equals an amount of revenue.  In many cases, podiatry is a perfect fit for partnership and collaboration with surgicenters and ambulatory care facilities.  Our practice (diagnosis and treatment) provides valuable encounters to free standing facilities.  Keep your eye on opportunities in this arena. 

Another aspect of our value is in improving the overall health of individuals by preventing, diagnosing, and treating conditions associated with the foot and ankle in a manner that is probably better than any other specialty.  Leveraging that value may give a practitioner opportunities to take other routes. 
 
We are all not sure where health reform will go from here or what form President Obama’s healthcare plan will ultimately take.  Of course it should be configured so all Americans can have health insurance; however, if that happens will some patients want to seek care outside the system?  Can a practitioner or group of practitioners be set apart from the ordinary as a center of excellence?

I attended the State University of New York at Buffalo. At that time, the hospitals and private practices there were filled with private patients from Canada.  These patients were unwilling to be treated by the National Healthcare System up North.  We are not talking about a handful of patients.  We are talking about an entire wing of the hospital.  Apparently, the health care organizations and practitioners in Buffalo, NY had found a way to set themselves apart from the ordinary health care in Canada.  Some Canadians perceived these providers as having more value to their health and well being than anything they could get back home.  This history shows that small independent practitioners or groups can carve out productive niches.  Models that focus on personalized care may be just the thing to compete with the medical – industrial complexes that are sure to dominate many markets. 

As we go forward into this new health care world, we will have to navigate our way and find the best fit.  I’m sure there will be plenty of options.  Affiliating with a surgical center is one opportunity.  Better yet, become an investor.  Surgical centers are more cost effective for elective procedures from the point of view of patients and insurance companies.  Creating a center of excellence with a group of practitioners is another choice.  Provide top quality care with a focus on personalized service. If you think out of the box, there are many possibilities.  Developing a comfort/walking shoe store that also offers foot health products is another way to leverage your expertise.  If possible, pool you resources with other podiatrists and sub-specialists.  Be “lean and mean.” 

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Stanley Kalish, DPM Interviews Warren Joseph, DPM at the 2010 Superbones West Conference. Follow this link, or click on the image above, to view the interview.

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