Thursday, November 25, 2010

PhysiciansPractice.com- Trendspotter: Featuring Beacon IPA

Trendspotter: Fledgling IPA Charts Its Own Course

By Ken Terry | November 24, 2010



Accountable care organizations (ACOs) are supposed to improve quality and cut costs by getting hospitals, doctors, and other providers to work together. But increasingly, observers are raising the possibility that ACOs might raise costs faster by consolidating providers and forcing payers to accept big payment increases.


The main reason for this concern is that hospitals are expected to be the driving force behind the ACO trend. As they grow by acquiring other hospitals and employing more physicians, healthcare systems are becoming ever more influential in many markets. The advent of ACOs promises to increase that dominance — assuming the government lowers the antitrust and other regulatory barriers to forming these organizations.


But hospitals need not control ACOs. In fact, under the health reform law, they don’t even have to be ACO members, although their cooperation will be needed. The American Medical Group Association (AMGA) has started an ACO collaborative to help large group practices form ACOs. There are also clinically integrated IPAs and PHOs that could easily become ACOs, and 50 to 75 other physician-led organizations are on the same path, according to one estimate.


Among these entities is the Beacon IPA of Manhasset, NY, on the north shore of Long Island. Formed last summer, the IPA already has about 200 physician members, according to nephrologist Simon Prince, the IPA’s leader. The IPA’s long-term goal, Prince says, is to become clinically integrated and ready for whatever healthcare reform brings, including ACOs.


The IPA is not affiliated with any hospital “by design,” says Simon, the immediate past president of the medical staff at North Shore University Hospital in Manhasset. “We are trying to remain free agents.” Instead of being part of a hospital strategy, he says, the IPA wants to create its own strategy.


The main impetus for formation of the IPA, he explains, is the growing power of the North Shore-LIJ Health System, which is the dominant healthcare player on Long Island. North Shore-LIJ has hired a lot of physicians, creating fears among some private-practice doctors they might not be able to survive on their own.


“A lot of doctors didn’t go into medicine to become employed physicians, but the environment is such that it’s very difficult to maintain your independence,” Prince says. “So I felt an IPA was the best alternative that would allow the individual practices to maintain as much autonomy as they can.”


To become clinically integrated — which would allow the IPA to negotiate with payers, as North Shore-LIJ does — the doctors must have EHRs. So its members have agreed that, within six months, they will either have EHRs or have plans to get them, Prince says. At that point, the IPA will start to build the infrastructure for clinical integration, following the Federal Trade Commission’s guidelines that have allowed other IPAs and PHOs to bargain with payers.


The government incentives for meaningful use of EHRs will be a significant help to the practices in the IPA, Prince says. In addition, the IPA will provide some technical support to help physicians implement their EHRs and show meaningful use.


Where will the money for these activities come from if the IPA isn’t affiliated with a hospital? Prince says the IPA is in discussions with Empire Blue Cross Blue Shield and other payers. He suggests that the plans might be willing to kick in some extra funds to help the IPA become clinically integrated with the prospect of lowering overall costs down the line. Later on, if the IPA’s added value brings in enhanced payments, he says, part of that extra money could finance the IPA’s operations.


So far, Prince has been pleasantly surprised by the local payers’ interest in working with the IPA. He speculates that their interest might be prompted by their inability to limit cost increases from North Shore-LIJ, which has negotiated “very big rates… If they give us something extra and help to avoid that, I think that’s attractive to them.”


Meanwhile, Prince doesn’t rule out a future agreement with a hospital to form an ACO. “Remaining a free agent and seeing what the best fit is for us could be our advantage. If we grow and become a little more attractive, it might put us in a better position to negotiate a deal with a hospital or health system down the road.”

Thursday, November 18, 2010

The Physician's Place in the ACO

This is a nice, thoughtful piece by Philip Betbeze today in HealthLeaders Media... "The Physician's Place in the ACO"

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"ACOs will include confederations of doctors, specialists, and hospitals working together to administer payments, determine quality and safety benchmarks, measure performance, and distribute shared savings, according to a June 2010 report from the American Hospital Association. Still, as we enter a four-year transition into new payment methodologies on which long-term strategic decisions must be made, organizations are left with making little more than educated guesses about how they might become an ACO.

Amid all this uncertainty, one thing does seem certain: The physician will play a key part—perhaps the key part—in whether such organizations are ultimately successful at removing waste from the healthcare payment system."
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I encourage everyone to read this article and stay up to date with this important topic. It remains to be seen how the ACO movement will unfold and what role Beacon IPA will play. But although there is a great bit of uncertainty, there is also the potential for a great opportunity. 

Tuesday, November 16, 2010

Sequel Systems’ EMR receives Important Meaningful Use Certification

Melville, NY – November 15, 2010 – Sequel Systems, Inc, a dynamic, service-oriented healthcare technology company, announced today that its Electronic Medical Record (EMR), SequelMed Meaningful Use EMR version 8.0, has been tested and certified under the Drummond Group's Electronic Health Records ONC-ATCB program. The EMR software is 2011/2012 compliant in accordance with the criteria adopted by the Secretary of Health and Human Services. The certification deems the electronic medical record (EMR) software capable of enabling providers to meet the Stage 1 meaningful use measures required to qualify for incentive payments under the American Recovery and Reinvestment Act (ARRA).

In addition to the monetary incentives, the adoption of EMRs can improve quality of care, advance patient safety, increase customer satisfaction and enhance office efficiency for physician practices. Facilities and practices using a certified EMR may also experience increased profitability through reduced costs and increased revenue.

“Choosing to test with The Drummond Group made sense for Sequel Systems because the organization is an independent leader in testing methodologies and test process management.” said Khurshid Mughal, CEO and President of Sequel Systems. “Given the level of experience The Drummond Group has, it offers a greater level of confidence to our customers and partners that the SequelMed software meets the requirements as set forth by The Office of National Coordinator.”

“Drummond Group has more than 10 years of software testing experience in several industries and we are pleased to bring that experience to the HIT marketplace. It is a privilege to carry out testing and certification in Electronic Health Records for HHS,” said Rik Drummond, CEO Drummond Group Inc.

Sequel Systems, Inc. is a leading provider of EMR and practice management software and solutions, serving approximately 12,000 physicians in North America. Meaningful Use Certification of SequelMed’s EMR means clients seeking federal incentives will be technologically prepared to do so.

SequelMed Meaningful Use EMR version 8.0 is a comprehensive clinical, financial and administrative solution that empowers physicians to advance the quality and efficiency of care they deliver. The SequelMed family of products includes integrated electronic health records, practice management, clinical and business intelligence, and Patient Portal - a Web-based tool for online patient engagement. Providers can access SequelMed EMR from multiple practice locations, from home, or other remote locations either through a central patient database server, or as a Sequel-hosted solution on a monthly subscription basis. The software allows for users to easily track the details of a patient’s clinical history, share and manage clinical information and combine complex medical practice functions into easy-to-navigate menus. SequelMed v8.0 features centralized financial operations including billing, reporting, task management, and EDI services.

BIPA Names New IT Committee Chairman: Dr Inderpal Chhabra

I would like to announce the new Chairman of our IT Committee, Inderpal Chhabra MD an Internist practicing in Glen Oaks, NY on staff at Long Island Jewish Hospital and North Shore University Hospital in Manhasset.

Dr Chhabra will help to coordinate and lead this vital  BIPA committee.

Last night, we had our first IT Committee meeting. It was well attended and productive. In brief we are moving ahead with our deal with Sequel Systems EMR. Some important language in the agreement was reviewed by the committee with legal counsel. Additionally we spoke about our plan for Clinical Integration and putting some regulations into place in regards to our expectations of the adoption of EMR and CI for Beacon IPA providers.

Furthermore, there was the exciting news of a potentially large subsidy to BIPA members who will be getting on EMR now.

All this will be discussed in more detail by Dr Chhabra at our next Steering Committee Meeting on Tuesday November 30th.

Thursday, November 11, 2010

NEJM: Physicians versus Hospitals as Leaders of Accountable Care Organizations



Another interesting perspective was published online yesterday in NEJM's 'Health Policy and Reform' section. Here they tackle the burning question... who will control the ACOs? Will it be primarily physician or hospital controlled?


"We can envision two possible futures: one of physician-controlled ACOs, with physicians affiliating and contracting with hospitals, controlling the flow of funds through the marketplace; and one of hospital-controlled ACOs that will employ physicians. Whoever controls the ACOs will capture the largest share of any savings."


Click here to read the complete perspective.


There is no doubt it will be difficult to accomplish a successful physician controlled ACO. The resources and infrastructure required should not in any way be minimized.  But, just because it is difficult, doesnt mean it cannot, or should not be done. There is a great opportunity for the private practitioners to collaborate without a hospital or health system. The first step is to organize ourselves. A clinically integrated IPA like Beacon IPA was put together as a potential vehicle to become an accountable care organization. We need your help and support.


Together we can do this.... please join Beacon IPA today!

Kaiser Family Foundation: Health Reform Hits Main Street

Tuesday, November 9, 2010

WSJ: Employed Physicians on the Rise --- The Beacon Alternative

The article in Wall Street Journal yesterday, "When the Doctor Has a Boss: More Physicians Are Going to Work for Hospitals Rather Than Hanging Up a Shingle" should not come as a surprise to anyone. The accompanying graph also clearly shows this disturbingly strong trend.

A study quoted in the article revealed that the share of practices that were hospital-owned last year hit 55%, up from 50% in 2008 and around 30% five years earlier. Projections show that this trend is likely to continue for a variety of valid reasons that include, but are not limited to:

·        Decreasing reimbursement
·        Fear of the unknown in regards to Health Care reform
·        Rising administrative burden
·        Increasing oversight
·        Expanding technology requirements
·        Shrinking referral base
·        Malpractice and health insurance concerns
·        Possessing a shrinking voice being increasingly marginalized due to lack of size

and more...

If it sounds like I am making the argument for consolidation… you are right, I am.

But you can still come together without becoming an 'employed physician' and maintain your independence and autonomy.

There is an alternative way in which you can keep your private practice and enjoy the benefits of consolidation without joining a hospital or health system. It can also be done effectively without having to rip down the corporation you have built to form one big multispecialty group. 

We believe our model is the most attractive for the independent physician in private practice. It is a clinically integrated independent practice association.

We value private practitioners, because we are private practitioners.

Together we can stop this disturbing trend highlighted by the WSJ and well know to every physician practicing medicine today. Be part of our movement, we need each other. Join Beacon IPA.

For more information, please contact us.

Thursday, November 4, 2010

Beacon IPA Featured in Long Island Business News

Independent docs pool resources

by Claude Solnik
Published: November 4, 2010


In some instances, small is not beautiful.


Doctors working solo or in small groups are at a disadvantage in negotiating reimbursement rates with insurers. These same practices have seen flat reimbursement rates while costs have risen due to new expenses such as electronic medical records.


Rather than merge a small practice with other doctors or a health care system, as some already have done, a different business model is catching on.


With an independent practice association, a group of doctors pool resources and collectively bargain with insurers and vendors while remaining independent.


The Manhasset-based Beacon IPA has grown to nearly 200 doctors since it was founded this summer, expanding more quickly than its organizers expected.


“This is a very good alternative where we can come together, provide value and clinical benefit and work to become a strong organization,” said Beacon President Dr. Simon E. Prince, who is also president of North Shore Nephrology in Manhasset and immediate past president of the Medical Staff Society at North Shore University Hospital in Manhasset. “Our model allows everybody to keep their independent practice and do what they want to do to their highest ability. Yet it still allows us a framework to come together in numbers, affect change and have higher-level discussions with payers.”


Jill Hummel, vice president of provider engagement and contracting for Empire BlueCross BlueShield, said although her company doesn’t only look at a practice’s size, larger practices often obtain “enhanced reimbursement” for certain measures.


“I think in some ways we are rewarding the larger groups, not just because they’re large,” she said. “It’s the value they bring to the table.”


That is so because large practices often are able to provide better care through electronic medical records, 24/7 access, prescribing generic prescriptions and other services, Hummel said.


Beacon is one of a still small number of Long Island IPAs, including Valley Stream’s South Shore Health System and Garden City-based Healthcare Partners.


Prince said the process of starting these groups is complex. Although they face state regulations, additional pressures make them more attractive.


“It’s very difficult for a small practice to survive. That’s why there’s so much consolidation,” he said. “That’s the economic reason. There’s utility in other things. We have autonomy, self-governance.”


Esther Horowitz, vice president of provider relations for 600-physician South Shore Health System, said her group obtained several reimbursement rate increases over the past few years while many doctors’ rates fell or were flat.


“We are an advocate for the physicians. We look at not only better reimbursement, but how to maintain their independence,” she said. “We have the clout to negotiate for our doctors for better treatment, rates and opportunities.”


Beacon, which hopes to be funded by receiving a portion of rate hikes it negotiates as well as dues, already is putting together best practices and negotiating on behalf of physicians.


“If I go as an individual practitioner and call an electronic medical record company, the price is prohibitive,” said Dr. Michael Ditkoff, an ear, nose and throat surgeon in Manhasset and Beacon member. “Now with this group, we’re negotiating to get a better rate. They’re getting a higher volume of physicians.”


Ditkoff said the group hopes to negotiate better deals with billing companies and provide better care by analyzing data from various practices.


Prince said even if physicians choose different electronic medical records, the group expects to analyze their information to help them qualify for up to $44,000 in federal money for providers who prove they’re using data to improve medical care.


“There’s a pressure, real or perceived, that if you’re not part of a group, you’re going to be left behind. You’re not going to be able to survive,” Ditkoff said. “I could’ve kept going the way I’m going. But the way things are going, every year it gets harder and harder. Everyone’s joining someone.”


Ditkoff said some physicians are merging their practice into bigger entities. Large multipractice groups such as ProHealth in Lake Success also provide strength in numbers. But he believes an IPA provides freedom and financial benefits.


Prince said Beacon will set basic medical standards for members, while leaving a great deal of latitude to doctors in terms of their practice.


“If you’re not providing quality care and doing what we expect through our guidelines, you’ll be asked to leave,” he said.


While Ditkoff believes small practices play an important role in providing care, he said without strengthening their position, they will remain at a disadvantage in negotiating rates.


“They’re not going to sit down with each practitioner,” Ditkoff said of insurers. “I can barely get them on the phone to talk about a patient let alone my rates.”

Tuesday, November 2, 2010

LIBN: Empire creates physician panel

Empire creates physician panel

by Claude Solnik
Published: November 2, 2010
In a move designed to open a better dialogue between the state’s largest insurer and healthcare providers, Empire BlueCross BlueShield has created a physician advisory council.
Although other insurers have long used physician panels to help develop policies, Empire earlier this month held the first meeting of a panel designed to advise it on an ongoing basis.
The insurer, which covers more than 6 million members in New York State, in the past relied on panels set up around specific initiatives and administrative policy changes.
“What we found is we didn’t have this forum that met on a regular basis to get input from a consistent pool of physicians,” Jill Hummel, Empire’s vice president of provider engagement and contracting for Empire, told LIBN.
She said the group will meet at least quarterly and as needed to deal with particular issues, proposals or changes.
Hummel said the panel is comprised of physicians from across the state, including two Long Island doctors, an obstetrician/gynecologist and a nephrologist.
“It’s a wonderful opportunity to represent my fellow physician colleagues, advocate for the patients we serve and partner more meaningfully with Empire,” said Dr. Simon E. Prince, a member of the panel, president of North Shore Nephrology in Manhasset and past president of the medical staff society at North Shore University Hospital in Manhasset.
Prince, who said doctors volunteered to serve on the panel, said he thinks it should be good for “physicians, Empire and most importantly the patients we serve.”
Empire at the first meeting discussed how it does business, including setting reimbursement and administrative policies and creating quality initiatives.

Monday, November 1, 2010

New BIPA logo

After a great deal of hard work and back and forth with Rohit Barman of DPS America - 'Digital Promotions Strategy for NY Brands' we narrowed our new logo down to a handful of choices. They were distributed to the group last week for review. The steering committee voted and our new logo has been finalized.