Richard Kube, MD, CEO of Prairie Spine & Pain Institute and Prairie SurgiCare in Peoria, Ill., tackles some of the big issues facing spine surgeons in private practice today and how surgeons can be successful in the 21st century. Q: What are the biggest opportunities for spine surgeons to build and grow their practices today?
Dr. Richard Kube: Creating an integrated care model remains a positive growth opportunity for spine practices. As accountable care organizations form, spine is specialized enough to be able to create an all-spine services ACO type of environment in a private practice setting. This is especially true if you have a surgical facility and utilize minimally invasive techniques to increase the number of potential cases for the facility. Care in this type of setting can be more comprehensive and efficient, thereby increasing patient satisfaction and controlling cost. This provides the practice the ability for a great variety of contracting options and access to patients not available to practices without such a model.
Q: As the healthcare environment is changing around the country, what are the most beneficial relationships for spine surgeons to make? How can these relationships lead to practice success?
RK: Surgeons should build relationships with their customer base. In an era when many of the traditional referral sources are employed by, and hence controlled by hospitals, insurance carriers, etc., one must form relationships outside those traditional models to assure practice growth. These relationships start when the patient enters the office and begins his or her experience with you, the physician. Tools such as internet, email, websites, and so forth can also interact with your patients.
It also is a good idea to be involved in the community as a whole. You will have a more successful practice in a more successful community. Many if not most small businesses owners make an effort to support local community businesses and events. These activities should not be overlooked for their value in creating a positive perception with your customer base to further strengthen your practice growth.
Q: There are many spine surgeons beginning to think about retirement while others are just starting out in practice. How can experienced spine surgeons help newer surgeons or partners build a successful practice?
RK: Helping a new partner get started presents a few challenges, but none that aren’t easily addressed. Communication is a critical starting point so that expectations and responsibilities of both existing and new partners can be defined. Ideally, these concepts should have been covered prior to hiring and now need only refreshing.
An appropriate amount of funding and support should be provided to the new partner. Practice databanks demonstrating traditional referral locations and opportunities for new growth can be very helpful to get a new partner started marketing in a higher yield environment. If you are adding a new partner, clearly, the existing partners are busy. That happened for a reason. There is a lot of insight and political capital existing partners can provide the new doc regarding local history and politics and what has helped to get referrals in the past.
The new partner should also realize when setting expectations that new patients do not just show up at the door. The new doc should be using down time and after hours to start marketing their practice. They must share the responsibility to grow and setting goals and following tried and true metrics for the practice is a good starting point. The new doc should expect that this is going to take extra work, especially in the beginning. Someone once told me, "From 8am-5pm I conduct business. After 5pm I grow the business." Truer words were never said.
Q: Medicare reimbursements have undergone cuts this year, and the downward trend seems likely to continue. How can spine surgeons in private practice continue to see these patients and keep their businesses running?
RK: I think that reimbursements as a whole are dropping whether it is Medicare or the standard PPO. I believe there's an opportunity for a win-win situation for the physician and society is to create an integrated spine care model. This moves most if not all of the spine-related services under one roof. The physician has the opportunity to offset reduced margins with more volume and more service lines.
From society's standpoint, the care will be less costly, more efficient and more convenient, i.e. greater value. Given most physician offices are compensated at rates often less than half that of the hospital alternative, huge savings can be seen in this model for patients, PPOs and Medicare. Satisfaction scores are higher for patients given the convenience and the ability for the care team to work together to provide more favorable outcomes.
MedPAC found in 2005 that PT integrated into physician groups posted a 38 percent savings over the independent models. We know this also holds true for procedures performed at ambulatory surgical facilities. For those physicians resisting hospital employment, the solution is to create an integrated care model and compete directly with the hospitals for spine care services.
Q: What role do the internet and online forums play in medical decision-making today? How can spine surgeons optimize online resources to build their business?
RK: Patients are increasingly savvy when shopping and assessing medical care. Our practice sees increasing numbers of patients finding us on the internet. In an age when hospitals are buying primary care practices and hiring specialists, the internet remains an opportunity to maintain control over a portion of your referral base.
It continues in my opinion to be an all too often overlooked part of marketing your practice. It is usually at least, if not more, cost effective as the typical marketing and advertising options many practices engage in the newspaper, TV, billboards, etc. The added benefit to the internet and webpages is the direct control you have on a daily basis to keep the message current and fresh.
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