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The Cost Effectiveness of Independent Physicians with Doctor John Moore

 

Scott: Hey, TXCIN Nation, I'm Scott Bullington with IMS and you're watching another edition of TXCIN TV. I'm really excited today because we're gonna bring you one of the co-founders of the TXCIN Network. He's gonna tell us his story about how he struggled as an independent physician in the early days, and what led him to the bigger purpose of the TXCIN vision.

When we come back, we're gonna meet Dr. John Moore. You don't want to miss this one.

The Beginnings of TXCIN

John: Specialty ENT group back in 1993 with seven people and our whole purpose was to be able to contract for ourselves in a metroplex. That group grew as time went on to basically 90 doctors in North Texas and we did all our contracting, we did all of our delegated credentialing, and we really found that we were fairly successful at that time.

But as time has gone on and the Fee for Service Model was beginning to wane, we needed to grow and we thought if we expanded to the State we would have much more leverage.

So I went and recruited physicians in the large markets, other places, and the last about three or four years ago we were at 260 ENTs statewide. The largest group in the country. The largest single specialty group in Texas and we thought we had the cat's meow.

And only what we found out was we had absolutely no leverage. So at that point, we had to re-trench and try to figure out, "How can we make this work as the future of medicine changes?" Especially more towards the pay-for-performance model or the value-added model. So I brought in literally about 14 different specialists and a primary care physician and we sat at a table every month for about two years. And we finally landed on the fact that we could do an ACO and have the very first product in the marketplace that not only had primary care physicians but specialists.

So on January 1st, 2015, we kicked off our ACO with about 90 primary care physicians and maybe roughly a couple hundred specialists. In that year we were managing 10,000 lives with Cigna and we were very successful. So we literally went from kind of a small fish to a whale in about one day.

This past year we've kind of come back down to what, 300 or 400 primary care physicians and probably 800 specialists, 700 specialists something like that, and we are performing well in the marketplace.

And that's something that sets us apart from everyone. And so, as we move forward this particular model is, we think it will expand and we think specialists are gonna play a bigger and bigger role in this because we have to engage them in order to really contain cost.

As time has gone on we've refined what we're doing, we can track patients in real-time, and we can start looking at targeted places for these patients to go where we know there's cost-efficiency. And, not only that, we can actually sort of we've been able to monetize our data for the very first time ever.

And that's something that sets us apart from everyone. And so, as we move forward this particular model is, we think it will expand and we think specialists are gonna play a bigger and bigger role in this because we have to engage them in order to really contain cost.

I can only say that this should go, the sky is the limit on this, and it's exciting for us, and it's exciting for the specialists, and it's exciting for the primary care physicians because for the first time they now don't just hand someone a card and say, "Please go see this guy." And then everything disappears.

For the first time, it's all gonna be literally, basically following an entire episode of care from the day that person sees a primary care physician until the day they're done with the specialist. So, this is really exciting for us.

 

The Role Independent Physicians Play In Lowering Healthcare Costs

What we've already figured out is that once you're owned, or owned by a facility, or owned by a large venture-capital group or a hospital group the cost of that care stays at 20% above an independent physician. No matter what they're having to drive, they're not as efficient, they're having to pay for more bureaucracy and more infrastructure whereas the independent physician is typically sitting in an office like mine with three or four employees. And if we're not cost-efficient and we're not doing a good job, someone walks down the street and goes and sees someone else.

So what we've learned is that we are the most cost-effective part of medicine. If we don't save us as the balance in the system, then we basically may as well go to a one single-payer system. I got to train in London and I've seen what that is and I don't think that we really want that.

So what we've learned is that we are the most cost-effective part of medicine. If we don't save us as the balance in the system, then we basically may as well go to a one single-payer system.

There was not a CT scanner in my hospital. There was no MRI machine in the entire British Kingdom and here we were, this, now you come back to the United States there's a CT scanner and an MRI machine on every corner.

Well, who's paying for that? So we don't necessarily need all of that but we still have the best healthcare system in the world, but we don't wanna destroy it. Save the independents and we will provide a really good alternative. 

This is really the future of medicine. Everybody's been clamoring for a way to contain costs in the system, yet no one's ever engaged us. If someone would come and ask me, I have a solution to the problem. The problem is that unless you incent me to change I'm not going to.

My behavior after 30 years of practice is pretty well-ingrained, but if you incent me to change my behavior because I'm independent I can do that and I can steer to wherever the best place to go is.

The Future of Medicine

This is the future. If we do this and do this successfully we will drive down the cost of medicine across the country and make it more efficient, and make it so that really the guys that are doing a really good job are highlighted in the system, and that's the way it should be.

No offense, it shouldn't be the lowest common denominator. If you do a good job and you're practicing good medicine, you're cost-efficient, you should be paid well for that.

We have to save who we are and we truly are the answer. If someone will engage the independents and keep us alive and make it worth our while to stay independent, we can actually take care of the system. We can drive 20% to 30% of the cost immediately out of healthcare and really do a good job with it.

Scott: Dr. Moore, thank you so much for that insight and story of the TXCIN Network. And friends, I hope today that you gained a better understanding of the impact that you have as independent PCPs and specialists. There's a huge place for independents in healthcare and I mean you.

Remember, if you have questions utilize your PS2s. They're there to help you be more successful and make you stronger along this journey. Ya'll have a great day and keep the mission rolling.

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