Asked and Answered

 Mark Wilson on the ACA and ‘Supergroups’

By Steve Thorpe
sthorpe@legalnews.com

With the arrival of the Affordable Care Act, physicians are re-examining the way they do business. One available option is the “Supergroup,” often containing  50 to 100 physicians with different practices who agree on joint guidelines. They then contract with insurance companies so that the physicians can control more of their cost and quality, with hopefully a positive impact on their patients. Mark E. Wilson of Dickinson Wright has represented large medical complexes and outpatient facilities and assisted in the formation of one of the largest physician-owned multi-specialty outpatient surgical centers in southeast Michigan. He has also represented a variety of medical practices in the acquisition, development, construction, or operation of medical offices, free standing dialysis centers, vascular access facilities, urgent cares, laboratories and surgical centers.

 

Thorpe: What is a “Supergroup?” 

Wilson: Supergroups are really common references larger scale group practices. They can range in size from 15-200 physicians all in the same practice. Many times they are set up in divisions based on specialty or geographic location.  

Thorpe: What challenges posed by the ACA (“Obamacare”) are addressed with such a group? 

Wilson: Although cited by everyone, ACA is really only a part of the future of medicine. The ACA part deals with expanding insurance coverage. The bigger changes are efforts to lower the overall cost of medicine. These Supergroups are formed in such a way that they can retain their individual doctor-patient culture but join forces to find medical practice quality and efficiency measures to lower the cost of care. 

Thorpe: What are the other benefits of the entities? Sharing overhead? Economies of scale? Clout? 

Wilson: The greatest benefit is the shared goal of increasing the quality of integrated patient care while lowering the costs. This does not mean cutting corners on care as that will only drive up the medical costs. It is about allowing physicians to find the highest quality care at the lowest effective cost. A solo or two person practice will not have enough clout to accomplish this on their own however by banding together with other like-minded physicians, they can in effect change behaviors by using  the most efficient quality providers in the market place. This would include all levels of care. 

For example, one trend is making available for use patient-specific urgent care operations or extended office hours rather than emergency rooms. It may mean the supergroup will compare each hospital to find the highest quality efficient in patient care for a particular treatment. No one institution can be the best at everything. Supergroups retain their independence to find the best efficient care for each particular patient. 

 Thorpe: How does the patient benefit? 

Wilson: Patients have a tough time being a consumer in the health care market. They don’t want to go to a cheaper place only to have a more severe health problem. The closest and strongest bond in the medical world is between a doctor and his/her patient. If you think about it, every patient trusts their lives to their doctor.  The doctors, however, know where the best treatment intersects with the lowest cost. Making the physicians accountable for the quality and cost of their patients will allow patients to participate in the health care marketplace with more confidence.  

Thorpe: Critics say that leaving a Supergroup can pose problems, including possible non-compete clauses and difficulty accessing records. Agree? 

Wilson: That’s an interesting question. In fact, the two seemingly diverse concepts of non competes and difficulty accessing records can become intertwined. Some groups look upon the establishment of an comprehensive electronic medical record system as a way to retain business. They are hoping that if it is easier to access records at one place and make it difficult to transmit it elsewhere, the patients will go where the records are stored for fear of not having their records accessible somewhere else. 

One of the most straightforward ways to cut costs is for government/insurance payor mandates that health records be accessible by all providers. You can go to an ATM machine anywhere in the world including your neighborhood service station and access your financial records. The same concept should be true for health records. Like ATMs with the proper safeguards patients should be able to provide their complete medical record to the highest quality lowest cost provider sanctioned by the physician no matter where the care is given.

Thorpe: Any other possible physician responses to the “new world” you see on the horizon? 

Wilson: There is  a whole host of changes going on in the health care industry. The drive to efficient quality care is coming in many forms. The market will adapt to the changes in insurance mandated by ACA and the Supergroups will be a part of that change. The hope is that the bedrock of the free market system championed in America will be allowed to develop the forward thinking health delivery systems necessary to increase quality and lower the costs  to make it sustainable for everyone in the future. 

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