Consolidation brings strength in numbers, culture shifts

A panel comprised of a highly experienced health care consultant and two group practice leaders finds that large group practices are likely to be one of the few entities allowing urologists or other specialists a refuge from the current chaos in the American health care system.

Dana Jacoby, a senior consultant with BSM Consulting, Incline Village, NV, told Urology Times prior to addressing the Large Urology Group Practice Association annual meeting in Chicago that, "In the past 10 years there has been a consolidation of medical practice across the nation and with that consolidation has come some great things. There is strength in numbers. Groups have a bigger footprint in third-party payer negotiations. They are able to offer integrated care. Overhead can be shared."

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But there are challenges, she added.

"These doctors came together under one tax ID, one financial understanding, and a legal understanding, but the culture, compensation, and other things that would move them from a group of successful doctors to a successful medical group requires different values, a kind of mind shift if you will. Some groups did not realize what a rigorous process this was going to be," Jacoby said.

She identified four characteristics of a successful large group: strong leadership; a healthy group culture conducive to collaboration; a sound balance of clinical, financial, operational, and vocational efforts; and a sense of responsibility toward the group.

"What has made Chesapeake successful is strong leadership and support from its physicians," Sanford Siegel, MD, president and CEO of Chesapeake Urology Associates in Baltimore, told Urology Times. Chesapeake, consisting of 57 urologists and 500 employees in 21 offices across Maryland, is thought to be one of largest group practices in the mid-Atlantic region.

"A successful large group practice has an infrastructure that supports its physicians and allows them to do what they do best: take care of patients," Dr. Siegel said.

Alan Krieger, MD, is president of the Urology Group of New Jersey, a group of 25 urologists in offices across New Jersey.

"There is no question that turbulent times are coming,” Dr. Krieger said. “People were anticipating change, but that change is happening so quickly that it is really hard to forecast what's going to happen next.”

Trust is essential to surviving the turbulence, said Dr. Krieger.

"Members have to trust each other and their leadership. Without trust, there is no foundation to build on and other aspects of success cannot be implemented. You don't want to be your worst enemy. We have to keep groups from falling prey to factionalism," he said.

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