The November/December Healthcare Innovation cover story examined a broad range of leadership and strategic issues around the current trends reshaping the U.S. healthcare delivery system, as the system overall shifts being operating on a volume-based payment system to operating on a value-based payment system. As the cover story noted, the COVID-19 pandemic hit hospitals, physician groups, and integrated health systems hard at a time when many organizations were actively shifting forward into value.
For the leaders of the most advanced multispecialty medical groups, however, recent experiences predating the pandemic actually reinforced learnings; for some that already had a significant percentage of their revenues coming from risk-based contracts, the pandemic’s hit on patient volume was not as devastating, since their percentages of volume-based revenues had already been reduced.
Among those highly advanced multispecialty groups is the 1,700-physician Summit Medical Group, based in Berkeley Heights, New Jersey, and which serves communities across northeastern New Jersey and in the New York City metro area. Jeffrey Le Benger, M.D., Summit’s president and CEO, noted in an interview with Healthcare Innovation Editor-in-Chief Mark Hagland in September, that his organization had survived the spring and summer relatively well. Hagland spoke with Dr. Le Benger regarding the current moment for medical groups, and near-term and longer-term future of multispecialty medical groups in the emerging U.S. healthcare landscape. Below are excerpts from that interview.
What were the earlier months of the year like for your organization, as the pandemic hit the healthcare industry?
We’ve managed through COVID extremely well. When the pandemic hit, we set up tents on the outside, we screened every patient, PCR-tested every patient; we saw over 1 million patients coming through for testing, and we still have amazing volumes coming through CityMD, and have arrangements with New York City to manage that as well. [In August of this year, Summit Medical Group merged with CityMD, the leading urgent care provider in the New York City area. As a press release published on August 13 announced, “CityMD, the leading urgent care provider in the New York metro area, and Summit Medical Group, one of the nation’s premier independent multispecialty medical practices, today announced the completion of their merger – the first-of-its-kind between an urgent care provider and an independent physician-owned multispecialty medical group. The combined organization, which has more than 1,400 providers, over 6,400 employees, and nearly 200 locations in New Jersey and New York, offers patients a full spectrum of high-quality primary, specialty, and urgent care.”]
What level of volume is our combined organization at right now?
In our urgent care line of business, CityMD, we’re at about 170 percent of where we were last year at this time, and that’s because of COVID. And we have partnerships within the New York City metropolitan area to provide services for that. And the patients like our model of care. We have over 135 CityMD sites, by the end of this year, in the NY metropolitan area. For our integrated healthcare model, our volumes decreased 60-70 percent when it occurred, but literally within one day, we were able to go from maybe 20 virtual visits, to maybe 4,000 virtual visits. It took us from June to the end of August, but we are close to 100 percent of our pre-COVID volumes.
What percentage of patients are currently seen virtually?
Probably less than 5 percent now. We’ve architected our services to meet the full range of needs. We screen everybody. And we have a virtual waiting room, where we have texting-based communications established for when they come into the office. We have air handlers to circulate the air. We have the correct amount of PPE. And we still have PCE screening for oncology. I have to give credit to Dr. Terry Le Benger, my brother, an allergist/immunologist, for putting the right protocols in place; our group has an 88 NPS score from our patients.
Looking more broadly at the overall medical group marketplace, how are you seeing the landscape evolve forward?
Nationwide, I think that physicians are going to see major consolidation in the marketplace. Unfortunately, for physicians who aren’t part of a larger group or system, they really have to ramp up their volume to make ends meet. Their reimbursement is low, their costs continue to go up, and the data analytics they need to run their practice, are unbelievably expensive. Hospital systems want to fill beds and increase ancillary-based reimbursement, and want to consolidate. Only certain systems really integrate; most hospital systems just want to consolidate.
Payers do try to execute on the clinic model and have been somewhat successful, but you are somewhat beholden to shareholders. So we have an option here, and have pursued it—these physician-run practices. In the New York City area, it’s us. In Chicago, it’s the DuPage Medical Group; In Houston, it’s Kelsey Seybold. I do think that you will see consolidation occurring in the marketplace, and it will continue. And it’s probably for the best. And hopefully, it will create a truly integrated system; and the total cost of care will be controlled. And until the bricks-and-mortar is just a cost center, you’ll never see a decrease in cost structure.
We will continue to consolidate, which for us will increase our integrative methodology. It takes a little over a year to change culture and behavior when groups come into an integrated methodology. It might be naive, but I still look at the group as a family, and how we are collegial, and how you reach consensus within the group. So I think we have the ability to grow within the New York City metro area. And our model is always this hub-and-spoke model, focused on the ambulatory sector. And we’ve invested heavily into an algorithmic chronic care model, to really manage our sickest patients. And that is beneficial for the patient and the employer base as well as for our company, but really for the patient. Patients want to be seen outpatient, and they really want access.
This shift into value will only continue to intensify, correct?
Yes. There’s pay-to-play, when you get paid by filling out forms and pursuing certain forms of quality. Then you move up towards a shared-savings model; and then a fully capitated model, where you own the premium. I don’t know that we’ll ever get to that fully capitated model in the NYC area. In MA, we’re doing that now. In the commercial marketplace, it’s going to be slow.
Would you ideally like to be fully capitated in the commercial space?
Yes, where we have the capability to do so, I would love to move to a capitated product. We’re already doing that in MA [Medicare Advantage]. Right now, in the New York metropolitan area it’s still a fee-for-service world; we have to beat the cost of care to compete. And we’re doing that.
Do you have any advice for leaders of medical groups that might follow you?
You have to have fortitude; you have to have perseverance. You need to develop a consistent model as best as you can, within your group. And when you negotiate, you have to open up your eyes and see the truth. And what my father always told me is, it’s better to get 50 cents than no cents. You have to be careful when you grow. And how you grow, and cover your expenses, matters, and you have to have a really good finance department to be able to weather the storm on your debt or on growth. I’ve seen it very, very often: you commit to grow very fast but don’t know how to manage your debt. You need to continue to offer a quality product, and continue