West Suburban Neurosurgical Associates
Location: Hinsdale, IL
Neurosurgeons: Robert P. Kazan, MD, Daniel J. Harrison, MD, Anthony DiGianfilippo, MD, Stanley W. Fronczak, MD, JD, and Ofer M. Zikel, MD.
Neurosurgical Capability: All adult neurosurgical services including heavy concentration in skull base and acoustic neuromas; brain and spinal cord tumors; pituitary surgery; complex spine with all instrumentation techniques; radiosurgery and neuroendovascular radiology.
Practice History
Our group started 50 years ago. The founding members decided that geographical diversification was desirable not only to capture the most interesting cases but also to be on multiple hospital staffs to protect against political and economic shifts. As a result, our group provides care to a whole county as well as some of the western Chicago hospitals. One hospital (Hinsdale) is our center of excellence with full and the most sophisticated technology including a neuro ICU, a dedicated neuro floor, neurological nurses, neuronavigational and 3-D computer analysis preoperatively of aneurysms and AVMs. Members in our group traditionally work in several hospitals during the week, and emergency weekend coverage is provided to all the hospitals by doctors on call. Periodically, hospitals are dropped or added depending on how many cases they provide to the group practice.
Business Philosophy
We employ a sophisticated analysis of our practice universe. Ongoing ranking of our insurance contracts is done to determine the percentage of our time spent with each company’s enrollees, how much they pay relative to the market and what is the time value of collections (30, 60 days or more).
We are also interested in ease of dealing with payers. Because we have so many contracts, if any of the studied companies reach a critical mass of negative ratings, they are dropped from the practice.
Business management requires a certain discipline that is similar to investing in the stock market. To continue to serve a medical contract that pays poorly, holds back payment (uses the float) and requires constant calling by office personnel is counterproductive. Instead of trying to do everything it is better economically to eliminate some of this exposure. The group does fewer cases but makes more money and the additional time can be spent reading, studying and preparing lectures or simply by spending more time with our existing patients.
Bargaining Tools
Many neurosurgeons are “babes in the woods” compared to their counterparts in business and the insurance industries. They accept terms that other business people would deem laughable and that is why they are taken advantage of so easily. We need to understand that there are some businesses who produce products that payment is required C.O.D. (cash on delivery). No payment-no service!
As physicians we are inclined in our treatment of patients to give wide latitude to payment. We have a humanistic side. This is something we need to maintain. But we need to remember, for our own health, that in business every advantage must be realized. If there is a way to make money from weaker, less sophisticated players, it will be done. And, anyone watching health insurance markets over the last 10 to 15 years knows that we’ve been “had” in many ways.
One technique that will work if a group is a major provider for an area relates to “out of network.” If a company will simply not negotiate a fair contract, a group may have to withdraw. Obviously, people from that company-insured pool will need to have emergency services. When that occurs, the “out of network”y; situation provides full payment by law of the neurosurgeon’s listed fees. One case of this type may equal three of the cases ordinarily reimbursed under the poor insurance conntract. Amazingly, some trauma surgeons have dropped all insurance contracts and operate “out of network” because of the legal requirement that they be paid on emergency cases. It won’t be long before the insurance companies come back to negotiate a better fee schedule. This is leverage-a valuable tool in negotiating.
Secondly, nothing substitutes for a numerical analysis. It used to be thought that insurance companies would work with people that provide only high quality. But there are many high quality neurosurgeons in our society, so cost does become an issue. Groups with low complications, fewer re-operations and shorter length of stays will be favored, especially if they can prove it.
Future Practice
We know the science of neurosurgery will advance. All of us continue to learn new ways to better care for our patients. This is exciting and that’s why we are neurosurgeons. Supply and demand is in our favor. We are in demand. Without that we have no negotiating power. Along the way, unless we fall to the inefficiencies and delays of a national health system, we must learn the rules of engagement of a competitive business world. Our prosperous future as scientists, surgeons and business operators depends on this.
Robert Peter Kazan, MD, is President of West Suburban Neurosurgical Associates.