Riding High in Colorado – Practice Deals Effectively with Managed Care

Practice Deals Effectively with Managed Care

With nine neurosurgeons, Rocky Mountain Neurosurgical Alliance (RMNA) is the largest neurosurgical group in Colorado, and one of the largest non-academic groups in the Rocky Mountain West. We have found that a larger practice has enabled us to develop a greater degree of individual focus and expertise. We have been able to build very active multidisciplinary brain tumor and movement disorders programs and cutting-edge complex spine, radiosurgery, vascular, and neurotrauma programs.

This paradigm allows us to participate in leadership positions in national, regional and state neurosurgery organizations, which we view as key to the future of our specialty. We are able to engage in community service and have a strong commitment to the medically underserved. A senior partner, Gary D. VanderArk, MD, takes the lead role through Doctor’s Care and Colorado Coalition for the Medically Underserved.

Our goal is to provide the best general neurosurgical care for our own community, while providing superb, accessible and responsive tertiary neurosurgical services to other communities in the Rocky Mountain West. We endeavor to build good relationships with other neurosurgeons in our region by helping them keep general neurosurgical cases in their own hospital while serving as their preferred tertiary resource option for more difficult or unusual neurosurgical problems.

Key affiliations. RMNA has always had a close affiliation with the Colorado Neurologic Institute www.thecni.org. Since its inception by Dr. VanderArk in 1988, this non-profit community-supported neurologic institute has become one of the largest, most complete neuroscience centers in the region.

We also enjoy a close affiliation with Craig Rehabilitation Hospital, a preeminent National Model Brain Trauma Rehabilitation hospital dedicated to the care of the brain and spinal cord injured patient. These affiliations allow for ample opportunity to develop research and clinical interests in a multidisciplinary environment.

Managed care strategies. Working in a rapidly growing community with a very high proportion of managed care, we have learned to work at maintaining an aggressive business posture, careful contracting practices, and most importantly, tightly monitored practice management data. The entire group reviews income, overhead, new contracts and receivables (including claims aging) monthly.

When individual contracts come up for renewal, we are able to come to the negotiating table with hard data on the managed care company’s performance. We have found our best contracts to be those we negotiated ourselves. To this end, we have abandoned affiliations with independent practice associations (IPAs) in favor of direct contracting with payors. We have found it useful to include our own provisions for hot buttons such as timely payment and strict adherence to nationally accepted coding standards such as the “Correct Coding Initiative.” We work diligently to exclude “boilerplate” provisions that we find unacceptable.

In some instances, we have had to temporarily resign from participation in managed care plans to successfully effect the contract provisions we sought. In addition, we have carefully cultivated relationships with hospitals and hospital systems and entered into several contracts for providing neurotrauma services for trauma centers. Such contracting practices have allowed us to maintain a positive cash flow and the fiscal leeway to bring on additional partners for practice expansion into other localities.

Investment initiatives. The infrastructure required to maintain superb data management across multiple practice locations, such as high capacity servers and T1 Internet connections, has been our largest capital outlay. It has already paid significant dividends by increasing our business office capacity and efficiency. We have recently spun off our practice administration as a separate management services company that provides cost-efficient coding, billing and practice management services to several other surgical groups. This further improves our own cash flow and produces good will: we have been able to increase collections in other practices by as much as 30 percent over baseline.

By developing a culture of excellence in a multidisciplinary environment, a private practice can participate in much of the best of the academic world, such as research, teaching, presentations and organized neurosurgery. By adhering to an aggressive private business model, the practice can maintain flexibility, independence and security in a rapidly changing economic environment. Rocky Mountain Neurosurgical Alliance has worked to achieve the best of both worlds.