December 2018, Volume XXXII, No 9
Challenges and rewards of independent practice
Keith A. Oelschlager, MD,
Entira Family Clinics
Minnhealth Family Physicians was formed in 1986 with the merger of Bellaire and Maplewood family clinics. Afton Family Clinic joined in 1987, and Larpenteur Family Clinic joined in 1991. East Metro Family Practice was formed in 1995 with the merger of the Gorman Clinic, Inver Grove Family Clinic, Woodland Family Clinic, Arcade Family Clinic, and Maryland Family Clinic. Highland Family Clinic joined in 1999. Minnhealth and East Metro Family clinics merged in 2008 to form Family Health Services Minnesota. The name of Entira Family Clinics was adopted in 2012. We serve the St. Paul and east metro communities with 12 primary care clinics and two express/retail clinics located in Hy-Vee stores.
Independence allows us to choose what is best for patient care. We can choose the best hospital and specialty care based on the Triple Aim: quality, patient satisfaction, and cost. We are not limited to referring inside a large, vertically integrated system. Our constraints are those of the insurance plan the patient has chosen.
The largest challenge is financial. There are not deep pockets backing us up. The physician shareholders’ salary makes up the not-so-deep pockets that balance the books at the end of the year. Second, we do not have the luxury of a large analytics department to help with population management. Third, since we are not a nonprofit, new residents cannot participate in the government loan forgiveness program. Fourth, we do not have the size to negotiate more favorable contracts with insurance companies.
Independence allows us to choose what is best for patient care.
Knowing that we have some of the best quality metrics, the best patient satisfaction, and can provide care at one of the lowest price points in the state. Our physician management team all practices at least three-quarter time. This allows those who make decisions to be on the front line of patient care and make better care and provider decisions. Our staff take tremendous pride in caring for our patients, and are extremely loyal to the organization. Our providers are on clinical practice committees that develop our patient care strategies, rather than having a distant organization dictating these.
Joining Fairview Physician Associates (FPA) Network is part of our strategy to remain independent. It provides us access to a group of patients that are within their narrow network. Our contracts that will go through FPA will account for about 9 percent of our business. These contracts through FPA give us better reimbursement, which puts us in a better financial position. This is not the only collaborative arrangement we are part of. We have recently entered into an arrangement with North Memorial’s ACO (accountable care organization) that serves the Medicare population. We participate in an IHP (Integrated Health Partnership) with HealthEast to provide care for the Medicaid population. We also have strong working relationships with HealthPartners and Blue Cross and Blue Shield of Minnesota. We are playing the field to find the best way to provide care for our patients and the resources to remain independent.
I work out of the Vadnais Heights clinic. We have the clinic divided into teams that work in hallways, with workstations in line of sight of the exam rooms. With the electronic medical record, much of the communication within care teams uses that medium.
Our care teams consist of a physician, physician assistant (PA), or nurse practitioner (NP) working with a certified medical assistant (CMA). The PAs and NPs are supervised by the physicians in that office. These teams are supported by a care manager and medical home registered nurse. Communication between these team members is conducted via email and direct conversations. The team determines which team member communicates with the patients depending on the issue.
Family practice is unique in that we provide a relationship with patients longitudinally. It is not uncommon to care for three and occasionally four generations in one family. This puts us in the unique position to understand the dynamics of the family support or lack thereof. These strong relationships allow trust to develop and help during difficult times and when making hard decisions.
Family practice providers are trained to provide short-term counseling and medication management for many mental health problems. Many of our sites have a therapist or counselor present to assist in mental health concerns. Our care managers assist patients in finding mental health resources, when needed, outside of Entira.
We do not have resources to act as a social service agency. Our care coordinators assist patients in getting plugged into the local, county, or state agencies that can help them. We have remained committed to staying in underserved areas of St. Paul. Our newest clinic under development will be in one of these areas.
The enjoyment is the relationships. These include patients, clinic staff, and other providers. The solution to health care will not come from Washington; it will come from building relationships within the Entira family and then extending those relationships to health care systems and health plans. Through these collaborative relationships, we can reduce duplication of services and waste.
Keith A. Oelschlager, MD, is CEO of Entira Family Clinics, where he has practiced for 30 years. Board-certified in family practice by the American Board of Family Medicine, he is a member of the American Academy of Family Physicians and the Minnesota Medical Association. A 1979 graduate of the University of Minnesota Medical School, he completed a family practice residency in 1982 at Methodist Hospital in St Louis Park.