First Choice Medical Group Positioned To Grow With The B.A.C.K. Center
By Ken Datzman, Brevard Business News // July 6, 2015
positioned to grow in the years ahead
To the tens of thousands of practicing physicians around America, the acronym “ICD–10” is a haunting thought. In reality, it’s a ball of fire fast coming their way, at a time when providers already struggle to navigate the murky waters of healthcare reform.
This much more detailed coding system — labeled a “clinical documentation improvement process” — will impact the entire health–care community, affecting virtually every business process and system in health plans, provider facilities, clearinghouses, and vendors.
Medical practices are scrambling to ramp up their operations to ensure their systems and business processes will be ready to go live on compliance day, Oct. 1.
The 10th version of “International Classification of Diseases” is set to be rolled out by the Centers for Medicare and Medicaid Services, or CMS. This is the newest coding system for healthcare professionals to code diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.
The system has been the talk of the industry for a number of years.
The implementation of ICD–10 is seen as a project unlike any that the healthcare industry has attempted in decades. The new codes on a claim will be used to classify diagnoses and procedures for billing to Medicare and private insurance payers.
One of the biggest issues with this upgraded documentation will be the level of specificity that physicians will have to abide by.
“This new compliance is going to increase the codes by tenfold on what a physician will have to do to properly code for a procedure,” said businessman Christian “Chris” Romandetti, the chairman, president, and chief executive officer of First Choice Healthcare Solutions Inc., which operates First Choice Medical Group of Brevard, a growing practice that specializes in orthopaedics, neurology, interventional pain management, and diagnostics.
He added, “There are some positives and some negatives of the new system, ICD–10. On the upside, CMS is trying to create a national database, as it relates to identifying underlying causes, complications of disease, and the conditions that contribute to the complexity of a disease.
But at the same time, there is a lot to learn. And the complexity of it all is coming to the medical community soon.”
The ICD–10 changeover was originally mandated in 2009, but has been repeatedly pushed back.
Meanwhile, by enabling more detailed patient–history coding, ICD–10 can help to better coordinate a patient’s care across providers, according to CMS.
Using ICD–10, doctors can capture more information, meaning they can better understand important details about the patient’s health than with the previous ICD–9. Moreover, the level of detail that is provided for by ICD–10 means researchers and public health officials can better track diseases and health outcomes.
Romandetti says First Choice Medical Group of Brevard has stayed on top of the coming ICD–10 transition, just as it did for the practice’s changeover from paper to the electronic medical–record system. The government provides financial incentives to physicians for their practices to make the switch.
“We have fully complied on the electronic medical records front and the incentives have paid for some of our systems,” he said.
“But there are some great doctors out there in the community who do not want to deal with the growing compliance issues that impact their practices, and we think we’re positioned to provide them with another option.”
He continued, “We believe we could enhance their practices by having them be part of our centralized overhead, centralized compliance, and centralized billing and collection systems. Once you have everybody under one roof, you can go to the payers and bargain for better contracts.
Right now, the market is fragmented. A lot of physicians are standing out on the end of a branch by themselves, and it will be very difficult for them to meet the increasing compliance demands while at the same time, be great practicing physicians.”
Services and scales of economy are “where you have to go in this new health care business world. At First Choice, what we do is allow physicians to be physicians and practice medicine while we handle the business end,” said Romandetti.
Experts say the ongoing reimbursement decline coupled with rising regulation will place more pressure on individual practices to partner with other practices or larger health–care systems.
According to “Physicians Practice’s 2014 Fee–Schedule Survey,” the average commercial payer reimbursement for all new and established office visits fell nearly 9 percent between 2012 and 2013. Many administrators predict that this downward trend will continue.
“There is no question about it,” said Romandetti, “the practice environment is changing,” adding, “I don’t practice medicine, but clearly, I practice business and will hang my hat on my reputation. I think I practice business pretty darn well.”
Romandetti, a longtime area entrepreneur, has been involved in marina management, boat sales and other business ventures. He is the managing member of Marina Towers LLC in Melbourne.
He draws this business analogy: “You can go to the post office and overnight a package. They’ll do a good job and the package will get there tomorrow, or you can take it to Fred Smith (the founder of FedEx) and have it ‘FedExed.’ It will get there tomorrow, and he’ll make money.”
Romandetti added, “We think we’re the ‘FedEx’ of the medical business. We can do the job. We can do it right, and we can make money.”
A publicly listed company (OTCBC:FCHS), First Choice recently expanded its portfolio of Medical Centers of Excellence in the local market.
The growing regulatory burden and new complexities of health–care reform played a role in Dr. Richard Hynes’ decision as president of The B.A.C.K. Center, in collaboration with his physician colleagues there, to align the longtime practice with First Choice Medical Group of Brevard.
First Choice, through a newly formed wholly owned subsidiary, TBC Holdings of Melbourne Inc., entered into an operations and control agreement with Brevard Orthopaedic Spine and Pain Clinic Inc., known in the region as The B.A.C.K. Center, or “Back Authority for Contemporary Knowledge.”
The practice, nearly 35 years old, has locations in Melbourne and Merritt Island.
The Melbourne facility of The B.A.C.K. Center has available space to readily expand the practice’s medical operations to support the addition of new physicians and care specialists.
“With our current capability, we feel like we have a nice range of services available and we are not competing with one another,” said Romandetti.
“The B.A.C.K. Center was not doing any general orthopaedics. The B.A.C.K. Center focused on the spine segment of the market and we focused on the sport segment, so they complement one another.”
The physicians at First Choice Medical Group Center of Excellence on South Harbor City Boulevard provide a full line of services, including shoulder reconstruction and total joint surgery. They also treat elbow and hand injuries, knee injuries, foot and ankle injuries, movement disorders, and cartilage preservation and restoration.
Dr. Hynes, a board–certified orthopaedic surgeon, recently commented on the deal, saying, “We have witnessed and strongly admire First Choice’s success with First Choice Medical Group and appreciate the enhanced quality of life and streamlined business practices that its proven business model offers medical–care providers — particularly those of us who would much prefer focusing our energy, time, and efforts on caring for patients, rather than being consumed by the complexities of new health–care regulatory reform coupled with other business challenges related to running a large, successful medical practice in today’s environment.”
Dr. Hynes will serve as the medical director, responsible for coordinating and managing the professional medical services of The B.A.C.K. Center. Together, the two entities expect to “administer” roughly 100,000 patient visits this year. Dr. Hynes calls the First Choice business model “the wave of the future in private medical practice administration.”
The First Choice family now has nearly a dozen physicians and six “physician extenders.” The MD team includes Anthony Lombardo, Donald Vliegenthart, Richard Harrison, Richard Newman, Roberto Saucedo, Lawrence Zeff, Devin Datta, Steven Ortiz, Farhan Zaidi, and Hynes.
“We have offers out to other physicians in the area, too, about joining our practice,” said Romandetti. “We are looking to round out our group with the ‘best–in–class’ surgeons in the region. These surgeons know who they are.
And even better, the patients know who they are. We have some really outstanding physicians in this community,
and some are single practitioners.”
First Choice is also seeking out opportunities to bring other practices under its Medical Centers of Excellence umbrella, he said.
“Right now, there are two facilities in Florida that we are looking at. They are in different counties. But we still think there is opportunity to grow in Brevard County, because many of these office–based practices do not want to be bogged down with regulatory paperwork.”
Medical practices are increasingly being forced to allocate more staff resources to manage new government regulations and processes, many of which are the result of health–care reform.
Doctors say the practice environment has become a jungle of complex and overlapping requirements. They cite current Medicare programs — such as “Meaningful Use,” which is using certified electronic medical–record technology, and “Physicians Quality Reporting System” — as forces detracting from time spent with patients.
Medical practices responding to the Medical Group Management Association’s 2014 “Cost Survey Based on 2013 Data” reported a 4.6 percent increase in spending on total business operations staff per full–time equivalent physician over the last year.
The report includes data from more than 2,500 groups and is touted as the “largest and most robust cost survey and benchmarking tool in the industry.”
Recently, First Choice reported profitable results for the first quarter of the year, with revenue rising 12 percent.
“Our Medical Centers of Excellence platform continued to demonstrate that our operations are materially benefitting from key efficiencies that we have continued to implement over the past year,” said Romandetti.
First Choice is positioned in one of the fastest–growing segments of surgery — orthopaedics. Just one piece of that market, total hip replacement, nearly doubled among middle–aged patients between 2002–2011, primarily because of the expansion of that particular population in the U.S., according to a study presented at the 2015 annual meeting of the American Academy of Orthopaedic Surgeons.
In 2011, 42.3 percent of total hip replacements were performed in patients age 45 to 64, compared to 33.9 percent in 2002. This trend is expected to stay in place or expand for years to come.
There are several reasons for the anticipated increase in total hip replacements and total joint replacements: an aging population with arthritis requiring joint replacement; the increasing prevalence of obesity, which puts undue stress on the knee and hip joints; and the trend toward baby–boomers remaining physically active later in life, which also places demands on the joints.
“We think the growth trend in orthropaedics is going to continue for a number of reasons,” said Romandetti.
“For one, the Affordable Care Act has opened access to a new segment of the population (25 million) that previously didn’t have health–insurance coverage. We have literally watched hard–working people, including roofers and masons, finally be able to have knee surgery, hip surgery and shoulder surgery at First Choice Medical Group of Brevard.
“They have put this off for years because of their lack of health insurance. So, with all the different dynamics going on in the market, we believe we’re well positioned to grow in the years ahead with our model,” said Romandetti.
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