I am the CEO of a physician-owned health system with facilities in southwest Missouri and northwest Arkansas. Our organization is unique in many ways. Its uniqueness provides an opportunity to test assumptions often made about this country's healthcare system and the path reform should take.
We are a for-profit organization providing care to a high percentage of patients covered by government programs in a region dominated by large charitable health systems that vie to control the commercial insurance market. Approximately 80% of our patients are on Medicare, Medicaid or Tricare or are uninsured. Even the federally qualified health center near our hospital in Springfield, Mo., has a higher mix of commercial insurance patients than we do. Unlike not-for-profits and federal clinics, we receive no donations, grants, subsidies or tax exemptions. Yet, during the past decade, we have grown from $7 million to $120 million in gross patient revenue with average payment no better than Medicare.
We have never sued a patient to collect a bill. We provide an across-the-board 40% discount for the uninsured based on our belief that those without coverage should never have to pay more than Medicare pays. We allow uninsured patients to pay what they can without having to beg for charity or fill out complicated forms “proving” they deserve charity.
Physician contracts do not include “no compete” or exclusive practice provisions and physicians can leave employment simply by giving 60 days' notice. Physicians are paid a fee for service without regard to payer source, risk of collection or practice overhead. Most of the owners are primary-care physicians (the organization employs about 50 primary-care providers), but referrals to our small handful of specialists are not sufficient to keep them busy and they see patients in “competing” systems. Our primary-care providers refer as much care outside the system as they do within it. They also simply make fewer referrals to specialists—no doubt a consequence of the composition of the original ownership group: general practice osteopathic physicians with a practice culture different than large systems dominated by specialists who consider primary-care providers mere “gatekeepers” whose main purpose is to feed referrals to the specialists.