Under Physician-Led Management, the Patient is King

The journey to wellness can be a long and complicated one, from emergencies to hospitalizations to post-acute care. That’s why Vituity’s physician-led culture puts the patient at the center of every decision we make.

In today’s post, you’ll hear from Douglas Brosnan, MD, JD, Director of Provider Relations for Vituity. Dr. Brosnan discusses why the patient is king in a democratic, physician-led partnership practice.

Tell us about your career path and how you chose Vituity, Dr. Brosnan.

Dr. Brosnan:  In residency, I had heard good things from my professors about Vituity — the value of physician-led practice, equal ownership, and open books.

They also warned me of the abuses prevalent in the community among contract holders and corporate entities trying to commoditize the hard work and passion of physicians.

Vituity made me feel not only welcomed, but also embraced. As a physician-lawyer, I had a unique vision for my career; Vituity not only accommodated this vision, but created opportunities to get me closer to it.

How does Vituity’s physician-led management structure differ from other physician employment models?

Dr. Brosnan:  Vituity operates under a partnership model in which all physicians have the opportunity to become owners. As such, they share both the group’s profits and the responsibility for its success.

Our core mission is caring for patients, and that means we expect all of our Partners to put their patients first in every decision they make. This tends to incentivize engagement, with physicians going the extra mile to care for patients, innovate new processes, and lead quality initiatives. It allows physicians at each hospital site to call the shots when it comes to patient care, workflows, productivity, and work schedules.

This is much different from hospital employment or employment with a corporate management group.

Under hospital employment, physicians sometimes lack autonomy in their jobs, with directives affecting their practice often coming from the top down. This lack of autonomy can stifle engagement and leadership.

With a corporate management company, the first responsibility is to shareholders. This can potentially create a conflict of interest between profit on one hand and patient care on the other.

Why is a physician-led management structure better for patients?

Dr. Brosnan: Under a physician-led management structure, our first responsibility is to help and heal the patient, which is the reason most of us went into medicine in the first place. Our goal is to provide high-quality and efficient care, good outcomes, and a superior patient experience. Those are the measures of our success. We’re not beholden to shareholders to meet certain financial projections through treatment or testing decisions.

We hear a lot about Vituity’s culture of caring. Can you describe what that means?

Dr. Brosnan: At Vituity, we foster a culture of caring, which is based on our belief that patients should be at the center of every decision we make. A culture of caring asks each group to consider the entire care spectrum, from the three-to-five days before the patient presents to the hospital through the crucial 60 days after they are discharged.

It means that even in the emergency department (ED), the staff is thinking about things they can do to make that patient’s hospital stay shorter. The hospitalists who later care for that patient constantly ask, “What can we do to ensure that this person has their best outcome and is safe to leave the hospital so that they don't have to come back? What resources are we going to put in place? What follow-up care can we help to coordinate?”

The New York Times recently published a story, “The Company Behind Many Surprise Emergency Rooms Bills,” that highlighted the results of a study on out-of-network billing. What did the study find?

Dr. Brosnan: The article detailed a study out of Yale University that primarily focused on one of Vituity’s competitors. Researchers found that the rate of out-of-network doctors' bills for patients of one large insurer jumped significantly when the acute care management and staffing company took over staffing for a hospital’s ED. The company’s out-of-network billing rate is 62 percent, compared to a national average of 22 percent, according to the study.

The Yale study proposed bundled billing as a solution to minimize out-of-of-network bills. What are your thoughts on that? 

Dr. Brosnan: Under the bundled billing proposal in the study, hospitals would negotiate ED payment rates with insurers and reach set prices that reflect the cost of both the physician and the facility. We don’t feel this is an ideal solution, because this could potentially create dissonance between the desires of hospital shareholders to meet financial projections and what is in the best interest of the patient — Vituity’s ultimate stakeholder.

No one wants to receive an unexpected bill. How does Vituity work with payers to minimize out-of-network bills?

Dr. Brosnan: Vituity’s physicians care for a combined 6 million patients annually, which allows us to negotiate with multiple national and regional insurers. This enables us to keep out-of-network billing of privately insured patients around 2 percent — far below the national average.

Our commitment to patients extends beyond the provision of high-quality, compassionate care all the way through the billing process. When a patient has a billing concern, we work directly with them to come up with a solution, whether it is setting up payment arrangements or simply answering questions about a billing statement.

To learn more about Vituity’s physician-owned, democratic Partnership model, visit our website.

Originally posted Nov. 15, 2017. Last updated March 6, 2019.