Tennessee Women's Care, PC is a quiet leader in Nashville's women's health market. Founded as Women's Health Alliance in 2003, the practice has grown from 20 practitioners in four locations to 34 docs in 15 care centers across the midstate. TWC also offers bone density scans, lab services, a mammography center and a laborist company that staffs hospitals 24/7.
Going it Alone - Together
TWC's ability to thrive independently is something administrators don't take for granted. In 2011, TWC was one of eight Nashville medical practice groups to create Health Innovation Specialists, a new collaborative physician network that included Anesthesia Medical Group, Tennessee Orthopaedic Alliance, Urology Associates and other thriving practices. "We all wanted to stay independent but work together," said TWC CEO Tammy Pearson. "We created Health Innovative Specialists as a group of single specialties who wanted to make sure patient care remains our focus and not the bottom dollar."
Smart Growth
"Intentional" best describes TWC's steady growth. "Our goal is not to conquer an area so we concentrate on keeping our focus as a true women's specialty," Pearson said. That means constantly looking at changes in Nashville's market and sometimes altering growth plans based on patient requests.
In the past year, TWC's market has expanded into Franklin and Cool Springs. Their physicians have privileges at Saint Thomas, TriStar Summit, TriStar Centennial and Maury Regional. Altogether TWC providers see 1,200 patients a day.
"Provision of care is our focus, and providers are very good about listening to patients," she said. "They understand that relationship is the most important thing and pride themselves on building those."
Spend Where it Counts
In an era of practice consolidation and provider buy-outs, Pearson said staying independent means establishing the right leadership that allows physicians to see patients and keeps them out of the billing, hiring and contracting game. "The business components consume so much these days that unless you have experts in that area you'll fail," said Pearson, a nurse and former hospital CFO. "Providers must be willing to pay good money for someone who knows what they're doing and let that happen if they want to stay independent. Get the right administrators and pay them appropriately. They're well worth their salt if they get you expense and revenue management."
At TWC, providers can focus solely on patients because of smart financial practice management. Being a debt-free company also allows providers more flexibility and increased cash flow. "We want to make sure physicians get the most optimal return on their investment, which is their time," Pearson said. "We want to be respectful about where and how they spend their time and eliminate as many conflicts as we can for them."
Avoiding Practice Management Pitfalls
A veteran healthcare consultant, Pearson said there are several common mistakes she sees in practice management. Groups often grow for revenue enhancement, and the desire to grow is often one-sided, lacking the realization that revenue is two-fold - what you have coming in and expense management. "We plan deliberately," Pearson said of TWC. "There's no business venture we go into where we haven't already decided worst and best case scenarios."
Another common mistake is a lack of realization that give and take is necessary. That means not every physician will win exactly when they want to win, but they won't lose either thanks to the cyclic nature of healthcare. Groups won't always "win" either, and Pearson said it's troublesome when administrators mistake "winning" for dominating the field. Winning takes on different connotations, Pearson said, and all parties should have fair and equal balance. "If you think you always have to be aggressive to be on top, at some point you will not be solicited and will become the bully in the market," she said. "Business needs to be fair to everyone because we're all here for a particular reason." That means there's value in every practice, from one provider to 100.
To Sell or Not to Sell?
While the lure of a big-name buyout might be enticing, the grass isn't always greener. "One of the things we as administrators know about is how to get physicians to move, and many administrators will push them to be scared," she said. Unfortunately they often don't realize that's what is transpiring; and if they don't have the right resources, they can make a decision that's not in their best interest. Pearson noted if physicians are pushed to make decisions about selling quickly, they might be ready to file for divorce once the brief honeymoon period is over.
So what should a provider look at when deciding whether to sell? "The primary focus doesn't need to be about cash, but what do you expect in your lifestyle, and what are you willing to compromise on to make 10 percent more income?" Pearson said. "If it's about insurance reimbursements, those can change tomorrow so providers need to figure out if that small margin in income is worth giving up autonomy. Don't assume what someone else is telling you is correct. That's the biggest misconception for practices."
Finding the right business manager can help a provider stay independent as long as he or she desires. For many providers, that extra expense is well worth the ability to maintain autonomy. "Being a provider is a service line business - it's you someone wants to see," Pearson said. "You can consolidate, but that doesn't mean you'll rob Peter to pay Paul."
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