Strategies to gain strength in the size. . . The MSO Model
Now it's time to talk about elephant in the room " - Consolidation - and how practice owners can really integrate without sale their practices, avoid giving up any control of their businesses, and prevent the loss of culture that they value so highly. And if you are a budding entrepreneur who wants to open your own practice, you can see how you can do it and position your business for long-term success.
Consolidation. What does it really mean?
Consolidation. Everyone becomes more health care. Have you noticed in your market? Hospitals acquiring or merging with other hospitals? hospital systems acquire primary care practices or even some specialty groups? How about physical therapy space? of physiotherapy-business organizations are moving in down the street from you?
So what is your consolidation plan?
See other health care organizations around you get bigger and look for the PT business groups move in your market are certainly a concern, but they should not make you panic.
start with a simple definition. A consolidation business is when two or more business entities organized under a single tax identification number (TIN) with an agreement on purpose and direction, leadership defined with the authority of decision making and the responsibility.
A horizontal network of the same types of suppliers and independent practice associations (IPAS) are consolidations; they are quite fragile, fragmented and unstable groups of independent practices. They lack governance decision making and accountability, and they add little to no value to health plans or ACOs
Moving forward in our health changing market, owners of the practice independent therapy essentially have 4 options :.
- stay the course. continue to do business as usual and hope for the best than other providers to integrate and get bigger all around you. Or maybe you want to consider becoming out of practice network and not have to worry about the requirements of health plans and ACOs.
- Grow Your Own. If you have access to a lot of capital and have the business sense to open several clinics and to acquire other private practices, you can get great on your own.
- It's time to sell. maybe it is time to sell your business. You may be ready to move to another opportunity or another phase of life. Or maybe he's just the best thing to do .
- get big but stay small. The MSO model provides value to member practices and payers. It is a great way to practice to acquire the force of the size while maintaining independent ownership
Look at MSO -. Its structure, its services, there are challenges, its advantages, and example of how MSO Therapy Partners is engaged in a very successful model of value on the basis of a large plan health.
The MSO physiotherapy model and keys to success
MSO is a business model that integrates independent practice as a consolidated team under one contract TIN purposes with health plans and other payers. Practical maintain their property, brand identity, and their own TIN to other tax and legal purposes. The MSO provides centralized administrative services, including the management of the revenue cycle, payment processing, certification, and other tactical activities. The MSO brings value to payers and Member Practices
Although there are a number of factors that influence the success or failure of an MSO, 5 are absolutely essential :.
- Trust. owners of the practice of members and their teams have very confidence and MSO team.
- leadership. MSO executives and owners of member practices must provide strong leadership image and everyone must share the vision and direction of the OSM.
- teamwork. MSO team must work "hand in hand with each practice, and practice owners and their teams must see all other practices as an ally and their employees as teammates.
- liability. OSM must have someone who has the power to hold each owner of the practice and their teams accountable for achieving the expected results and performance standards.
- Workflows disciplined. The MSO provides centralized billing and processing of payments for members. Workflows must be defined, the members of the disciplined team, and managed results accurately
MSO organization and leadership -. It is a team sport
The OSM must employ a management team and staff. The management team includes those positions involving 1-3 people :.
- CEO This person provides direction, drives change, and develops the company MSO. This position is full time taking the full-time focus.
- COO. This performs operations chief, helps owners and managers with the management practice and holds responsible practices to produce the desired results and achieving objectives.
- CFO. Depending on the size and financial position of the OSM, a CFO can be hired to be responsible for financial management, data analysis, and the creation of models of care for risk. sharing contracts
according to the breadth and depth of services provided to members practice, the OSM employs :.
- CMO A Chief marketing officer who provides marketing services for practices.
HR Professional. The MSO can provide human resources management, including benefits such as Medicare. - Compliance Officer. The ACA places of regulatory applications more on suppliers. The MSO can provide expert high-level compliance to provide this vital responsibility for all practices. Manager
- relationships with customers. This person works closely with the owners of the practice and staff,
health plans negotiating team contracts, revenue cycle management providers, and other suppliers and customers.
- Business Support Manager. This manager oversees and participates in activities related to the processing and payment distribution practices.
- Payment Processing team. All payments for services provided by the members come to practice and OSM are processed, reconciled, posted, filed and distributed by the payment processing team. They depend defined workflows with checks and balances at every stage. Payment reconciliation must balance "to the penny" every day. The practice owners know how much was collected for them every day since everyone is on the same billing system with integrated EMR. Payments are wired to the weekly practices with daily and weekly reports of all collections.
- Revenue Cycle Management (RCM). Although the MSO can perform RCM internally, we strongly recommend outsourcing this complex process.
As you can tell by now, the OSM is really a team sport, and all practices should have input. Much of the decision making is done through collaborative efforts. Examples of MSO working groups are:
- BOD or Consultative Group The MSO must create a strategic decision to team with some of the owners of the practice the MSO executives, perhaps. an external member.
- Owners Group tactic. owners practice to collaborate and solve problems on tactical issues daily. This group offers all owners a chance to work together and collaborate for better practices.
- Other working groups. Organize various working groups not only creates consistent processes through practical, it creates buy-in staff members practices and helps build trust. Examples of these working groups are clinical desktop support group, career development, groups of clinical studies, reimbursement, and practice management.
MSO Services
In its most complete structure, an MSO should provide all the services of a practice of other needs basic reception duties related to the care of patients and patient care:
the benefits of MSO members
Here is my Top 10 benefits for members of the MSO Therapy Partners:
- size gets your foot in the door Consolidated size gets attention from health plans, and we have. advantageous rates negotiated for our members. In addition, leaders of health plans place a high value on the ability of the OSM to simplify the processes involved in outsourcing, communication, care management, claims processing and payments.
- Value keeps you there. The mission of MSO Therapy Partners is to offer a triple objective value, and we have created a culture that supports this mission. We promote our commitment to the Triple Aim, FOTO our results, and our willingness to share the financial risk. Thanks to the contribution of value, we have become not only a source for physical therapy, but a precious resources to Triple Aim solutions . delivery of value ensures long "seat at the table with decision makers in your market.
- The proof is in the pudding. Through a commitment to achieving FOTO high level results, a contract based on the value of a local health plan, and the process of training and well defined FOTO management, the CFI practices have achieved results very impressive used to promote practices with health plans, OCA, reference sources, existing patients, and their communities.
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We Got Big Small but stay. Therapy Partners MSO allowed the practice owners members to keep control of their companies as they have become part of a large, integrated organization, well positioned for long-term stability.
- Eats Strategy Culture for breakfast. Each member of the CFI held cultural value of owners and employees, and the TPI culture is aligned with practical crops.
- economies of scale. functions centralized business office OSM reduced operational costs for members.
- Value by technology. BMS, outsourced billing TPI 'partner', provides their effective billing and EMR technology for IPT members practices.
- Sharing and Caring. TPI team works closely with practice owners to measure productivity, teamwork, leadership, clinical outcomes, and change management indicators. owners and practice managers to share and compare the results with each other to create the best clinical practice and productivity criteria.
- The 'Edge' is leadership. Thanks to the leadership and development program of the 10-team session TPI - called The Edge leadership - team members in any position to learn and grow as leaders who see themselves as valuable contributors. This commitment of senior employees leads to greater success and growth in a difficult market practices.
- The Power of Focus. By centralizing many front and back office functions with the MSO, practice owners can focus on improving their management, new service development, building stronger community relations and growing practices.
the challenges of an MSO
Although there are some advantages of the MSO, there are also obstacles to overcome:
- A common billing system All members of the OSM must use the same billing system .. This creates efficiency and transparency, but it takes at least some practice to let go of their old system.
- integrated EMR. For efficiency and simplicity, the members of the OSM must use an EMR that is integrated to the billing system. This may require practical out of their EMR comfort zone.
- practices must renounce contracts Health Plan under their name and TIN. The MSO rolls up all contracts under their name and TIN. Some practice owners may not be comfortable giving up their status to contract with health plans.
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Letting Go. Employees A major advantage of an MSO for a start practice is that the owners do not have to hire as many employees. Existing practices who join an MSO will probably staff members, they should not because the MSO provides services to practice once did. The elimination of positions and letting people go can be emotionally painful.
- Outcome measures are essential. One of the main responsibilities of the OSM is to look for value-based contracts with health plans, OCA, and other payers. In doing so, each member practice bears the financial risk as a team, and all must measure and manage their performance effectively. By becoming a member of an MSO, you must be willing to use their chosen tool results.
- Give some control. When you become a member of an MSO, you are part of an integrated team. Therefore, you will have to compromise sometimes, do what is best for the team, and follow some of the marching orders of the OSM.
- Change is hard. We are talking about a new business model. Let's face it, many people do not like to simply change, and to work through the challenges of change is difficult. But as Jack Welch, former CEO of GE said, "If change outside exceeds the rate of change in rates, the end is near."
although training or be part of an MSO involves significant challenges, the benefits it brings make the effort worthwhile. The threat not to change a much greater risk that the threat of consolidation that way.
Therapy Partners Value Based Model with a Grand health plan
Therapy Partners has directly experienced the benefits of the MSO size and value. In 09, management of TPI approached the director and contracts medical team of the health plan HealthPartners a proposal to implement a payment model based on the value using the results of FOTO. HealthPartners (HP) covers 1.3 million lives and is an innovator in payment models based on value. The proposed model TPI-HP was based on a per diem payment rate with a percentage of the rate used and the potential to earn the most amount ABSTAIN an additional bonus for reaching FOTO benchmarks results.
HP initially turned down the proposal, but after 8 months of discussions and against-proposals, they agreed to a pilot based on the value. FOTO The management team of the late Dennis Hart and Al Amato created a results matrix FOTO 9-Cell values based on two determinants - expected number of visits and PT predicts the functional score change of the patient (FSC). Based on the FSC and used the visits, each patient was placed in one of the 9 - 3 cells are considered "higher than expected" results; 3 are results "expected"; and 3 "lower than expected" results. HP, TPI and FOTO set benchmarks for each of the 3 categories of FOTO results. HP agreed to pay 0% to 100% of the holding and bonuses based on results achieved levels of TPI.
The pilot of a year in 2010 was truly a collaborative effort between HP and TPI FOTO. FOTO provided the results of the quarterly, and members of the TPI-HP driver team held quarterly meetings to discuss the results. Ultimately, HP and CFI considered that the original benchmarks were unrealistic and agreed to reduce slightly. Accordingly, the CFI received 100% of the ABST-bonus payment to its members practice. HP felt so for the benefit of FOTO results, they eliminated their prior authorization model for TPI practices. They also said they had a better understanding of the physiotherapy process and expected business results and patient costs. HP CFI practices rewarded financially for effort and excellence of clinical care members suppliers. Equally important, HP and TPI created a long-term trust relationship. TPI received HealthPartners 2011 Excellent in Innovation Award .
TPI and HP have engaged in a pattern of contract based on the value every year since 2010 successful pilot. HP has awarded TPI with between 84-100% of the payment ABST-premium each year. TPI received 100% gain of 4, 96% 1 year, and 84% a year. The model has proven to be a "win-win-win" for HP, TPI, and patients. TPI and HP continue to work on refining the model based on the value to include the total cost of the care component
We were able to get first HP's attention in 09 for four reasons :.
- many TPI clinics
- All physical therapists TPI were using FOTO process with patients
- TPI had a large base data results and
- TPI the expressed leadership a willingness to share the financial risk with HP
Since that time, we were able to maintain the model and growth our relationship with HP executives based on our constant efforts on improving the value of our care by a sincere commitment to the Triple Aim - measurable quality, exceptional patient experience and total cost of care . This model is an example of how payers and providers can work together to develop new payment models better aligned with the value rather than the volume of services.
leadership and high performance teamwork is essential in times of change
Change is never easy. William Bridges in his book Managing Transitions shows that 5-10% of all hate group changes so they try to make it fail. Another 15-20% will resist change. 30-40% will "go with the flow", but need a lot of help fully engage in change. Wow! More than half of your organization will need a lot of time, attention and support to do your job change. 20-30% of your team will be excited about this change and must become "champions of change" to these efforts.
great leaders engage their "partisan" and "Champions" to help them lead and manage through the challenges change until the change becomes part of the culture of the organization.
design, implementation, and value based selling models require innovative thinking, commitment of all team members, and the work of high-performance team. This requires great leadership. As you start planning to build models based on value, do not fail to prepare to lead these change efforts and fully inspire and engage your team members. It will be well worth it. The sale of our real value and build meaningful relationships with health plans is what we have sought for years.
In summary
The current health care environment creates exceptional opportunities for independent physical therapy practices that meet market demands. Physiotherapists who succeed will first understand the key factors related to the reform of health care and recognized that rotate almost all around 2 central demands - the consolidation and value delivery. They will create and effectively manage strategies that deliver tangible value to policy makers in health plans and ACOs and will be willing to share financial risk. The MSO model is an excellent consolidation solution for practice owners who want to maintain ownership of their businesses.
If you want more information, please contact Jim Hoyme to Jhoyme@therapypartners.com and follow us on twitter @TherapyPartners.
Up and Onward!
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Jim Hoyme, PT, MBA
Jim is one of the principal owners of OSI Physical Therapy Stillwater, Minnesota, September 1-clinical practice started in 1979. It is also one of the principal owners of Therapy Partners, Inc. (TPI), a management service organization (MSO) for 16 independent physical therapy practices with 32 clinics in Minnesota and Wisconsin.
Since 1999, TPI MOS has provided its customers with health plan contracts, managing the revenue cycle, and many other administrative services for members under a unique identification number tax. TPI provides operational costs lower limbs, visit payment improvement, and practice management services. They engaged in a very successful contract, based on the value using the results of FOTO with a large health plan since 2010.
TPI is positioned to extend its services to MSO practices in other states and is an excellent partner for starting practices.

Latest posts of Jim Hoyme, PT, MBA (see all)
- strategies for self-treatment practices During Changing Times - MSO- Part 2 - May 17, 2016
- strategies for self-treatment practices During Changing Times - May 10, 2016
- the 'Volume Value' change in health care: the threat? . . . ? Or Opportunity - March 17, 2014
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