True partners in EM and HM physician services are hard to find

Happy holidays everyone!

As I look back on 2022, one of the biggest questions I’ve been asking about our business—and about the HM and EM physician services market as a whole—is this: what fuels growth?

As a relatively new group, this is close to an existential question for us. We think we have a unique offering in both Emergency and Hospital Medicine Physician Group Services. But are those differentiators important to growth, or is success as an HM or EM group purely dependent on debt-fueled, private-equity-driven market consolidation?

I have some thoughts. But first, just to get the news out of the way: last year was a very good year for Core Clinical Partners. We had starts at 14 new sites this year, all of which we won organically, by responding to and going through the RFP process. It was also a good mix of new business, with 6 of those sites being emergency medicine services, and 7 being hospital medicine (the 14th is an infectious disease program).

That amount of growth is a huge accomplishment for the team here. Everyone went above and beyond to get those new programs launched, in some cases under very difficult circumstances. It is exciting to be leading a team that combines an entrepreneurial mindset with decades of experience, helping to grow a national company from the ground up. 

The growth is even more satisfying because last year was a challenging year for many in our space. Right around the time of the ACEP Scientific Assembly in Boston, the largest annual meeting of emergency medicine physicians in the country, many of us were following the news that the largest company represented there was having so much financial difficulty that they were in danger of defaulting on their debt. Meanwhile, the No Surprises Act (NSA) added additional pressure to an already difficult market. After ACEP, I wrote about how the NSA would impact emergency medicine as a whole.

A record of growth

While the largest group in the country was sending up warning signals and unsettling their hospital partners, Core Clinical Partners was moving forward: 

In February, we announced a new partnership to manage emergency medicine services at Providence Medical Center in Kansas City, KS. We took over the contract from the aforementioned largest EM group in the country, who was having trouble getting it staffed. To address the staffing problem, we partnered with a local multidisciplinary group—something a company that was overly attached to one particular way of doing things might not have considered. Our flexibility and no-one-size-fits-all approach helped us to solve a difficult staffing challenge and the ER is now fully staffed with local physicians.

In March, we launched a major new hospital medicine program with Hillcrest HealthCare System in Tulsa, Oklahoma. The partnership covered eight sites across Oklahoma serving 180,000 patients annually. In my decades of leading physician services programs, this startup was truly unique in its challenges, so much so that I devoted an entire newsletter issue to it in July. I highly recommend you read that story. It is another example of our team’s incredible flexibility and experience, as well as our investment in outstanding clinical and operational leaders. 

In September, we expanded in Ohio to manage EM services for Trinity Health System in Steubenville. The story is an interesting one. A local group was providing great service in the ED, but in this environment, the business just wasn’t working financially. They approached us to see if we could help—and after reviewing the financials, we realized that our enhanced RCM capabilities would improve the bottom line enough so that we could be financially successful at the site where they couldn’t. I think it’s a good example of how a group of our size has combined the capabilities of a large national group with the commitment to partnership usually only expected at smaller ones.

Finally, in October we formally started EM services at three sites for OakBend Medical Center in Houston. With that announcement, Core now manages 30 emergency medicine and hospital medicine programs in 7 states. Throughout the year, we had been announcing multiple awards for growth—this year, we continued that trend.

The Power of Partnership

So back to the original question: what is fueling this growth? Our model is clearly resonating with hospital leaders around the country. What is that model? It comes down to four things:

1. We are flexible in our approach to hospital contracting, able to structure different partnerships to meet the needs of individual communities.
2. We are independently financed, meaning important operational decisions are made entirely by our in-house leadership team.
3. We have built expansive capabilities (such as our RCM capability mentioned above) while managing to stay nimble and entrepreneurial as a group.
4. Finally, we are “Dedicated to Partnership.”

It’s that last point that I want to expand on here. What does it actually mean to be dedicated to partnership? After all, we’re not the only physician services group with the word “partner” in our name. When you look around at the industry, it seems like every group claims they’re great partners to the hospitals and health systems they serve.

But how do you measure that? Every calculation in physician services ultimately comes back to value, or cost + quality. But I think there’s another metric, upstream of quality, that proves we are more dedicated to partnership than the competition. And I think it’s a big part of what’s fueling our growth.

What does “partnership” really mean?

Everyone says they’re a great partner, but I think to actually be a good partner to hospitals, you need to first, hire amazing clinical and operational leaders, and second give them the time and bandwidth to truly devote the attention that is necessary at each site.

What does this mean in practice? It means our operational leaders have fewer relationships and sites to manage than would be the industry norm elsewhere. There isn’t a definitive rule that can absolutely govern how many contracts each operational leader manages, but here at Core, it works out to about 4-5 contracts per Director of Operations, whereas a lot of other groups see the right number as 8-10. I think that’s just too many to be really effective at driving and sustaining change, improving patient satisfaction, and ultimately meeting hospital goals for quality care.

Some might look at our team and think we are over-invested in operational capability. But I think we are properly invested. It’s just a matter of building a model that allows us to hire those people and give them the time and bandwidth they need. So, for example, if there is a major Covid surge, our VP of Clinical Operations can be boots-on-the-ground in Louisiana, implementing a split-flow model that dramatically reduced wait times and got patients the care they needed, even in a pretty rural part of the country.

When I originally started Core Clinical Partners, I thought partnership was all about ownership at the local level. But soon I realized that there was no one “secret sauce” to organically growing a physician services group. What we needed was a combination of flexibility, experience, dedication, and more. What was needed was for every single administrator at every hospital we partner with to think so highly of us that they would be references on the RFPs as we sought to win more business.

We could only do that by truly putting our money where our mouth was on partnership. This is why, when we did a web redesign last year, we kept our tagline, “The Power of Partnership.” It’s the same tagline we’ve had since the beginning, and we still stand by it.

In fact, as a happy New Year announcement (you heard it here first), I am announcing yet another new partnership here. Starting soon, we will be managing hospital medicine services at Lake Charles Memorial Hospital, expanding our footprint in Louisiana. We’ll post a full announcement soon.

Until then, Happy New Year to all, thank you to everyone at Core Clinical Partners for all the hard work over the past year, and here’s to continued growth in 2023, fueled by the power of partnership!