Brett Trockman, MD
One of the ongoing debates in US politics involves the pros and cons of big government versus small government: Does big automatically equal bureaucracy and groupthink while small inherently fosters individual creativity and enterprise?
The physicians and staff at UroPartners in Chicago have achieved what generations of politicians have struggled with—building a large organization that exists to support its individual stakeholders. Ready to celebrate its 10-year anniversary in July, UroPartners has more than 30 offices in the Windy City and its surrounding suburbs. There are more than 60 physicians with the practice; in addition to urologists, there are affiliated pathologists and radiation oncologists. The support staff numbers over 300.
“Some large-group practices will have a huge bureaucracy,” acknowledged Brett Trockman, MD, UroPartners’s medical director. “Sometimes, the centralized administrative office can take on more importance than the ‘boots in the field’ who are actually taking care of patients. We recognize that the physicians and the clinical staff are the most important component of our practice as they interact with patients on a daily basis.”
“Our job as a large-group practice is to support that talent,” he added. “It’s not our job to micromanage every patient interaction.” Trockman, along with President and CEO Richard Harris, MD, discussed how being a large-group practice has allowed them to implement the new rules and regulations of health care while staying true to UroPartners’s commitment to always putting its healthcare providers and patients first.
The EHR Era
UroPartners was formed when a number of smaller groups in the Chicago area decided to join forces; looking down the pike, the founding members knew that multiple challenges lay ahead in the healthcare environment, including the implementation of an electronic health records (EHR) system.
“Our biggest challenge was implementing EHR,” Trockman explained. “That was expensive and tough; it changed the way we interacted with patients.”
UroPartners began its EHR implementation in 2010 and has been working with the system ever since. On the upside, EHR has become the go-to modality for practice members when it comes to communicating about patients internally and maintaining cohesive care.
“For patient-specific issues, we utilize our EHR. That’s basically the only way we communicate about patients for [Health Insurance Portability and Accountability Act] reasons. And that’s really the best way for us to share patient information,” Trockman said. “So my notes about a patient will be available to the radiation oncologist or the next physician that the patient will see within the practice.” On the downside? “The thing I dislike about EHR is that patients wind up talking to my forehead because my head is down, keeping up with data input,” Harris said. “That makes the physician-patient interaction a bit impersonal. But for intragroup communication about patients, it’s turned out to be pretty useful.”
Trockman and Harris agreed that they couldn’t imagine adopting an EHR system as a small practice. Indeed, news articles abound about physicians in one- or two-person practices struggling to make EHR work for them. A 2013 report from the RAND Corporation, titled “Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy” (http://tinyurl.com/q4duuhk), found that physicians’ frustration related to EHR negatively influenced their attitudes toward their careers and medicine overall; some doctors even pointed the finger at EHR adoption struggles as the reason for their early retirement.
“I can only imagine how daunting it would be for a small physician group to try to implement EHR,” Trockman said. “We were fortunate in that we could bring in outside experts to help us through the process, and try to make it as painless as possible for our physicians and staff. That is one of the benefits of being in a large group and being able to use, and afford, those kinds of resources.” UroPartners is now going through the same process with ICD-10. For that, the practice turned to another large group for guidance.
“We had an expert in ICD-10 coding from Chesapeake Urology Associates [of Maryland] come in and work with us on that, give us a preemptive look at what it’s all about,” Harris said. “We often work with other large-group practices, because we have enough in common in terms of our structure to be able to learn from one another. A smaller group won’t necessarily have that kind of network.”