Changing Face of Healthcare: Local physician works to breach the gap between the practice and business of medicine

Twenty-five years ago, the M.D. degree was considered the pinnacle of medical education. After long years of study, delayed gratification and grueling, sleep-deprived work hours, young physicians began their practice ready to provide care and to establish themselves in the medical community. They did this in exchange for professional satisfaction and the knowledge that hard work would pay off in the form of a respected, comfortable lifestyle. Today's physicians, however, find themselves in a markedly different situation that is frequently driven by financial considerations and marketing concerns as they work to compete in a changing health care environment.

As a new school year commences, Gregory Caronis, M.D., a Lake County orthopedic surgeon, is back in the classroom once again - this time as a student of business administration. "After 17 years of practice, I've come to realize that a significant portion of my time is spent addressing the business aspects of providing patient care," said Caronis. "I decided to work toward a Master's in Business Administration (MBA) in an effort to better contribute to the management of my practice and to try to gain a better understanding of administration interests on the hospital committees where I serve."

While continuing his busy, private practice, Caronis hopes to integrate his medical experience with improved knowledge of the business world and ways of relating to the various stakeholders involved.

"As a physician, I have a significant amount of input and sway on a patient level by accurately diagnosing and treating the patient's problem," explained Caronis. He adds that on a daily basis, his medical practice involves making significant decisions on ordering tests, prescribing medications, and performing surgeries.

"Like most physicians," Caronis said, " I was trained as a clinician and not as a businessman. Like it or not, much of medical practice and running a private practice is intimately related to business as well as clinical issues."

As payer and governmental influences have grown, physician time and resources spent dealing with the nonclinical side of medicine has increased. Billing demands complicated by ever-increasing coding requirements have multiplied staffing needs. Evolution of the electronic medical record and financial penalties levied by the government for noncompliance mean greater technology-related problems and staff resources to ensure that data requirements are met. The threat of practice audits for Health Insurance Portability and Accountability Act (HIPPA) violations have made the security of patient information a growing administrative requirement.

Beginning in 2015, physicians began seeing a 1 percent decrease in Medicare reimbursements for failing to meet meaningful use requirements. The penalty will increase by 1 percent each year to a total of 5 percent. Claims reimbursement has become increasingly complex with physicians required to immerse themselves in minute detail of chart documentation to ensure that a "clean claim" is submitted for provider reimbursement. These multiple mandates and the complexity of ICD-10 codes mean that physicians spend more and more time with documentation - and often have less time available for patient care.

"The most rewarding part of being an orthopedic surgeon is watching my patients walk into the office, recovered to full function and mobility," declared Caronis. "It is immensely frustrating when so much time is consumed by burdensome governmental and administrative requirements that often don't pertain to important aspects of good patient care," he added.

The health care climate has changed dramatically with mergers of networks and increased administrative demands on physicians. As large networks acquire more physicians, they direct patients to their physicians. For some physicians, joining a large hospital-owned network has been a haven from administrative burdens and the competitive pressures facing small, privately-owned practices.

In light of these trends, Caronis, currently serving as Vice Chairman of Surgery at Advocate Condell Medical Center, believes that an MBA will allow him to more effectively build health care teams, communicate with hospital administration and to more effectively fulfill the leadership duties involved in his various committee positions.

"I feel strongly that this experience will provide me with a greater administrative credibility and allow me to better straddle the divide between financial and medical issues," said Caronis. He adds that, "the practice of medicine continues to evolve, and in my view, clinicians can no longer focus solely on patient care and separate themselves from the complex administrative, marketing and financial issues involved in running a practice or ensuring viability for a hospital."

• Gregory Caronis, M.D. is a practicing Lake County orthopedic surgeon specializing in disorders of the foot and ankle, trauma and fracture care.