It is ironic that in order to stay in private practice, these physicians have formed a super-size entity—the very thing that hospitals represent and that these independents want to avoid. But Grosso, Tritinger, and Levitt—CAO's executive team—say the arrangement is very different.
For one, CAO has a one-vote-per-practice rule for its board, no matter how big or small the practice. Secondly, if a practice joins CAO, but has second thoughts and wants to back out, it can do so without much hassle.
"When you're getting large groups to form, you're warned not to have an easy 'unwind' agreement, meaning how do you get out of the group once you're in?" says Tritinger. "We knew the benefits of being in would be so overwhelming that we allowed the 'unwind' to be pretty easy … to allow for groups to leave."
There also aren't many strings attached for buy-in. Groups did have to agree to bill under one tax ID number, but physicians weren't required to change their practice management systems (there are 18). The logo and signage has changed to reflect CAO's affiliation, but office managers and secretaries stay the same at each practice, and the business pretty much runs just as it did without CAO.
But with the backing of a corporation, each practice has a louder voice and bigger presence. It's that concept that Levitt says resonates with this group of physicians.