Physician Finds Optimism Amid New Realities of Practice

The co-founder of a large primary care practice and long-term leader at the American College of Physicians says medical homes and new payment models improved his practice satisfaction "tremendously."

"At the heart, we're a private practice," Yul Ejnes, MD, MACP, an internal medicine physician and chair-emeritus of the American College of Physicians' board of regents, says of Costal Medical, the practice he co-founded with one partner more than 20 years ago.

Today, Coastal claims to be the largest primary care group practice in Rhode Island, with 19 locations and more than 100 clinicians. The group is a successful Medicare Shared Savings Program ACO, with all of its offices recognized by the National Committee for Quality Assurance as level-3 patient-centered medical homes.

Throughout this growth, Ejnes has remained a shareholder of the independent group.

"There are ways of staying in practice, seeing patients, and living in new realities," he says. "But [physicians] have to wake up and start paying attention and doing what they have to do."

Some of these tasks include learning about the Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA) and understanding new payment and practice models in general. I spoke with Ejnes recently; the transcript below has been lightly edited.

HLM: How has becoming an ACO changed your group's dynamic?

Ejnes: Becoming an ACO was an evolutionary step from becoming a medical home, which required us to start thinking in terms of population health, being proactive, and welcoming reports on how we're doing.

We're doing things we didn't do five years ago: having weekly care conferences, identifying and talking about our high-risk patients, working with our clinical pharmacist to manage drug costs.

This is stuff that wasn't part of what many of us trained to do or signed up to do, but it gives us some control over what happens with our patients as opposed to leaving it all up to the insurance companies.

HLM: For hospitals that own physician groups, what insights can you share about how they can engage physicians?

Ejnes: That's a good question. We formed our group because we didn't want to live under the jurisdiction of a hospital system.

But the model does work for some physicians. Speaking abstractly, because I haven't lived it, I would think it works when the hospital system says, "We're not going to get into your business. We're going to let you do your job and we'll provide support services."

I would think it would have to be the kind of environment where leadership is focused on the interests of patients and the physicians supporting the patients.

HLM: What about today's practice environment makes you optimistic?

Ejnes: Over the years I was more involved in the ACP, we were working on a lot of these initiatives that are now reality. In my personal experience, medical homes and new payment models, if implemented well, actually do make a difference.

And for me, it's improved my practice satisfaction tremendously. It's gotten a lot of the administrative minutiae off my desk and allowed me to play more of a role of a manager for that rather than a grunt worker. It's freed up time to spend in ways that is more meaningful for patients.

I'm not going to say I'm spending twice as much time with patients or getting out of the office an hour earlier, but the time I do spend is focused on things only I can do.

And at the end of the day, even if it's still a long day, I'm usually smiling.