All about the model

The forces driving the merger of four small practices into the Florida Medical Clinic in northern Tampa Bay 19 years ago are the same forces that continue to drive its growth today.

The continuing complexity of the business side of health care makes it harder for doctors to be in single practices and grow as a business. Most doctors are ill-equipped to handle dealing with insurance companies, HMOs, Medicaid and Medicare, taxes and regulations.

“Doctor's are not well trained to handle the processes,” says Joe Delatorre, CEO of the Wesley Chapel-based company. And, he says, they miss out on economies of scale, negotiating leverage with vendors, and the ability to generate revenue beyond the immediate physician practice.

Hence, Florida Medical Clinic was birthed with nine doctors in Zephyrhills and Dade City seeing maybe a hundred patients daily. Today it has 135 doctors and nearly 1,000 employees, sees 4,000 patients per day throughout Tampa Bay and generated $147 million in revenue last year.

The key to the company's success is the model it has created for doctors and other health care providers.

“This is completely owned by the doctors. And we want every doctor to be an owner in the process,” Delatorre says.

It is Florida Medical Clinic's model that attracts doctors — the company rarely seeks expansion opportunities.

“I get calls every week from physicians interested in joining our group. The problem one doctor has over here is the same problem the other doctor has over there,” Delatorre says. “Once you understand the model and have the system, you can replicate it pretty easily.”

And that is important because the business of health care is changing faster than the medicine itself, and often health care providers are left in the swirl.

“The industry is moving at a very high rate and competitive issues are high,” he says. “It's only getting more complicated.”

Model growth
The Florida Medical Clinic model is pretty simple in concept.

First, give physicians an organization where they are among equals, working cooperatively with other doctors in other specialties. Then give them an equity stake in the company, provide professional management for the business side and offer further revenue opportunities through ancillary services such as ambulatory care centers and diagnostic labs.

And the Florida Medical Clinic is a multi-specialty company that is fully integrated, as opposed to single-specialty firms. Delatorre believes the multi-specialty companies are the strongest in dealing with what is coming.

Further, the company was at the forefront of creating unified patient records in a digital format seven years ago. “Every doctor gets to see everything going on with his patient with every other doctor,” Delatorre says. It is almost hassle-free for the physician — no small benefit.

Patients and doctors both like the digital patient records, and the trend in health care is moving toward more of them. The federal government is now offering monetary enticements to get practices to do this — $44,000 per health care provider. But most practices remain paper-chart oriented and are only beginning to make the change.

Florida Medical Clinic makes the entire process all turnkey for doctors, a huge attraction, particularly for small practices struggling with the non-medical overload of work.

“If doctors can find a platform in which they are fairly treated, they have an equity platform, and on top of that ... you have a professional management team with a 20-year track record, you have a formula for success,” Delatorre says.

That has resulted in continual interest from physicians wanting to join.

“We get a lot of opportunities. The question is which doors do we open?” he says.

Florida Medical Clinic has 19 medical facilities in North Tampa, Carrollwood, Town N' Country, Wesley Chapel, Land O' Lakes, Zephyrhills and Dade City. The company would look at nearby places such as Brandon and Trinity, but has passed on opportunities from St. Petersburg so far because it is too far from its other offices.

In the integrated model of health care, proximity is important for patients. When someone needs to be referred from their general practitioner to a specialist, they want it to be nearby because they likely live near their doctor.

“We're conscious of not opening doors in areas where we don't have a strategic interest,” Delatorre says.

Government care impacts
Florida Medical Clinic is bracing for implementation of the Affordable Care Act, commonly known as Obamacare, but sees plenty of opportunities.

“This is a massive piece of legislation that will affect every American,” Delatorre says. “I think a lot of it is very good. I love the benefit enhancements where you can't exclude pre-existing conditions.”

In fact, there are portions of the law that will surely benefit the business side of health care as it pushes more dollars into the industry.

Speaking carefully as an executive of a large medical provider, Delatorre says the overall goal of the law is to make sure everyone has health insurance. A doctor's office visit is a fraction of the cost of an emergency room stop.

“When dealing with population management, if you don't have health insurance, you end up accessing health care at the most expensive place, in the ER,” he says. “You've already lost the game if that is going on.”

So that philosophy alone is good for the Florida Medical Clinic, which provides care before the ER.

In the details of the law there is an element on which the company has already moved. Obamacare creates accountable care organizations, or ACOs, which are contracts that health organizations can have directly with Medicare. It's based on the Medicare recipients for whom a health care firm is currently caring.

A company such as Florida Medical Clinic goes through the process to get approved and signs a three-year contract with Medicare, agreeing to do three things: improve the quality of care to the Medicare recipients on 33 measures laid out by the feds; create happy Medicare members, who will be surveyed to get their opinions; and reduce the costs of care.

If a company is successful at these three things, the savings will be split 50-50 between the company and Medicare. “That's a very big change,” Delatorre says.

About 150 ACOs have been approved nationwide, three in the Tampa Bay area, including the Florida Medical Clinic, Reliance Healthcare Management Solutions in Tampa, and Allcare Options in Parrish.

“You have to be organized, have the infrastructure, have the management, have the care teams to manage this,” Delatorre says. “I think our group is taking a leadership position in that.”

The company is hiring case managers to be a link between doctors and patients to ensure that care is improved and a patient's experience is a good one. “We're adding what we call care coordinators to our managed care population,” he says. “If you can do that it is much more inexpensive than to deal with the chronic episode that occurs.”

The U.S. Supreme Court ruled that states cannot be required to expand Medicaid coverage under Obamacare, and Gov. Rick Scott has said Florida will not. Delatorre does not see significant impact either way on his company.

However, he sees real possibilities for his company in the portion of Obamacare that requires coops to be developed in every state. The coops are intended to cover people who do not qualify for Medicaid but also do not have any health insurance.

“We will more than likely participate with coops out there,” he says. “Anytime you can create more access to your provider, that enhances us and is good for the patient.”

Delatorre has been the right man at the helm for Florida Medical Clinic.

A hospital administrator by trade, he was tapped as the first, and still only, CEO of the company at its formation in 1993, and has guided its growth. A Florida native and University of Florida graduate, he had previously run Pasco Regional Medical Center in Dade City, followed by what is now St. Joseph's Women's Hospital in Tampa.

He left St. Joseph's to put together the Florida Medical Clinic, choosing it over an offer to run a hospital in Texas. He expects to see it through:
“My job as CEO of this company is to position this company to survive and strategically be in the right place at the right time to keep us moving in the right direction.”