As reimbursement pressures intensify and consolidation accelerates, many independent practices feel forced to consider employment models or to accept a private equity deal. But Derek Cantrell, CEO of Carmel, Ind.-based Goodman Campbell, says leaning on agility and entrepreneurship has helped the practice remain strong over the past 20 years.
Mr. Cantrell spoke with Becker’s about his strategies and outlook.
Note: This conversation was lightly edited.
Question: What have been some of the biggest changes that you’ve seen this practice go through?
Derek Cantrell: It’s mostly the change around us. Our culture remains the same. We tend to attract a certain style of physician who wants to be in a private practice and control the environment of treating patients. It’s just all the headwinds from not being able to control revenue streams or declining revenues over the last 20 years versus rising costs. But in private practice you’re nimble, and you can pivot and look to other ways to offset those negative changes. That’s what we have done over the years — trying to stay true to our clinical mission and academic mission and adjust to the times from a business point.
Q: Many orthopedic leaders have touted the importance of a strong culture within groups. How do you keep a consistent culture? How does being in private practice give you an advantage?
DC: We’ve done a great job with culture. Over the years we’ve tried to strengthen that by reinforcing a patient-first culture. We’re striving every day to have engaged employees, and the best way to do that in a private practice is to have them involved in the patient’s care. Whether it’s face to face or behind the scenes, it really matters. We share as patients give feedback on their visits and outcomes from our practice. We share feedback companywide as they come across, so that everybody can hear it. We also created a collegial physician culture around education and learning. Even though we’re a private practice, we have various conferences weekly and monthly like an academic practice would. For example, our spine physicians meet weekly to present and collaboratively discuss the most appropriate treatment approach for each individual case. This same collaborative review process is applied across our other specialties and occurs internally as part of our coordinated approach to care.
We also have our own quality review process. That keeps everybody together from a clinical standpoint. They’re pretty much all practicing like they want to with those three steps in mind as clinical quality first and employee satisfaction next. Those two things add up to high physician satisfaction. We also allow our physicians to specialize in what they’re interested in and passionate about.
Q: What are some other advantages that you’ve seen with Goodman Campbell, staying independent?
DC: Physicians have a say in their work, and they also have the freedom to be entrepreneurial if they want to. They have the freedom to do research if they want to. We provide avenues for them to do that. We just partnered with Ascension here in Indianapolis, and we started the Ascension St. Vincent Hospital Neurological Surgery Program together. The program began last year, and it allows physicians to follow whatever their passions are. It’s a comprehensive approach. Even in a private practice, we do a lot of quality- and patient-reported outcomes work, which gives us a national spotlight for our practice and for our individuals who are really interested in that.
We publish numerous peer-reviewed papers and book chapters as a private practice. It’s tough because we have to fund that, but when the culture lines up with the mission, then the funding falls into place. We do a great job of letting people follow their passion with regulatory advocacy, and they are able to get involved in societies of their choice. We encourage that, and we want them to be involved in their profession and follow their interests when they have them.
Q: In terms of advocacy, what policy do you think needs to change to ensure independent groups like yours can survive and thrive?
DC: Mostly it’s just how they reimburse all physicians, not just neurosurgery. How can CMS and insurance companies update the payment schedule to at least follow along with the cost of living as everything else does? The physician fee schedule from CMS is on a downward trend over the last 20 years, and costs and hospital reimbursements are on an upward trend. That has to be fixed.
That’s one of the reasons private practice gets driven to employment or other private equity situations. Some practices can’t balance the equation of lowering revenue while accounting for higher costs. So we’ve been entrepreneurial enough to figure out ways to do that so far. Our goal is to keep doing that.
There are some prior authorizations, like having other entities involved between the physician and the patient’s direction of care for approval, which to me is an added burden and time to a patient’s journey. Some of those things could be softened. There are, on the other hand, certain things that are happening in the private sector that might be helpful such as AI. I think that will make some things more efficient.
Q: How are you using AI in your work? What advantages are you seeing with it?
DC: The advantages of AI are taking some of those administrative minutes or seconds away to give the physician more time in front of the patient. This includes some of the ambient AI that we’re using with office visits so that the physician can concentrate on the patient and not on note taking. Scheduling will also become AI-driven eventually. It’s already started for the simpler type of appointments, but it can’t handle complex situations. We’re looking at all those things right now. It’s all about operational efficiencies that either give the provider more time in front of the patient, or allow them to see one or two more patients per day, and decrease the patient’s wait time to get an appointment.
Q: When you think about the spine and orthopedic landscape today, are you optimistic or nervous for independent practices?
DC: I’m optimistic because those individuals who become spine surgeons, neurosurgeons, orthopedic spine surgeons, have a certain personality that drives them to be the best at what they do. That tends to lead to being able to figure out complex situations so that they can thrive. There are ways to offset their declining professional reimbursement with investments in ASC. I also think they don’t see spine surgery as a commodity. There are reasons why some patients get spine surgery and some don’t, so I don’t think it can be commoditized. It’s all individualized. It takes that interaction to make those decisions with a patient and a physician.
