Growing Competition
The city of Columbia, Missouri, stretches out over 60 square miles and has a huge patient base. When Dr. Pecorak moved to town ten years ago, the city was years behind other areas of the country in terms of a competitive healthcare market. The University healthcare system was not yet a major competitor and the private practice sector was predominant. That competition has since increased dramatically. With a new CEO at the helm, the University’s goal is to take over as many private practices as they can to develop their narrow network, said Dr. Pecorak. Another healthcare system, which owns a competing nearby hospital, has also added a number of satellite offices for family practitioners and internal medicine.
Despite the increased competition, Tiger Pediatrics has retained roughly 50 percent of the area’s market share for pediatrics and has grown from eight to 12 providers since opening their doors. The competition has, however, spurred them into action. “In the past, we’ve been able to put our shingle out and stay busy, but we know we need to work harder than that to retain our market share and stay independent.”
Over the past few years, they’ve expanded the practice, opening two new branch offices — one in downtown Columbia and one in the southern part of town — in addition to their clinic in the nearby town of Moberly, Missouri, that they’ve had for some years. “Columbia is a small city of about 125,000 people, but for some reason people think that driving 15 minutes is really inconvenient and don’t want to do it. The newest office is not far from us, but makes it more convenient for patients,” said Dr. Pecorak. “We’re listening to the environment that’s out there. The next thing is population health and managing populations and we feel that we need to be where the patient is rather than them coming to us.”
They are also increasing their hours and hiring nurse practitioners to help them keep up their patient volume. “We used to be open on Saturdays until noon, and will now be open both Saturdays and Sundays, and weekday evenings until 7 p.m.,” he said.
Independence Means Better Care
In the midst of the increasingly competitive healthcare environment, Tiger Pediatrics has grown and adapted. So what’s their reason for wanting to stay independent? “All of us are dedicated to the idea that we can provide better care as private practitioners than as part of a healthcare system. We have control over how we care for and treat our patients,” said Dr. Pecorak. “We’re also stubborn Midwestern people that don’t want to be told what to do by anybody.” Additionally, he knows they are able to do better financially as an independent practice. “Hospitals are not in the mode of managing private practices. There’s too much overhead, and too many hands in the pot to be as efficient.”
In addition to adding satellite offices and expanding their hours, the practice is also working toward improving care for existing patients. That’s where Dr. Adam Wheeler, who is known as “the numbers guy” of the practice, comes in. “Since we already have about 50 percent of the market share in the area, I’m not sure if we can grow much more,” said Dr. Wheeler. “The way we’re going to do better financially is by doing a better job of taking care of the patients that are already in our care.”
Last year, the practice used their EHR recaller to nearly double the rate of well visit coverage among 7 to 11 year olds. This effort also generated nearly $300,000 in additional revenue. “That’s a lot of patients now coming in for checkups that weren’t before,” said Dr. Wheeler. They have also changed their office policy so that patients with ADHD must be current on their well visits in order to get medication refills. These changes have helped bring current patients in the door and improved the care they receive.
This year, the practice has been working toward becoming a certified Patient-Centered Medical Home. “The process is a practical way to transform our practice, especially in terms of becoming more patient-centered than visit-centered,” said Dr. Wheeler. He said it has helped them improve their operations in everything from screening teenagers for depression to working better as a team. The practice didn’t have a formal process for tracking adolescents who have been screened for depression before December 2015, but have taken their coverage from one percent to 36 percent in just the last six months. “These improvements have been very valuable from a clinical perspective,” said Dr. Wheeler.
