David Conway, M.D., CEO of Littleton Internal Medicine Associates—The Evolution of Private Practice Medicine

The more things change, the more they stay the same. It might be an old cliché, but it is a comforting sentiment during this tumultuous time in healthcare.

“It’s all about changing while you’re staying the same,” said David Conway, M.D. during a recent interview with Andrew Graham in the latest segment in the video series, Best Practices in Medical Practice Management. Dr. Conway’s analogy referred to how he and his staff approach patient care in an ever changing landscape.

“Medicine is changing at a blistering pace from capitation, to fee for service and now accountability in care. We are going full circle and needing to show the government and the insurance companies the qualities that we measure.”

“The main thing to remember is it’s about a doctor and a patient and that’s what really matters. As all these changes happen we need to keep that focus and keep doing what is best for the patient. Doing the best we can to deliver quality healthcare care to meet their total needs. That’s where we need to go in our practice, and striving to maintain and keep that as our guiding philosophy.”

Dr. Conway has experienced many changes since he joined Littleton Internal Medicine Associates (LIMA) in 1999. He now leads the vibrant practice as CEO while continuing to practice medicine. His responsibilities focus on setting the tone and the pace for the practice, supporting the staff and ensuring the culture and moral at LIMA is positive and supportive.  

Dr. Conway explained that one of the biggest changes in medical care is the evolution of Care Teams. “Medicine has evolved to Care Teams where we have MA’s and PA’s. Each Care Team is taking care of patients. It’s not just the doctor’s responsibility to be looking after a patient, but everyone on that team.”

As a result of Care Teams, medical care is now more nurturing and proactive than in was the past. Everyone takes ownership for what the patient needs. If anyone on the Care Team notices a patient is due for a diabetes blood test for example, that individual can be proactive and ask a patient to come in for a test or exam.

The practice has also changed as a result of national and state health reform, and the focused efforts to reduce costs while also improving quality.  “That why I’m really excited to be part of a physician run ACO. As we are pruning back networks and trying to keep patients out of the hospital, we are doing it with physicians in charge of making those decisions, determining those networks and how those policies get put into place.”

The back office of the medical practice has also evolved. “We used to have our own in-house billing group. They were all certified coders. Our coders were good but they were extremely busy and I don’t know if they could keep up with all the changes in coding. We waited for rejections instead of being more proactive with billing. Accounts receivables got out pretty far and there were a lot of things we were writing off at that time. So we took a closer look and talked with other groups and found an option we are very happy with.

“Over time it really helped us have a more proactive look. Your team works with our team and tells us about changes coming. Your team might say these are some things other practices are doing that you’re not utilizing as much. These are things you might want to consider doing to add extra revenue. Also the accounts receivable has been much more favorable. We are getting better returns and more quickly that we could do with our in-house service.”

“We also like that we’re learning how we compare to other practices. Details aren’t specific to a certain practice but we get a good idea if we are on par with certain codes, or if we are outlier. Could we be somewhat at risk for being evaluated for an audit? Are we within the community standard? That gives us a better sense of security as well.

In addition to professional advice, Dr. Conway said an important benefit of partnering with a medical billing company like Clinic Service is it the comprehensive reporting. “I like that there is different ways to access information. There is a hundred page report and there is a nice summary.  Over the past year you have developed additional reports, a graphical representation of the data and that has certainly enhanced our understanding and ability to see the differences in at our organization at a glance. Having that information quickly, on a regular monthly basis–and reliable information—is really very helpful.”

Looking ahead, David Conway, M.D. sees a bright future for those practicing private medicine. “We are very happy we have been able to stay independent and plan on doing so for the long term. What I like about outpatient internal medicine is the reward, the relationships with people. It’s knowing people over decades, helping them with their care, and making a difference in their lives.”