Dr. Julie Marmon, one of three owners at ER Specialists Urgency Center, will never claim superiority to a fellow physician. However, she does believe the Royal Pine Drive center’s business model affords her patients some distinct advantages.
“Because of the way we’ve manipulated our environment and said, ‘I am not OK that patients get 12 minutes of my time, so I’m going to change it,’ we get to spend more time with them,” Marmon said. “The end result of that is, we just get the time to hear what the patient needs and do it.”
Marmon and partners Chad Davis and Linda Sturtevant, who opened ER Specialists Urgency Center in February 2017, represent a rising trend in the Pikes Peak region of physicians leaving behind larger health care systems in order to take up their own entrepreneurial endeavors.
Mike Ware, CEO of the El Paso County Medical Society, said 50 percent of physicians in the Pikes Peak region still have an ownership interest in their medical practices. These numbers buck a national trend in which 70 percent of physicians are employees of their medical practices — mostly larger hospital systems, Ware said.
A survey conducted by the American Medical Association showed a 6 percent bump in employed physicians from 2012 to 2018, compared with a 7 percent drop in self-employed physicians during that same time period. Physicians in hospital-owned practices accounted for 26.7 percent of all patient care physicians, up from 23.4 percent in 2012, the survey found. In the aggregate, 34.7 percent of physicians worked either directly for a hospital or in a practice at least partly owned by a hospital in 2018, up from 29 percent in 2012, according to the survey.
However, those numbers may already be moving in the opposite direction nationally, Ware said. Seeing private medical practices purchased by hospitals and other large health care systems is a common industry trend that tends to spike for about four years before reversing, he said.
“Every 15, 20 years, there is a brief spike in hospitals buying medical practices, but then it breaks down,” he said. “Anecdotally, last summer, the model was starting to break down. It’s a little early for it to show up in quantitative data, but qualitatively, we’re starting to see that.”
Ware said the demands of the Colorado Springs health care market have kept the region largely isolated from national industry trends in recent years.
“We really, until recently, have been a medical island. … Being pretty well self-contained, both geographically speaking and [in terms of] the distance from the state’s largest metropolitan area, it isolated us,” Ware said. “We were two to three years behind the national trend in hospitals buying up medical practices.”
Now the region is seeing an uptick in physician-owned practices consolidating with one another, giving doctors the economy of scale needed to grow their businesses while also preserving their clinical autonomy, Ware said.
“What we are not seeing is acquisitions by larger health systems,” Ware said.
As the city’s shifting landscape is being reflected in the makeup of its physician and medical practice community, Colorado Springs is growing ripe for health care innovation, Ware said.
“Colorado Springs and Salt Lake City are the places where you’ll want to be in health care innovation when you look back in the next 10 years,” he said. “I think we’re in the sweet spot in the business community where we have the population to really have the resources to innovate and try new things, but we are small enough to where, when we are innovating, we’re going to very quickly see the impact of the decisions that we’re making.”
Even with two large hospital systems — soon to be three when Children’s Hospital Colorado comes online this year — patients in the Pikes Peak region need more cost-saving health care options, Marmon said.
“I think if you go to a place like Denver where there’s so many hospital systems and so many microcosms of neighborhoods, you can easily get pigeonholed into one neighborhood and have trouble spreading out,” she said. “Because we only have those two hospital systems, I think there’s a void that allows specialty groups [to] have room to grow and expand and care for patients without being usurped by the system. We do have a population that needs care, and we have the space to grow it right now.”
In the era of high insurance deductibles, patients are more likely to research their health care options and decide where best to spend their money, Marmon said.
“I think with all of those forces combined, we’re just right, because people want something better,” Marmon said. “I’m not sure they always know what it is, and I’m not sure I always know what it is either, which is why we spend a lot of time talking to people saying, ‘What’s the best way to answer the question? Maybe we even have the question wrong.’”
STRIKING OUT ON THEIR OWN
After completing her medical residency, Marmon spent five years as an emergency medicine physician in a San Diego trauma center. She decided not to return to that line of work when her family moved to Colorado Springs.
Marmon and her business partners share a background in emergency medicine, along with an ultimate goal of providing emergency department-level services at more cost-effective urgent care prices.
“I say all the time around here, getting us all in a room is sort of like magic,” Marmon said. “We troubleshoot and … we solve a problem because we’re all focused on the right goal, which is patient care at reasonable costs. We can pull together with that frame of reference for everything.”
The ownership consolidation model affords both medical professionals and patients a flexibility that is rare among larger practices, Marmon said.
“I know people are trying desperately to talk about innovation in health care, but the reality is, the bigger you are, the more cogs there are going from point A to point B, and the less we’re able to see what we need, and do what we need to make a difference,” she said.
Still, leaving behind a large medical group has its drawbacks, such as losing the bargaining power larger systems typically have with insurance companies, Marmon said.
“I have no bargaining power with insurance companies. When I say, ‘Look, I can save a patient up to 70 percent or more compared to an ER bill,’ there are still some insurance companies that say, ‘No, we’re not doing that. We’re going to give you a $160 flat fee to see every patient,’” she said. “I say, ‘Well, I can’t even do a CT scan for $160. That doesn’t work.’ So that ability to step outside the typical box is what makes it hard.
“It’s also hard to get paid by patients,” Marmon added. “It takes manpower to get paid, which seems crazy… but the industry that is health care, just because of what it’s become, it makes it difficult to put the systems in place that get a physician paid on a regular basis, unless they’re part of a bigger group with the resources to do that.”
This “back office management” is where consolidation of ownership has its advantages, Marmon said. Physicians can streamline those administrative processes without being absorbed into a more corporate setting.
“We don’t have to be taken over. We can work together,” Marmon said. “We can share and pool resources in a manner that gives patients the access to the care they need with the options they desire, without the physician’s office being usurped under big corporate umbrellas.”
One of the top barriers to physicians’ professional satisfaction is the loss of clinical autonomy that many doctors admit to feeling when they take a job with a larger practice, Ware said. The partnership model being implemented at ER Urgency Specialists Center is one solution to that, Marmon said.
“When we become employed, we lose control, but as a physician, the ultimate responsibility of being responsible for a life is all-encompassing, so we lose control and yet we still have all that responsibility. That’s one of the top factors that leads to burnout,” she said. “When you get away from that employed setting, you take back control.
“It’s hard work, I will tell you — it is not easy — but… the physicians are happy, the employees are happy, we’re laughing 90 percent of the day. And what that does is, it then rolls directly over to the patients. They feel that. They know that.”