Riding into the wind

  • Whether a large group or small group, external challenges of payers, health systems, inflation, and recruitment present a headwind to all private practice groups. Much of the OTO Forum discussions focused on how groups are defining their future strategies – get big, stay small, expand services, and improve existing ones. One doctor likened their group’s circumstances to an O2 concentration curve – they used to be at 99% but feel like they’ve trended to the lower 90s and are trying to make sure they don’t land in the mid-80s.
  • Our take: We are building our peloton. Like a peloton in cycling, Align ENT + Allergy is building a community of practices to help our partner practices go faster with less effort. Big continues to eat small with payers and health systems taking advantage of balkanized specialists like private practice ENT groups. We are riding into the wind together while maintaining the individual identities and autonomy of our individual practices (everyone continues to ride their own bike so to speak).

Benchmarking and Baskin Robbins

  • Several of the main sessions covered benchmarking across practices. It was striking how much variability there is in the scope and arrangement of services across practices. Like Baskin Robbins, there are a lot of flavors of private practice, as evidenced by the high variability in ratios of physicians to APPs and Audiologists, rates of hearing aid sales per ENT and audiologist, and in the various services individual practices do and don’t offer. The need for greater benchmarking is clear and getting to like-for-like comparisons across practices will certainly help the ENT community better identify opportunities for improvement.
  • Our take: Measurement isn’t improvement, but it’s a start. Benchmarking is necessary but not sufficient to drive improvement. Every one of our practices at Align has a unique “fingerprint.” We’ve recently built our analytics platform across our practices and are identifying improvement opportunities in each of our practice divisions while leaving room for local customization.

Nothing new under the sun (mostly) – it’s not what, but how

  • The conference was an impressive sharing of practical thinking across audiology services, allergy programs, billing/revenue cycle ASCs, real estate, physician compensation and office-based surgery. These topics remain the key drivers of financial sustainability for private practice ENT and Allergy groups. In conversations between sessions, you could hear the passion that many physicians had about the specific ways they have constructed their clinical programs to be effective, efficient and convenient for patients.
  • Our take: The slow sawing of hard boards. The financial sustainability of private practice ENT and Allergy hinges on providing a broad set of patient services consistently and well. ENT practices are a rich laboratory of experimentation, with groups running the same experiments – in parallel – but with high variability in outcomes. That tells me that it’s not the concept, it’s the application. To paraphrase sociologist and economist, Max Weber, practice improvement requires the strong and slow sawing of hard boards.  Few small and medium-sized groups have the capacity, capabilities, and processes in place to do this consistently and well. Align’s business leadership team supports each of our practice divisions’ programmatic improvement across the key profit opportunities of ENT practices.

Below the waterline (but becoming mainstream)

Several topics are percolating through ENT practices that were less talked about but important, nonetheless. I suspect that these models will become increasingly mainstream.

  • Opportunities in expanding office-based surgery – impressed by the thoughtfulness of the conference panel especially on appropriate procedures, anesthesia, and patient care protocols.
  • ENT urgent care and the role of APPs in primary care ENT – the disruption of primary care, particularly post-COVID, is inundating ENT practices. How do we serve the needs of our community and patients in a timely, financially sustainable manner?
  • Technology – risks and opportunities – cybersecurity remains an underappreciated threat to practices. It’s expensive and hard to manage without expert support.
  • Asset-light – how to decrease the fixed overhead of practices – smaller and more flexible footprints and expanding use of technology to decrease labor costs.

At Align we continue to build our community of ENT and Allergy practices. If you are interested in getting to know us or learning more, please contact me at [email protected].

James A. Grant, MD

CEO, Align ENT + Allergy