Some healthcare organizations prefer their physicians to be of one mind, but The Toledo Clinic does things a little differently. “Our organization attracts individuals who are independently minded and thrive in a hard-working, entrepreneurial environment,” states Henry Naddaf M.D., president of The Toledo Clinic.
Based in Toledo, Ohio, The Toledo Clinic provides high-quality and accessible healthcare services at a low cost throughout Northwest Ohio. Started in 1926 by three surgeons, The Toledo Clinic is now in its 93rd year. Since that time, the organization has grown steadily to a staff of more than 250 healthcare providers. This includes 195 doctors who make up the shareholders of the organization. “These physician-owners are encouraged to take control and oversight of their work and set the course for both their patient care, and their financial outcome,” says Dr. Naddaf. “If they are hard-working, and are able to focus on costs and efficiency of healthcare, the outcome creates a system that prides itself on low-cost, but quality care; and this is the place for them.”
Toledo Clinic infoHowever, if they are interested in simply making money and prefer to do nothing more than what they are obligated to do, “This is not the culture for them,” Dr. Naddaf explains. “We on the flipside, are available and accessible which is one of the reasons for our growth and success.”
The Toledo Clinic currently has 62 locations and is seeking to grow further. Chief Administrative Officer Michael D’Eramo, DHA, says the group is meeting its strategic goals by forming collaborative relationships with various community hospitals, including St. Luke’s Hospital in Maumee, Ohio, and Wood County Hospital in Bowling Green, Ohio. “These are like-minded organizations, who seek independence, high quality, and a low-cost means to help the patient.”
The Clinic plans to expand its footprint and add services, which it will do with a new south campus in Maumee. “This is a growing market where we’d like to have an established presence,” Dr. D’Eramo says. “We want to be measured in our efforts, however, as bigger does not necessarily mean ‘better.’”
While the south campus in Maumee is focused on oncology, surgery and orthopedics, “The intent is to be more focused on sub-specialties,” Dr. D’Eramo explains. “There is a need for both hospital-based specialties to support our hospital partners, as well as market demand for more primary care. Somehow, we need to give this area more attention in both aspects.”
The Best and Brightest
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“The Toledo Clinic hopes to grow its number of primary care doctors, which is approximately a third of the group,” says Dr. Naddaf. But finding the right recruits can be challenging.
“It takes a special breed of doctor to be a modern, independent physician,” Dr. D’Eramo says, noting that The Clinic strives to be selective. “New PCPs are faced with a daunting task of still being required to see a large number of patients, and, be able to collect and convey quality data to ensure proper payment, not an easy goal. Our goal is to attract highly skilled candidates and illustrate to them why the independent model is more rewarding. This can be difficult when competing against larger organizations.”
Dr. Naddaf is aware that when students come out of medical school as residents, many are carrying up to $250,000 in student loan debt. “Very few come out with little or no money owed. Therefore, when a hospital system offers them a guaranteed contract, they feel comfortable knowing they’re going to receive a steady paycheck from the start,” he says, noting that some do not want to take a chance with The Toledo Clinic’s model, where it might take longer to accrue income.
“Unfortunately we don’t have deep pockets like the hospitals which puts us at a significant disadvantage,” Dr. Naddaf admits. “However, when the right physician comes along who wants to work for themselves and is willing to put in the hours of hard work while also taking on some of the risk, they generally come out rock stars. The irony is that Medicare is aggressively incenting PCPs to ‘be in control’ of cost and quality, with significant money at stake. A less inclined doctor will look at that and say, ‘give it to my employer.’”
The Toledo Clinic also copes with competition when it comes to service, but that is where the group’s low-cost model has the advantage.” Dr. D’Eramo stresses, “It’s important to include a quality component when promoting low-cost.” Due to mandates from the Centers for Medicare & Medicaid Services (CMS) and commercial payers that require clinicians to report on their performance, the group has proven it can provide both.
“Dr. Naddaf’s leadership has guided us into becoming a four-star Clinic based on these metrics,” he says. “These mandates may seem like a hindrance, but the importance lies in taking the time to report back to the commercial payers that the physicians are in fact following such mandates.”
Technologically in Touch
The Toledo Clinic strives to ensure its operations are up-to-date with technology. “The level of technology that needs to be used and accessed on a daily basis has increased significantly,” Dr. Naddaf adds. “For instance, “mining and sharing cost and quality data is a big part of being successful in order to meet the expectations of new value-based measures. As part of this focus, the group has invested in analytics which allows them to obtain data reports much quicker.”
D’Eramo reinforced, “Previously, the general expectation for The Clinic was that it would get data reports in about a week. However, currently not only management but also physicians have the ability to run analytical reports on their practice in real time.”
The Toledo Clinic also invests in cutting-edge technology to improve patient care. “We were the first outpatient surgery center in the state of Ohio to add the da Vinci X® Robotic Surgery System to our facility,” Dr. Naddaf says. “This addition will improve access and lower costs to area patients.
“Robotic-assisted surgery at an outpatient surgery center is a game changer for this region,” he states. “Robotics are used for many different procedures in the hospital, some of which are outpatient; but now The Toledo Clinic provides quality robotic surgeries in a more convenient and suitable outpatient setting.”
Robotic-assisted surgery is also known as “minimally invasive surgery” because smaller incisions are required, and surgeons operate with greater precision. The outcome is less trauma to the body, resulting in less blood loss, less pain, faster recovery times and fewer complications, including less risk of infection. “With The Toledo Clinic’s addition of the da Vinci X to its outpatient surgery center, patients will be able to receive all of these benefits at a lower cost reducing out-of-pocket expenditures,” Dr. Naddaf says.
The group’s patients are keeping their finger on the pulse of technology, as well. “Even the older patients seem to be researching their physicians and new medical technologies online,” Dr. Naddaf adds.
The Right Road
Dr. Naddaf is proud of The Toledo Clinic and how it has thrived over the last 92 years. The group has competed with other institutions that have tried to close its doors, but have failed. “We’re fighting toe to toe with Goliath, it feels sometimes. The doctors, have been able to enjoy financial success while providing exceptional care to their patients,” Dr. Naddaf says. “We offer our patients and the Toledo community quality healthcare while allowing them to obtain significant cost savings and control their out-of-pocket expenses.”
The Toledo Clinic foresees increased pressure from the government and the market to operate more like a single-minded group. “From my perspective, we’re going through an evolution,” Dr. Naddaf says. “From the Government and insurers expectations, they want more rigid structuring that takes away some of our flexibility and independence. The Clinic, is working to achieve a balance between the two. We’re heading down the right road.” Dr. Naddaf attributes this success and growth to Mike D’Eramo’s leadership.
After multiple years of healthcare experience, Dr. D’Eramo came to The Toledo Clinic three years ago with a vision. “The goals that he is striving for are ones that we would never attempt on our own,” Dr. Naddaf adds. “He’s the strongest administrator to lead this organization. The road he’s taken us down is going to ensure our existence well into the future, as it is not easy for our kind of group to make long-term investments. However, it was essential that The Clinic make commitments to quality reporting and analytics to ensure we can self-report and improve patient care quality and efficiency.”