Some healthcare professionals might still be analyzing the Patient Protection and Affordable Care Act, but other physicians are making the legislation — and the ideas behind it — come to life. 
John Caruso, MD, is one of those physicians. He has nearly 20 years of experience in neurological surgery and currently practices with Neurological Specialists, a private group in Hagerstown, Md. A physician advocate, Dr. Caruso believes it's time for physicians to become more involved in healthcare economics and policy. Here, he shares his insight on physician-hospital relationships, population health management, and why physicians should broaden their understanding of a hospital's bottom line.
On working with hospitals
Dr. Caruso says physicians' tenure in a community generally outlive those of CEOs. "Philosophies can change quickly in regard to healthcare," says Dr. Caruso. He mentions a friend who once told him CEOs are similar to ball players that frequently relocate and work for different organizations. Young and eager CEOs, however, can make a noticeable difference in a hospital's relationships with other providers in the area. "When you get a CEO that really wants to innovate, that's when you get a home run," says Dr. Caruso.
Tense relations with hospitals are nothing new to Dr. Caruso, who has battled a hospital in his market for the past four years. The hospital saw the private practice as a competitor, taking inpatients away from their spine services. "The hospital saw us as a source of leakage. They fought us tooth and nail. Then they finally admitted that their inpatient volumes had been rising and they were improving their bottom line due to our practice," says Dr. Caruso.
He says hospitals often evaluate things from a service-line perspective, and need to widen their lens to focus on the large picture. His spine practice helped provide follow-up care for hospital patients, which could eventually lead to reduced readmissions. "Inpatient and outpatient care are married; you can't separate the two," says Dr. Caruso.
A sharpened focus on healthcare economics
Healthcare experts often speak on the gap in understanding between the head and the heart of healthcare — the people crunching numbers and the those providing care. As a physician activist, Dr. Caruso has made an initiative to educate himself on the economics, finances and business behind healthcare — the only way he thinks physicians can change the system. He encourages physicians to develop a deep sense of curiosity and become engaged in discussions, collaborations, meetings or other forms of activism to improve healthcare. "You have to understand that healthcare is at risk right now. You've got to realize you can't keep playing by the same rules. Become the champion of that change," says Dr. Caruso.
"It would be wrong for me to sit there and put my head in the sand," says Dr. Caruso. Physicians can no longer turn a blind eye to the cost of the care they provide. "You should become involved in your hospital, understand relationships with other physicians and maximize the economies of scale," says Dr. Caruso.
"You're a back-pain management specialist"
Dr. Caruso realized his field was evolving when one of his peers in the medical community told him he is not a spine surgeon, but a back-pain management specialist. "I thought he was nuts, but he was right," says Dr. Caruso. "He understood the concept that conservative care is the best way to go."
Dr. Caruso's change in mindset reflects a broader change in healthcare: population health management. The three-word term has become a buzzword in the industry, married to healthcare reform since it is believed to reduce spending while boosting efficiency. More physicians are extending the focus of their care to help manage chronic conditions — such as back pain — and serve across the continuum of care rather than episodically. As Dr. Caruso mentions, this can not only benefit the healthcare system but physicians' practices as well.
Less than 5 percent of people need surgery of the spine, which is why Dr. Caruso has expanded the musculoskeletal and neuromuscular health focus of his practice. As a result, Dr. Caruso's practice has also expanded its role in the marketplace. Sixty percent of all trauma patients have neuromuscular problems, which automatically ties the practice to inpatient hospital services. "That becomes an energy in and of itself,' says Dr. Caruso. "We are forming a group that expands upon our ability to keep trauma services open."
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John Caruso, MD, is one of those physicians. He has nearly 20 years of experience in neurological surgery and currently practices with Neurological Specialists, a private group in Hagerstown, Md. A physician advocate, Dr. Caruso believes it's time for physicians to become more involved in healthcare economics and policy. Here, he shares his insight on physician-hospital relationships, population health management, and why physicians should broaden their understanding of a hospital's bottom line.
On working with hospitals
Dr. Caruso says physicians' tenure in a community generally outlive those of CEOs. "Philosophies can change quickly in regard to healthcare," says Dr. Caruso. He mentions a friend who once told him CEOs are similar to ball players that frequently relocate and work for different organizations. Young and eager CEOs, however, can make a noticeable difference in a hospital's relationships with other providers in the area. "When you get a CEO that really wants to innovate, that's when you get a home run," says Dr. Caruso.
Tense relations with hospitals are nothing new to Dr. Caruso, who has battled a hospital in his market for the past four years. The hospital saw the private practice as a competitor, taking inpatients away from their spine services. "The hospital saw us as a source of leakage. They fought us tooth and nail. Then they finally admitted that their inpatient volumes had been rising and they were improving their bottom line due to our practice," says Dr. Caruso.
He says hospitals often evaluate things from a service-line perspective, and need to widen their lens to focus on the large picture. His spine practice helped provide follow-up care for hospital patients, which could eventually lead to reduced readmissions. "Inpatient and outpatient care are married; you can't separate the two," says Dr. Caruso.
A sharpened focus on healthcare economics
Healthcare experts often speak on the gap in understanding between the head and the heart of healthcare — the people crunching numbers and the those providing care. As a physician activist, Dr. Caruso has made an initiative to educate himself on the economics, finances and business behind healthcare — the only way he thinks physicians can change the system. He encourages physicians to develop a deep sense of curiosity and become engaged in discussions, collaborations, meetings or other forms of activism to improve healthcare. "You have to understand that healthcare is at risk right now. You've got to realize you can't keep playing by the same rules. Become the champion of that change," says Dr. Caruso.
"It would be wrong for me to sit there and put my head in the sand," says Dr. Caruso. Physicians can no longer turn a blind eye to the cost of the care they provide. "You should become involved in your hospital, understand relationships with other physicians and maximize the economies of scale," says Dr. Caruso.
"You're a back-pain management specialist"
Dr. Caruso realized his field was evolving when one of his peers in the medical community told him he is not a spine surgeon, but a back-pain management specialist. "I thought he was nuts, but he was right," says Dr. Caruso. "He understood the concept that conservative care is the best way to go."
Dr. Caruso's change in mindset reflects a broader change in healthcare: population health management. The three-word term has become a buzzword in the industry, married to healthcare reform since it is believed to reduce spending while boosting efficiency. More physicians are extending the focus of their care to help manage chronic conditions — such as back pain — and serve across the continuum of care rather than episodically. As Dr. Caruso mentions, this can not only benefit the healthcare system but physicians' practices as well.
Less than 5 percent of people need surgery of the spine, which is why Dr. Caruso has expanded the musculoskeletal and neuromuscular health focus of his practice. As a result, Dr. Caruso's practice has also expanded its role in the marketplace. Sixty percent of all trauma patients have neuromuscular problems, which automatically ties the practice to inpatient hospital services. "That becomes an energy in and of itself,' says Dr. Caruso. "We are forming a group that expands upon our ability to keep trauma services open."
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