Proliance Surgeons: Dave Fitzgerald, CEO

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Proliance Surgeons began as a group of orthopedic surgeons in 1993. They merged with a group of general surgeons in 2002 and have since grown to become one of the largest surgical practices in the nation with 165 surgeons, 70 allied health professionals, and 37 locations operating in five counties of the western portion of the state of Washington. They own and operate 13 ambulatory surgery centers at which many of the surgeries are performed.

The group is now comprised of a mix of orthopedic and ear, nose and throat specialists. They also have general surgeons who are specialists in breast, thoracic, vascular, and colo-rectal surgery.

The Doctor/Patient Relationship

Dave Fitzgerald, CEO of Proliance Surgeons, says that the driving mission of the organization is to leave the patient care in the hands of doctors. “When you talk about culture, it is centered on the patient and the doctor and that relationship,” he says. “While healthcare is a big business—and it has to be to be able to survive—it is a day-to-day, everyday, very small business. The transaction is a visit between a doctor and the patient. That’s the element we look at.”

The question becomes: How does a group enhance that element and make it work for the whole organization? “That’s the philosophy we have,” says Fitzgerald. “The doctor/patient relationship dominates every thing else.”

Proliance doesn’t have any formal training programs and doesn’t subscribe to any particular philosophies of efficiency or operation. “It is more on-the-job training,” says Fitzgerald. “We’re a physician-run organization, so we do things the way they do things.” Each office within the larger group is able to look for the type of person who fits with their style of running things. When new doctors are thinking about joining the group, they might come back two or three times to spend time at different locations, deciding where they would best fit. “One of our practices might have kind of a 60s look to it because that’s the style those physicians feel comfortable with,” Fitzgerald says. “Another might have a completely modern office feel, and it works for those who are there.”

Healthcare Finance

Fitzgerald doesn’t believe in controlling the nitty-gritty details. The physicians control their own environments and make the decisions that pertain directly to their own offices and staff. Fitzgerald’s job, as he sees it, is to take care of the bigger picture that gives Proliance doctors the advantage of existing within a larger organization without taking away their autonomy, which would detract from the doctor/patient relationship, the key to the best healthcare.

“Obviously, healthcare finance is always at the top of our agenda,” says Fitzgerald. “What’s happening with Medicare? What are all the regulatory things happening right now? We’re kind of fighting to provide healthcare knowledge, in dealing with the legislature. That’s what’s on my agenda.”

Proliance has recently entered a test phase for a pay-for-performance initiative with one of its insurance providers. The goal is to work toward reducing imaging studies and reducing other issues that add cost back into the system such as readmission, infection rates, etc. “It was during our last contract negotiation,” says Fitzgerald. “We both really wanted to be able to create something different and this is a chance for both of us to figure out how we are going to meet future needs, how we are going to start to change things.”

“Doing more with less,” says Fitzgerald. “That’s the economy right now. How can we continue to provide a quality product and do so more efficiently? It’s a lot of operational cleanup. Tune up, right now, is the name of the game.”

Fitzgerald sees a qualitative evolution for Proliance, bringing the costs down within the surgery centers and making sure that the organization is part of the solution rather than waiting on the sidelines to see what happens in healthcare. “Our focus will include growth, it will include IT, and it will include tighter relationships with payers,” he predicts.

Capital Investments

Proliance’s capital is currently being directed at facilities and information technology, bringing the level of security and backup to a superior level. In the past two years they have built several new facilities that have integrated clinics, therapy, imaging, and surgery centers all in one building.

“We’re big, but we want to remain local,” Fitzgerald says. The goal is not to build the biggest, most centralized practice, but to build practices that fit the size of the area. Proliance wants the primary doctors to remain connected and the patients to feel comfortable when they come in for a procedure because they know the doctors involved in their care.

Finding Direction

Fitzgerald hesitates to talk about future growth because there are so many unknowns on the horizon, and the organization isn’t focused on growth as much as meeting the needs of the patient population.

“What we want to do is to give doctors their voice back in the healthcare community. We will be as big as we need to be in order to do that.” Fitzgerald says, “Our focus will be helping those physicians who are maybe getting squashed by an insurance carrier or by a hospital, and being there to give them the strength that comes from being part of a larger organization.”

“You work with one issue and you get it going the right way. Solve those issues. Work with another and you solve those issues. As long as we’re all going the same direction, we’re all going to win.”

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