Latest / Becker’s Healthcare Podcast / Strengthening Independent Medicine and Rethinking Employer Health Benefits with Scott Hurst

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Strengthening Independent Medicine and Rethinking Employer Health Benefits with Scott Hurst · Becker’s Healthcare Podcast

• 0:01
  This is where health care leadership comes together.
• 0:04
  Becker's sixteenth annual meeting brings more than 3,500
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  hospital and health system executives and nearly 800
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  speakers to Chicago
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  April.
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  This year's event includes keynote conversations with Dallas
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  Cowboys legend Troy Aikman and former president George
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  w Bush. For the agenda and event details,
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  visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right. We're looking forward to hosting you
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  in Chicago.
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  This is Scott Becker with the Becker's Healthcare
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  Podcast.
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  I'm thrilled today to visit with Scott Hurst,
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  and Scott's had a tremendous leadership career.
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  He's gonna talk to us a little bit
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  today about where he's most focused today, what
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  he's doing, and a lot more.
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  Scott, can you take a moment and introduce
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  yourself?
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  Sure. I appreciate the opportunity to to rejoin
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  you on the podcast. I was telling
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  one of your colleagues that I I'm pretty
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  certain we did this about three years ago,
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  but it doesn't
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  feel like that long ago. So
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  I am currently serving as CEO and president
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  of a large IPA, independent practice association in
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  the Dallas, Texas area. We've got just short
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  of 600 providers,
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  that trust our organization to assist them in
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  contracting, delegated credentialing,
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  group purchasing,
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  value based care operations.
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  And most recently, and one of the things
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  I'm most proud of, the creation and development
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  of a MEWA
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  offering for health insurance to our practices, their
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  members, and their families.
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  And and tell us what a MEWA offering
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  is. I'm I'm sure I should know, but
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  talk to us about what that is. I've
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  seen the term, but don't really understand.
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  It it's it's a it's a relatively emerging
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  term. Well, I I think well, let me
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  let me back up. I think it's been
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  out there for a while. I don't think
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  many people
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  implement it
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  in the space that we exist in. So
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  meanwhile, stands for multiple employer welfare
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  arrangement.
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  And there's very specific things you do, and
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  we had to work with lawyers to
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  check all the boxes, you know, for lack
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  of a better term, to get granted the
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  ability to run this through the Texas Department
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  of Insurance.
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  So we all we offer a fully insured
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  product
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  to all of our member offices
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  for our members, their staff members, family, so
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  on and so forth. And we did that
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  in large part because the
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  increasing cost of health insurance, I I viewed
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  as
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  a remarkable
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  impediment or a remarkable threat to my offices.
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  And that was three years ago when we
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  started it. We started with just short of
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  50 participants. And then this year coming into
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  '26, we've
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  got almost 250
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  people participating on the plan.
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  Fantastic.
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  And and and and and tell us about
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  IPAs today.
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  It feels like at one time, everybody was
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  building an IPA
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  and seems like not so much. Give us
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  a sense of where do IPAs sit today
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  and and and how is that going,
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  and and what's the trends? I know in
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  some markets, bigger than others, but tell us
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  what you're seeing with with IPAs today.
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  I think, it's a challenging time for IPAs,
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  unless you're in an IPA beer.
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  But
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  I think
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  independent medicine in general is remarkably
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  challenging,
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  and it's largely because the payers
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  are not recognizing the value that independent doctors
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  can bring to the table.
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  And probably most importantly, because employers don't realize
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  the resources available to them to lower their
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  cost.
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  In the Dallas Fort Worth market, 80% of
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  the major employers are self insured entities.
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  And just yesterday, I was talking to an
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  individual from a large employer at a an
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  event,
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  and we were talking about the rates that
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  my doctors get
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  from
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  the BUCAs,
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  you know, Blue, United, Cigna, Aetna,
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  comparative to what the big vertically integrated systems
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  get.
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  And it is a remarkable
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  disparity. In fact, almost shameful disparity now, what
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  my doctors get comparative to
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  vertically integrated systems.
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  And the sad reality is that money is
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  not going to the doctors in those systems.
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  It's just going to cost in those systems.
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  And that cost is being transferred down to
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  the employers,
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  and the employers are not being told what's
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  really driving their cost increases.
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  Thank you. And how could that change at
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  all? How how does this change? It seems
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  like we've got this crazy situation in health
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  care that between the government, the big payers,
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  money's moving around, but costs are going up.
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  And then the flip side is we're not
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  producing enough doctors and nurses. We're getting better
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  on nurses, but it seems like on doctors,
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  a disaster.
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  How do we fix this? Is there any
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  way to fix some of this?
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  I I wish there was a single snap
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  of the finger that could fix health care,
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  but I'm afraid that's not,
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  that wouldn't be a true statement. Let's put
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  it that way.
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  Small steps can be taken to fix it.
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  First and foremost, you know, this this conversation
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  I had yesterday with this major employer,
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  he suggested that we write a contract between
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  PPN
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  and the employer for provision of care from
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  my network
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  and that he would write the contract at
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  this value and then
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  drive his employees to see physicians in my
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  network
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  and take the savings from using that network
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  comparative to using
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  large integrated
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  health system,
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  and share it with his employees.
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  And I was like, that is an outstanding
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  plan of action,
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  but too many employers don't sort of think
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  through that. They don't understand that if you're
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  if my doctors are being paid
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  right around Medicare, which is unfortunate, and then
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  other doctors are being paid
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  $19,202
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  50 of Medicare,
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  Like, that cost differential is real dollars in
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  terms of professional fees, in terms of surgical
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  fees, in terms of,
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  labor and delivery fees, all of those things.
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  Now it doesn't address some of the really
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  big charges inside of hospitals,
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  and and that's not my job today.
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  Is it something that'll have to be addressed
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  also? Absolutely.
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  But right now, my concern is just trying
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  to create a path by which independent medicine
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  can survive and thrive.
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  Thank you. And where do you see that?
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  It seems like not enough doctors,
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  you know, 9% are employed by United,
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  9% are employed by private equity, 7%, 8%
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  by private equity,
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  truly independent less and less, too complex a
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  payer situation to be truly independent, very hard
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  unless you're really big.
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  Where is it going in terms of independent
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  practitioners?
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  And Texas is one of the last bastions
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  of a decent amount of independent practice. What
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  do you see?
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  Yeah. I had to tie up my horse
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  before I got on the phone for, today's
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  call. But,
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  you know, I think independent medicine has a
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  place.
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  I do believe, and I've been very,
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  active and honest with my board of directors
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  about this,
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  that the days of an independent organization like
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  PPN having 200 different approaches to rev cycle
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  and 46 different EHRs
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  and
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  five or 10 different clearing houses,
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  that has
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  to go away.
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  Right? We have to move to where we
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  have one unified rev cycle. We have to
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  move to where we have no more than
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  three or four
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  enterprise level EHRs and probably target getting to
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  one
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  because then
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  we can let people be independent. I don't
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  wanna tell them when to practice, where to
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  practice, how to dress in their practice.
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  I don't wanna do any of those things.
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  But what I do wanna make certain is
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  that they're being as efficient and as effective
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  as possible at the thing that lets them
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  do the thing they wanna do, which is
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  practice medicine.
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  And there's way too many instances where
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  doctors are being
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  denied, delayed,
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  underpaid,
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  where they're being downcoded right now. I mean,
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  we we received documented
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  notification
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  from major payers that they were gonna take
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  9921
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  fours and 21Fives
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  and downcode them one level automatically.
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  That's them practicing medicine. That's not their job.
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  And so Yeah. A 100%. Organization's gonna have
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  to fix that.
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  And and talk about in the opposite side
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  of all this, lots of challenges. What are
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  you most focused
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  and excited about this year?
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  This year? I two things. One, continuing to
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  grow the MiWAA. I I really do think
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  that that's a remarkable value for our members,
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  but it's also a learning experience. You know,
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  I've I've talked to dozens of practices
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  where,
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  you know, they they call their broker every
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  October, and they say, hey. We need to
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  renew our insurance.
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  And the broker says, okay. Let me get
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  back to you in a couple days. Then
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  the broker calls back and says, well, you
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  know, we can keep you here. We can
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  go here. It's gonna be 10% increase, but
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  it's tough market out there.
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  The brokers very rarely talk about,
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  new and creative ways to approach this business.
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  And, you know, the plan that we offer
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  our members
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  does two things. One, it it's a zero
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  co pay, zero deductible,
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  $52.50
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  out of pocket max plan.
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  At the same time, it pays my doctors
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  fairly,
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  well above what I get from the BUCAs.
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  And so the the reality is that's one
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  thing I'm really focused on. Another thing I'm
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  really focused on is this idea of
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  kind of bringing my doctors together to let
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  them understand that scale is the name of
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  the game today,
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  and we have to find a path to
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  scale without
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  sacrificing all of their independence.
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  Because those that run out to the edge,
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  they're being forced to move into employment because
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  they don't have any other options right now.
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  No. I I I love your perspective on
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  it. You're absolutely right about being forced to
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  go into groups, into health systems, into every
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  place else because there's no other option. So
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  I will I I love your perspective, and
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  I love your perspective on the growth of
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  multi employer welfare plans too is fantastic.
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  Scott, you've had this great career in health
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  care. Any advice that you would give to
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  emerging leaders?
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  Well, I won't imitate a lot of my
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  doctors who tell their kids don't practice medicine.
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  I I we need good people in health
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  care. It's gonna take good people working together
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  to solve this.
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  I think the biggest piece of advice I
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  would give right now
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  is don't assume or 100%
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  accept the idea that AI is gonna fix
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  everything.
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  Because, unfortunately, I'm already seeing too many instances
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  where people are 100% on the train of
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  AI,
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  but they don't know enough about what they're
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  asking AI to to populate or create or
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  design
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  to then identify the errors.
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  And if all we do is throw more
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  junk on top of junk, it's gonna get
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  real messy.
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  So I think I would counsel new leaders.
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  Hey. Take a breath.
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  You can take time to really evaluate this,
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  study it, understand it, ask good questions,
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  demand accountability from your teams and your people,
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  but don't be,
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  rude.
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  There are generations coming up right now through
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  the schools, because I've got kids,
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  who really aren't learning per se.
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  They're just repopulating
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  documents.
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  And and it's a problem that's gonna catch
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  up with us if we're not careful. Well,
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  it's some it's so interesting to say that
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  because we have a a really close colleague
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  who teaches advanced math in high school,
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  and he is saying that the rigor of
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  the students' minds is the worst he's seen
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  in years because they're doing exactly what you're
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  talking about. The more repopulating, they're actually thinking
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  with rigor.
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  And I think that is a really fastened
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  perspective. And And in health care, I could
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  not agree with you more.
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  It's gotta be AI
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  plus people, AI plus specialists to to to
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  make this work in the long run.
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  I could not agree with you more.
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  Thank you so much. Scott, I wanna thank
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  you for joining us today on the Becker's
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  Healthcare Podcast. I love getting a chance to
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  visit with you. You've got just this most
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  realistic view of the world and what you're
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  seeing. You don't sugarcoat it. It's a real
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  pleasure. Thank you so much for taking the
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  time to join us today.
• 12:27
  Hey. Thank you for giving me the
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  opportunity.