The direction healthcare reform is taking today is no surprise to Thomas Brown, CEO of Eye Specialty Group (ESG).
In Alabama two decades ago, Brown pioneered what were then groundbreaking approaches to building primary provider networks – networks with connections to local hospitals and, through them, to tertiary facilities in larger cities that could provide specialized care. Today Brown again is in the vanguard of the movement to provide better quality care to ESG’s ophthalmology patients through mutually beneficial partnerships with primary care physicians and area optometrists, who together provide the bulk of ESG’s referrals.
“Twenty years ago," he said, "we had the concept of primary care doctors and specialists working together on patients, and that’s where we’re going with healthcare reform now, with great communication between primary care doctors and specialists. The care that’s being rendered out in the communities by the optometrists and primary care doctors is then supplemented by the specialists, who are treating patients and sending them back (for continued or maintenance care)."
The network-building exercise Brown attempted in the '90s failed because “we never figured out how to communicate back and forth between the various providers,” he said. At that time, practice management companies purchased multiple practices to create efficiencies, but cooperative efforts between them were largely doomed by poor communication.
“That’s why I’m excited about healthcare reform today," he said. "Now we’re saying, ‘Let’s not worry about who owns who; let’s just figure out how to work together.’”
To that end, Brown’s Eye Specialty Group is meeting with hospitals, payors and health systems to introduce them to ESG’s “200 friends” who are community eye care providers.
Payors ready to start paying for quality — defined in this case as ensuring that 75 percent of their insureds’ diabetic patients are getting dilated eye exams every year — are already contacting Brown to ask if he can place an eye care provider in their primary care doctors’ offices to perform the dilated eye exams.
Working together with their “200 friends,” said Brown, “. . . we can conveniently provide all the services that hospitals, payers and the government are asking for – within a system that we in ophthalmology have already created.”
He has also begun working to identify Mississippi optometrists located near primary care physicians who may have previously dilated their own patients. His goal is to expand the network’s reach by connecting Mississippi doctors with community optometrists while still enabling ESG to accept referrals when the patient’s pathology dictates specialized ophthalmic care.
The greatest challenge he faces is posed by the different brands of software that physicians and optometrists use. “The systems don’t communicate well with each other," he said. "The government says they must but has established no specific standards."
Five primary EMR systems are currently in use in the optometric community, and Brown is working with their users to set up demos to expedite the process. “If we are successful in this endeavor,” he said, “we’ll be one of the first places in the country to accomplish this — ahead of LA, Nashville and other major cities.”
A certified ophthalmic executive (COE) with 20 years of healthcare industry experience, Brown graduated from Samford University in Birmingham and earned his J.D. degree from University of Alabama Law School before following a career path that led him to Memphis in 2006 to serve as administrator at ESG and Ridge Lake Ambulatory Surgery Center. In 2015 he assumed the role of CEO of Provident Practice Management Services when the group was restructured to separate the provider group of 14 physicians and nurse practitioners from the 135 non-physician staff that supports and administers the practice.
All assets — employees, services and equipment — are now owned by Provident Practice Management Services and leased back to ESG and the Ridge Lake Ambulatory Surgery Center. In time, he hopes to also offer management services to other practices.
He notes that the door to the Ambulatory Center, where ESG performs its primary line of service — cataract surgery plus oculoplastics, glaucoma and retina procedures — is always open to other doctors.
The group’s locations include leased space inside the Southern College of Optometry’s Eye Center, where they provide specialty and medical services onsite, largely for the benefit of students willing to “observe and learn from what we’re doing on the medical side," he said. "We believe in a collaborative relationship between optometry and ophthalmology, so we work with them for training.”
Called into medicine as a child, Brown served as a 13-year-old volunteer at the county hospital in his hometown of Dothan, Alabama, but his early phobia concerning needles stood in the way of becoming a healthcare provider. His law degree led him into service with a group of southeast Alabama hospitals that needed an attorney during the implementation of 1993 healthcare reforms. When an opportunity with a large ophthalmology practice in Dothan arose, he began the network-building that ultimately led him to Memphis.
“My attitude has always been that healthcare and this practice improve by working together with other people," he said. "I’m here for anybody who wants to talk and share.”
He regards his proudest accomplishment as ESG’s growth and his 10 years of success there, working with others. That growth is likely to continue, as ophthalmology typically serves a rapidly growing segment of the healthcare market. “The vast majority of our patient population is at or approaching Medicare age,” he said.
His vision for the future? Encouraged by recent agreement of both parties on 2015 healthcare reform legislation emphasizing quality of care, Brown predicts, “I think you’re going to see great changes — exciting changes — happening.”
Brown has passed on a lifelong love of waterskiing to his two teenage daughters, and leisure finds him and his family at the lake and on the water whenever possible — and supporting Alabama football always.
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