Few, if any, could have imagined the advances and changes in health care and medicine that have occurred over the last century. The innovation, invention, improvement, discovery and development related to diagnostics, treatments, drug therapies, techniques and cures have been extraordinary.
Fewer still may have anticipated health care delivery systems driven by health insurance, Medicare and Medicaid, or that today professionals and consumers alike would be working hard to wrap their heads around complex changes including those being brought about by the Affordable Care Act (ACA).
Nevertheless, at any given time, there have been individuals and groups whose foresight and determination have propelled health care forward for future generations.
Among them, in 1923, were Doctors James P. Matheson, Clarence N. Peeler, and Henry L. Sloan Sr. who established the 37-bed multispecialty group, Charlotte Eye Ear and Throat Hospital (CEET) on Seventh Street in downtown Charlotte. At the time, treatment of the eye, ear and throat was a single specialty, and the hospital was the first of its kind in the nation.
“There are not many practices in the entire nation that are 90 years old,” attests Jag Gill, CEO of the now-named Charlotte Eye, Ear, Nose & Throat, P.A. (CEENTA).
CEENTA has spent a little short of a century growing its practice from three to 74 physicians; from one office to 15 offices scattered across the extended Charlotte metropolitan region. Its staff is now 600-strong and cares for millions of patients each year. Combined, the offices form a tertiary center amid Charlotte’s two major hospital systems: Carolinas HealthCare System and Novant Health.
CEENTA offers a broad range of services that include eye care; ear, nose and throat care (ENT); audiology; sleep medicine; allergy; facial plastics; voice and swallowing care; and optical and contacts.
Its subspecialties include otology, neurotology, adult and pediatric otolaryngology, vitreoretinal diseases and surgery, glaucoma management and surgery, neuro-ophthalmology, pediatric ophthalmology, oculoplastics, corneal and refractive surgery, and more.
The group offers treatments around cochlear implants, ear tube surgery, hearing disorders, hearing aid services, voice disorders, sleep apnea, allergies, comprehensive ophthalmology (including cataract surgery), and optometric eye care, among others.
“We cover all of the subspecialties of ENT that you would get in a university or academic center,” says Steven Gold, M.D., CEENTA’s chairman and president on the ENT side. “There’s really almost nothing we need to refer elsewhere. It’s the same in ophthalmology.”
The practice is expected to reach $100 million in revenue this year. Growth has been steady over the years at a rate of approximately five percent.
Assuring Quality Outcomes
Still, the large and growing practice is not immune to the uncertainty that is currently the mood of health care.
“These are turbulent times in health care,” says Andrew N. Antoszyk, M.D., president of the ophthalmology side of CEENTA. “There is a lot of confusion right now as the ACA rolls out. What coverage will be available and to whom? What does a plan include or exclude? What impact will the ACA have on hospitals, physician practices and reimbursement policies? We don’t have all the answers right now.”
Drs. Gill, Gold and Antoszyk all agree, however, in the group’s philosophy and strategic plan.
“With all the confusion with insurance companies and the ACA, there are a lot of things out of our control,” explains Gold. “But we remain firmly in control of our commitment to providing the absolute best eye and ENT care, the most compassionate care possible to the whole region.” Gold says that there is not a companywide statement or consensus regarding the ACA, but “with 70 physicians, there is certainly a diversity of opinions.”
In general terms, the Affordable Care Act calls for reforms to reduce the inordinate rise in health care costs while maintaining quality, provide access to health care to millions of uninsured Americans, utilize Accountable Care Organizations (ACOs) to provide coordinated care, create transparency of costs, employ uniform electronic medial records, shift the paradigm of health care to one of wellness, establish metrics for quality health care and outcomes, and to construct formulas for value-driven reimbursements to providers.
While most of these initiatives will first, and most directly, be driven through primary care providers, specialists will also be increasingly impacted.
“Access is important,” stresses Gold. “There are still lots of people who slip through the cracks and don’t have health coverage. The bottom line, with the start of the ACA, is that supposedly there will be millions of people who become covered. That will be a good thing. If the ACA can deliver on its promise of providing affordable insurance to all, we at CEENTA see this as a positive.” However, both Drs. Antoszyk and Gold agree that it is unclear how this is going to transpire without spending more money.
“Value-based reimbursement for providers is something that will be here,” says Gill. “Before it gets here, we have to figure out how to measure value—what quality metrics should we be measuring?”
“The quality measures that are out there now are check boxes put into a computer about what was and wasn’t done. It doesn’t really tell you much about outcomes,” explains Gold. “It’s very difficult to tell how well someone is or if one patient with diabetes is getting better care than another patient with diabetes.”
While the CEENTA execs admit that there is a long road ahead, the firm has begun this work and considers itself to be a leader among private practices. “We collect data on outcomes, conduct peer review on cases, and go over film and CT scans and compare to operative reports. Most private groups are not yet doing this,” says Gold.
“One of the most important things we have to do is determine which quality care metrics we need to measure, then come up with a robust IT system to measure that data and get it to the payors,” says Gill.
Operating the Practice
The combined education, training and experience of CEENTA physicians is beyond impressive.
Gold completed medical training at Boston University School of Medicine in 1982, followed by residency at Naval Hospital in San Diego. His fellowship was through the University of Pittsburgh.
Antoszyk received his medical degree from New York Medical College in 1983, followed by internship, residency and fellowship at Duke University Eye Center.
Gill, new this year, came to CEENTA from Dignity Health’s Medical Foundation in California where he was president and CEO. He holds a master’s degree in Health Administration from the University of Missouri and a doctorate of science in Health Systems Management from Tulane University.
CEENTA operates under a 10-physician board of directors, five from each specialty. The board directs the administration while the administration presents ideas and proposals to the board.
The CEENTA staff is comprised of physicians, audiologists, optometrists, physicians’ assistants, nurse practioners and sleep and voice specialists as well as a chief executive officer and chief operating officer and employees in marketing, accounting, human resources, IT and electronic medical records (EMR).
“The culture here is one of collegiality and patient-first focus,” affirms Gill. “That is one reason I accepted this position. As long as we put the patient first, things always come out well in the end.”
New physicians are most often recruited by current physicians as well as from small groups looking to join a larger group, especially those without EMR systems. CEENTA remains open to considering practices who are interested in joining them.
“Keeping quality employees is always a challenge,” adds Antoszyk, “but we have developed a comprehensive employee package including generous salary and benefits, flexible working hours, continuing education and health care coverage that has been instrumental in helping us retain outstanding employees.”
According to Antoszyk, the goal is to operate in a more efficient manner since 80 percent of costs are fixed: “The recipe is simple: accommodate more patients in a timely and efficient manner. We plan to address this by hiring more providers and placing them in offices close to where patients live or work so that they can be seen quickly with reduced wait time. This increased volume will allow us to enhance productivity through more efficient use of our facilities and staff.”
“Costs are going up—inflation, increases in equipment costs, rent, utilities, salaries and benefits—areas every business has to contend with including health care,” continues Gill. “We are constantly striving to provide the highest quality patient care in a caring environment and we believe we are able to succeed because we have a compassionate and caring administration and staff that supports our outstanding clinicians.”
“Things can change quickly in health care but we have a three-year strategic plan,” Gill maintains. “We want to grow, provide quality care, measure and report that quality, and remain an independent practice.”
Innovation and Invention
In 1992, CEENTA started its own research department to coordinate Phase I-IV ophthalmology and otolaryngology clinical trials. The department grew into Southeast Clinical Research Associates where CEENTA physicians further studies in age-related macular degeneration, retinal vein occlusion, diabetic eye disease, macular edema, glaucoma, cataracts, dry eye, uveitis, chronic sinusitis, nasal polyps, Meniere’s disease, and otitis media.
“We are now heavily into clinical research, doing trials with pharmaceutical companies and the National Eye Institute,” describes Antoszyk. “We are particularly proud of our collaboration with Diabetic Retinopathy Clinical Research Network (DRCRnet) which has yielded ground-breaking treatments in the management of diabeth retinopathy and has been lauded by Congress on numerous occasions.
“This network is a unique collaboration between academic institutions and private practices that identifies clinically relevant problems and then develops protocols to answer the questions.
“One DRCR study—Protocol I—has completely changed how we manage diabetics with diabetic macular edema,” continues Antoszyk.
Innovation and invention are not new to the practice. In 1952, it was Dr. Beverly Armstrong of the firm who invented the tympanostomy, or ear tube and surgery, the most common surgical procedure performed on children in the United States that requires anesthesia. The design of the tube and the procedure remain the same today.
Relationship with the Community
Critical to CEENTA are the relationships its physicians have with the region’s two health care systems, Carolinas HealthCare System and Novant Health.
“It can be difficult to maintain a balance while affiliated with each of them,” says Antoszyk. “We must consider each decision with regard to the impact it will have on one or the other hospital system. Our goal is to provide surgical and medical support to both hospitals while remaining independent.”
CEENTA also takes part in the training of doctors with medical students and residents coming through on rotation. “We work with UNC Hospitals through Carolinas HealthCare System where they have a campus for third and fourth year medical students,” explains Gold.
Antoszyk continues, “Our focus is on providing quality care for all the senses above the neck, but we’re also very involved with giving back to the community.
“Through CEENTA Cares, the firm has been able to make a difference in the community, volunteering staff time, talents and energy to projects like Second Harvest, Habitat for Humanity and Wounded Warriors.”
One of the firm’s recent projects was dubbed “Runnin’ Up Rainier,” led by Dr. Scott Jaben. Last year, he had suffered a back injury that prevented him in his attempt to climb Mount Rainier, the second highest peak in the Pacific coast range. So, as part of his training to reattempt the climb, he started his virtual climb of the 25,000 stair steps via the stairs at the SouthPark office.
He invited employees and acquaintances to join with him from home, office or gym, with a goal of raising $50,000 for the Wounded Warrior Project.
“For those at the SouthPark office, that meant five daily trips up the stairs for the three months of the fundraiser,” says Antoszyk, “building strength, stamina and character, but more importantly, contributing to the community on behalf of the firm.”
Another of the firm’s projects, the CEENTA Cares Walking Team, recently raised $3,375 for the Charlotte VisionWalk supporting the Foundation for Fighting Blindness.
“Our staff is very active in community service and we foster that,” attests Gill.