Medical Associates, a pioneering for-profit multispecialty medical group, has been a stalwart in providing comprehensive healthcare services since its inception in 1951. Founded by the visionary Dr. James R. Fairchild, the group embarked on a journey of expansion and innovation, evolving into a multispecialty medical care provider in 1972 under Dr. Fairchild's leadership. Dr. Fairchild, a passionate advocate for multispecialty medicine, played a pivotal role in shaping the group's ethos and instilled a commitment to high-quality, convenient, and cost-effective patient care.

The retirement of Dr. Fairchild in 1995 marked a significant transition, symbolized by the renaming of the Jasper facility to Fairchild Medical Center. Despite his retirement, Dr. Fairchild continues to contribute as an "interested observer," providing valuable insights based on his extensive experience and deep understanding of the community's healthcare needs.

Medical Associates has witnessed generational shifts in its physician composition, with the original cohort gradually retiring or relocating. New physicians, many recruited immediately after completing their residencies, bring fresh perspectives and expertise. Notably, a cohort of osteopathic physicians, formerly affiliated with Webster Hospital, has joined Medical Associates, enriching the group's diversity and skill set.

The organizational structure is robust, featuring two key departments, Medicine and Surgery, each led by an annually elected chair. Dr. Clyde Eason, the Medical Director for the past seven years, plays a pivotal role in ensuring medical quality assurance and overseeing crucial contracts. The executive manager, Cynthia Worley, oversees non-medical operations, exhibiting astute leadership in navigating the complex landscape of healthcare administration.

Governance is vested in a seven-member elected Board of Directors, representing shareholder interests. The board convenes monthly, with standing committees addressing critical facets such as audit, clinical standards and quality, finance, and management. This structured approach ensures that Medical Associates maintains financial stability, operational efficiency, and adherence to rigorous clinical standards.

A significant accomplishment for Medical Associates under Worley's leadership is the establishment of a state-of-the-art electronic health record (EHR) system. This EHR, compliant with CMS's Promoting Interoperability Programs, stands as a testament to the group's commitment to leveraging technology for improved patient care. The EHR not only facilitates streamlined operations but has been instrumental in expanding telemedicine services and remote patient monitoring, especially crucial during the challenging times of the COVID-19 pandemic.

Despite these successes, Medical Associates faces challenges that reflect the dynamic nature of the healthcare landscape. Disagreements within the clinical standards and quality committee regarding the recruitment of primary care physicians for the Jasper facility exemplify the complex decision-making processes inherent in healthcare organizations. The need for professional analysts to meet the demands of population health and medical outcome studies adds another layer of complexity.

However, Medical Associates remains proactive, engaging in innovative initiatives to enhance its services and brand value. Participation in second-opinion programs with nationally recognized clinics, such as the Smith Brothers Clinic and the Cuyahoga Clinic, demonstrates the group's commitment to providing top-notch healthcare and staying abreast of the latest developments in the medical field.

As Medical Associates looks toward the future, strategic evaluations of agreements and exploration of additional opportunities are on the horizon. The organization, with its rich history, adaptive leadership, and commitment to quality care, stands poised to navigate the evolving healthcare landscape, ensuring the well-being of the communities it serves for years to come.

The group's commitment to inclusivity and adaptability is evident in its approach to physician recruitment, welcoming osteopathic physicians and considering the recruitment of primary care physicians for the Jasper facility. This adaptability aligns with the group's ethos of responding to evolving community needs, ensuring a diverse skill set to address a wide range of healthcare requirements.

In the operational domain, Medical Associates boasts modern facilities in Middleboro and Jasper, equipped with advanced imaging technologies and a patient-friendly centralized appointment and registration system. The group's embrace of telemedicine, expanded office hours until 9 p.m. twice a week, and the addition of a 24/7 convenient care center (Medical Associates Express) underscore its commitment to accessible and patient-centric care.

The financial landscape of Medical Associates is characterized by a thoughtful approach to compensation and benefits for its diverse staff. Physicians, whether full-time or part-time, are provided comprehensive benefits, and the group maintains a 401(k) retirement plan for all employees. The group's revenue streams are diversified, with Medicare and Medicaid contributing a substantial portion alongside commercial/private insurance. The group's responsiveness to the shifting dynamics of insurance revenues during the pandemic demonstrates its financial acumen and adaptability.

In addressing the challenges ahead, Medical Associates is actively considering the recruitment of primary care physicians for the Jasper facility, recognizing the importance of bolstering healthcare access in the community. The internal debates within committees and the acknowledgment of the need for professional analysts signify the group's commitment to strategic decision-making and staying ahead of the curve in terms of healthcare analytics and population health management.

Furthermore, the group's participation in second-opinion programs with esteemed clinics positions Medical Associates as a clinical affiliate of highly respected networks. This not only enhances the group's reputation but also underscores its commitment to providing the best possible care to its patients.

As Medical Associates navigates the complex healthcare landscape, the foresight embedded in its leadership structure, the adaptability demonstrated in its operational strategies, and the proactive approach to emerging challenges position the group as a resilient and patient-focused healthcare provider. The group's rich history, coupled with its commitment to innovation and inclusivity, ensures that Medical Associates remains a cornerstone in providing healthcare services to the communities it serves. What approach would you give to the Ambulatory Surgery for Middleboro? We have achieved our targeted utilization and financial projections for ambulatory surgery in Jasper. Our surgery center in Jasper has hit capacity and the surgeons would like us to build out space in our Middleboro office and recruit additional surgeons to support both. Assume the following information regarding costs of the expansion: Annual fixed costs $500,000 Average variable per case $1150 Annual procedures $3,000 Average charge per procedure $2350 Payer % of Visits Revenue/Charge Ratio Medicare 35% 75% Medicaid 15% 50% Managed Care 15% 85% Swift 10% 88% Other Commercial 5% 0% We estimate that this unit, using a standard relative value unit (RVU) system used in hospitals, will generate 1.1 surgical procedures per case. What should the type of cases be at each locations. Further, if we need to recruit additional surgeons, what specialties do you recommend and what are the recruitment costs associated with this? Lastly, the state has also announced that in 18 months, all Medicaid rates paid to physicians and hospitals may be reduced by an additional 10 percent. Today, Medicaid pays Medical Associates on average 60 percent of gross billed charges. Further reductions in reimbursement may require management action. Options include no longer accepting Medicaid, no longer accepting Medicaid for ambulatory surgery, and/or maintaining a quota for Medicaid patients. What other options exist. Please review all the above and recommend what we should do and provide the supporting information regarding your recommendations.