Practice Management Partnerships

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1 Practice Management Partnerships For over a decade the MediSync management team, in partnerships with forward thinking physicians, has helped medical groups become very highly successful even in these challenging and difficult times. MediSync s mission is to help our partner medical group to clearly be the market leading medical group in its region. Together, with our partner physician groups, we are succeeding. For example: Our disease management processes have achieved the best outcomes in the United States for common and expensive conditions like hypertension. In other disease states we are in the top 10 medical groups in the nation. Our focus on patient experience has helped partner groups achieve very strong market expansion as measured by new patients and total patients. Often we have achieved this growth despite competing against much better funded medical groups. Our partner groups have increased revenues in excess of 40% over a multi-year period based upon our medical quality and practice growth results. The physician groups that we support are not financially subsidized yet physician compensation is in the upper quartile of national averages across several specialties. Core operations (i.e. revenue cycle management, practice operations costs, etc.) that surpass the national averages by a considerable margin. Why Change? MediSync is headquartered in Cincinnati, Ohio, which is home to some of America s best and most successful companies Proctor & Gamble, GE s Transportation businesses including its jet engines business, Toyota s North American headquarters, Kroger and Macy s. All of these companies have increased their success in part by using outsourcing strategies. Strategic outsourcing allows a company to focus capital, talent and leadership focus on its core competencies. Outsourcing is a way to harness the creativity, capital and skills of sector specialists in areas that are vitally important but not core competencies. MediSync is dedicated solely and exclusively to medical group management and performance improvement. For more than a dozen years our team has invested millions of dollars to research, create, implement and improve systems and processes that enabled our medical group partners to succeed well beyond the market and national averages. Many medical groups whether part of a health system, affiliated with a hospital or independent struggle to find and maintain the resources to achieve these results. The Cost and Rewards of Success In the last 12+ years MediSync has invested literally millions of dollars on: Black and Green Belt Six Sigma training for the majority of management personnel Lean Six Sigma Master Black consultant, full-time on our team

2 A team of five to nine highly skilled management level team members without direct management responsibility available to be deployed to improvement projects Six to ten improvement projects per year covering practice operations, clinical care and EHR deployment Numerous inventions that have been tried and tested by our current partner medical groups. Many are now being re-sold to other medical groups and are reported to help other groups significantly Massive investments in the development of physician leaders to enable physician groups to achieve higher outcomes in all areas clinical, financial and operational The reward for all of this has been highly successful medical groups in which third party compensation has increased 40% over several years, market leading new-patient volumes, high patient retention, financial success, etc. If we can do all this, another organization likely can, too. However, we have the advantage of a multi-year head start, we ve already made a lot of the mistakes and discovered several roads to nowhere (often having traveled down them for a bit). How is a Practice Management Partnership Structured? MediSync reports to the Board of Directors and/or owners of a group. Our first priority is typically on core operations. We strongly encourage medical groups to develop a strategy, and we provide expertise and guidance about how to do so. Once adopted, our management team plans with physician leaders and others how to execute the strategy. The group or group sponsor has the final decision about what the strategy will be. MediSync assigns two or more senior executives and managers exclusively to each group. Some services are supplied by our central team. Our range of services is all inclusive - we take total management responsibility for the success of the group, and we report to the board and physicians on our performance. It takes a lot of expertise to make a physician group highly successful in today s healthcare economy. In the end, we mark our success based upon whether our partner medical groups are more successful with our help than without. This is measured financially, operationally and clinically. The value we add to the physicians is greater than the cost of our services. When partnering with MediSync, our comprehensive management partnership obligations can include: The senior MediSync team member assigned to your group becomes the Executive Director of the group. S/he reports to your physician President and Board of Directors. The Executive Director consults in the development of strategy for your medical group. The Executive Director is responsible for all the aspects of management for the group. MediSync provides a highly trained and experienced senior clinical manager(s) to oversee practice operations for each 20 to 30 physicians. Titled Directors of

3 Practice Operations, they often hold both clinical and MBA degrees. They directly supervise the site or practice managers at each medical office. MediSync provides all the central computer servers and software to perform the scheduling, billing and collections. In addition, we provide the staff to perform the billing and collections, and we pay all fees related to claims submission, claims follow-up, electronic filing, etc. MediSync provides accounting staff, covering the costs of staffing all your group s accounts payables, financial statements and other financial analyses. In addition, we provide highly detailed monthly and annual financial and accounting reports. MediSync provides marketing and communication services. This includes the opportunity for us to create a website for each group and to develop a plan to help the group become #1 in its market. MediSync provides the central server and software for an electronic medical record (EMR). We also provide the training and assistance that is necessary for successful implementation of an EMR, along with ongoing upgrades and maintenance. MediSync provides the information systems infrastructure and the team of professionals that run it. This includes a network connecting all the offices and the billing system, , web services, the EMR to its central server, computer support, etc. MediSync provides high levels of financial analysis by experts who are highly experienced in evaluating and negotiating contracts with payers, creating budgets and pro formas, etc. MediSync has built or renovated over 25 physician offices, and we have developed both a theory and expertise at using facility design to improve productivity, reduce operating costs and increase the quality of patient experience. As a group grows MediSync has experts that develop and/or manage ancillary services such as imaging, lab, physical therapy, and diagnostics. MediSync staffs and COO coordinate physician recruiting, in conjunction with the physicians in your group, should the need arise.

4 If you are considering outsourcing significant aspects of medical group management the following check-list may be helpful to you: For Hospitals and Hospital Systems Is your current medical group meeting basic expectations (i.e. financial results, revenue cycle parameters, physician recruitment and retention and patient loyalty)? Is your medical group an asset (i.e. adding new patients to the system, adding positive brand value, etc.) or is it a liability (i.e. losing patients, losing unacceptable amounts of money, or losing market share to competing groups or systems)? Do you regard your medical group s role in the system in a defensive light (i.e. maintaining referrals to the hospitals and physician loyalty) or an offensive one (i.e. adding patients to the system, taking market share or increasing system negotiation clout)? Do you believe that medical groups will be accountable for clinical quality performance by CMS, state and national credentialing or other means? For example, do you think that medical groups will be expected to be transparent about outcomes? Will we see third party compensation linked to outcomes in the next three to five years? If so, do you know how they perform now? Do you have a strategy for performance improvement? How much time and how many dollar resources are you willing to invest in medical group management and improvement? How vulnerable are you to the loss of a given one or several individuals on your management team? For Independent Medical Groups Do you have the financial resources to mount significant quality improvements for clinical care, practice operations, etc.? Have you been able to keep current with market demands including new technology deployments, market expansion and financial performance in spite of current market conditions? Does your management team assist the group to develop long term strategies that have advanced your group in its market? Do you have increasing or decreasing financial results and physician compensation? Do you have a significant reason to change the group in a more positive direction in the near, mid- and long-term?

5 Do you think that medical groups will increasingly be rewarded and/or punished based upon clinical and operational performance? In Conclusion With MediSync you can expect to achieve greater results, more quickly and less expensively, as you leverage our years of experience. MediSync can become the solution to your many challenges, as we integrate our management process and disciplines.

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