The nuts and bolts of delivering medical care

Posted: January 07, 2014

For longtime pediatrician John Tedeschi, the future of medicine relies less on the whiz-bang advances of scientific researchers and more on the nuts and bolts of delivering medical care.

"The academicians can't solve the operational problems," said Tedeschi, 75, who founded Advocare L.L.C., one of the largest primary-care providers in the region, and Continuum Health Alliance L.L.C., which manages doctors' practices.

The push to ensure patients get the care when they need it, in the best, yet least-expensive setting, has been the heart of government interventions to lower health-care costs.

Data drive the innovations, which is why Tedeschi's Marlton-based businesses provide a perfect laboratory. Caring for 1.7 million patients, most of the 1,000 affiliated doctors and nurse practitioners share a computerized medical-record system.

Question: How do you see the Affordable Care Act?

Answer: I think it was a wake-up call that we could no longer afford the medicine that we were delivering, but a lot of the cost was from waste, improper procedures. We needed to straighten out where we had gotten in medicine.

Q: When patients are released from the hospital, you schedule them for a doctor's visit within 48 hours. Nurses and health workers frequently call these patients to check on them. Why?

A: You have one in four patients who are discharged from a hospital readmitted in 30 days. That's horrible. They may not be taking their medicine. They may not have understood the instructions. They didn't get a checkup after they got out of the hospital. But we make those arrangements. Our recidivism rate as a company was about 22 percent. We have reduced that in 11/2 years to 7 percent.

Q: You have health workers calling patients. What surprised you the most?

A: The compliance of patients taking medicine is so bad. It was shocking.

Q: You loved doctoring, yet you haven't seen a patient in five years. How has that been?

A: It was the biggest adjustment of my life. I absolutely loved my career. I loved being part of families. I'm a baby freak, so I love hugging them and kissing them. It got a little trickier as time went on, because parents said, "Oh my God." But I can't help it.

Q: Why did you start these management businesses?

A: It made me unhappy that doctors were so unhappy being doctors. [They] can't stand the business of medicine.

Q: What do you mean?

A: The collection process, malpractice - all the business aspects of running an office. Doctors are extraordinarily overwhelmed. They just want to be good doctors and they want all this stuff removed from their lives.

Q: Can doctors have a work-life balance?

A: Forget the business and do what's right medically. You are home when you've done the job. Young doctors . . . want a home life, but the profession has certain demands and you owe that to the people you are caring for.

Q: How do you balance it?

A: I don't want to call myself a workaholic because I'm not. I don't have hobbies. I'm not a golfer. I don't have an obsessive nature, but I like order. If you came back tonight, there would not be one paper on my desk.

Q: Any plans to retire?

A: I doubt it. My mother drove to Philadelphia to work every day at age 91.


Title: Founder, chief executive Advocare L.L.C. and Continuum Health Alliance L.L.C.

Home: Philadelphia.

Diplomas: Camden Catholic High School; Villanova University, biology; Creighton University School of Medicine.

Family: Wife, Geraldine; children, John, 46, Elizabeth, 40.

Resumé: Longtime pediatrician, acted as medical director of US Healthcare HMO of New Jersey, led medical staffs at Garden State Community Hospital, Virtua Health, West Jersey Hospital-Voorhees.

Unexpected: Thinks astrology helps in understanding people.

His sign: Cancer.


Advocare L.L.C.: Physician-owned medical group for 600 doctors and nurse practitioners.

Continuum Health Alliance L.L.C.: Practice management and population health management services.

Main office: Marlton.

Locations: 409.

Employees: 4,000.


Dr. John Tedeschi on how complaints built his business.



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