Join us for our interview with Craig Kilgore, CEO of Coastal Vascular & Vein Center in Charleston, SC. Craig has served in IT, Finance and Administrative executive roles for multiple and successful independent specialty groups in the Southeast.
During his 30+ years in the practice setting with these groups, needless to say, Craig has encountered the many challenges independent physicians face. More importantly, how to best thrive in our continuously evolving landscape.
We’ll talk through these challenges and strategies for the independent practices with Craig. Join us as we continue with our provider discussion focus this season.
Guest: Craig Kilgore, CEO of Coastal Vascular & Vein Center in Charleston, SC
After graduating Cum Laude from East Tennessee State University with a BS in business with accounting emphasis, Craig began his Medical Practice Management career with Holston Medical Group in Kingsport TN. Starting as Director of IT, then CFO, and eventually Chief Administrative Officer during his 23 years with the 150+ provider multi-specialty physician owned practice.
A Certified Member MGMA’s American College of Medical Practice Executives, former Chair of the Large Group Executive Forum, Immediate Past President of ASCENT, and on the ASCENT Executive Council, and one of the founding members of OASIS.
Craig started with Charleston ENT & Allergy in October 2012 and his family relocated to the area. Married to his wife Tammie for 39 years, they have three children: Amanda, Andrew both who live in Knoxville, TN, and Carter who lives in SC.
In August of 2023, Craig accepted the position of CEO for Coastal Vascular & Vein Center, PA based in Charleston. With over 10 providers, 6 locations a new Ambulatory Surgical Center and two OBL’s, CVVC is looking to grow and add more physicians and locations including physician owned MOB’s and ASC’s.
Craig enjoys golf, football, water activities, and the beach in his spare time.
Transcript
Jason Crosby:
Welcome to Beyond the Stethoscope, a lot of conversations with SHP. I’m your host, Jason Crosby. Today I’m joined with my partner in crime, Aaron Higgins, as we interview our guest, Craig Kilgore, in the first of two new episodes. Craig is the CEO of Coastal Vascular and Vein Center, based in Charleston, south Carolina, where he recently took the helm after 10 successful years as CEO of Charleston ENT and Allergy and 23 years with the Holston Medical Group in Kingsport, Tennessee, where he served in various leadership roles. We discuss the challenges of remaining independent staffing and other healthful insights from Craig. Are you ready for this vital conversation? Let’s get started. Hello everyone, Jason Crosby, here and today we are joined by Craig Kilgore, CEO of Coastal Vascular and Vein Center out of Charleston, South Carolina. Craig, appreciate you joining us today. How are you Craig?
Craig Kilgore:
Thank you, Jason.
Jason Crosby:
Fantastic. Well, I’ll tell you what we’ve run across, craig, in different paths over time and we know you’ve had a pretty successful background on the independent practice setting and we really wanted to kind of pick your brain and get your insight on that sort of path that you’ve been on over the last gosh couple of decades in your career here. So we want to hear give our audience a sort of a background check or summary of your background, as to how you arrived in your current role.
Craig Kilgore:
Sure, I’m happy to. I’m originally from Tennessee and graduated from ETSU with an accounting degree and was able to work for IBM while going to school, so that kind of started my career with a good foothold, knowing accounting but also having some experience with computer systems. So I was able to get a job with a multi-specialty group that was growing in Tennessee Holston Medical Group and started as the IT manager and operations and then also CFO and eventually the CEO. I was there for 23 years before leaving that position and then joined Charleston ENT and Allergy in 2012 as the CEO, was there for the past 11 years and just recently joined Coastal Vascular and Vain Center. So I’ve always been with independent practice. I just enjoy working for physicians. That may be a little bit strange for some people to understand, but I just really have a tremendous amount of respect for what they do and it gives me a lot of enjoyment and satisfaction to be a part of the delivery system.
Jason Crosby:
That’s very interesting. So, as you started out in that IT and you had the finance background, how would you say being in those roles and having that early on in your career helped you as you got into the more administrative and CEO roles?
Craig Kilgore:
Well, it was really interesting because my first week with Holston Medical Group was spent in Burlington, Vermont, actually training to use the IDX computer system. So my background with accounting understood you had to figure out how to make money revenue somehow and of course the IT part of it was like, okay, we have to install computers to use them. But anyway it was like a perfect fit. I had a lot of folks that taught me medical billing and collections and revenue cycle. I didn’t know it when I was 25 years old starting there, but I had a good foundation and so I think it was the best potential training and experience for me was to come back from that first week and then install the IDX system throughout the multi-specialty group.
Aaron Higgins:
And certainly you’ve seen a lot of change in healthcare just from an IT perspective and most certainly that’s been fast forwarded a little bit with COVID. How have you seen changes in private practice in a post COVID world?
Craig Kilgore:
Post COVID. So it’s been an interesting time period, I think, for, depending on what specialty you’re in, you either had some significant impacts to the practice from COVID and related to the aftermath of COVID, but some actually did very well. I think primary care overall you did pretty well during COVID. But what we’ve seen overall in the specialty world is that the volume really fell off, I mean because of COVID, depending on what the specialty was. But I know in ENT there were significant impacts, maybe not in every specialty. I know Ophthalmologists did really well, but for some specialties it really fell off and honestly the volume really has been pent up for several years and it’s just it’s came back very strong really in the second half of 23. And so not so much the first half but the second half of 23. It’s been a long recovery for a lot of the medical practices. But I know that now some of the payers are even complaining about their medical loss ratio is being too high because of the volume in 23.
Aaron Higgins:
Right. So suddenly everyone’s seeking care that they previously put off for the last four years and certainly we’ve seen with our clients that there’s just then this kind of rush to get care and it’s been certainly overwhelming. So maybe you could help frame it by how big of a clinic that you work for today, how many providers you have.
Craig Kilgore:
Yeah, there are eight physicians and four PAs, and so vascular surgery is not one of the ones that most people know a lot about because of the unique procedures that we do and often life saving, limb saving procedures that are done. But the practice is in a growth mode. We’re looking to expand and it’s exciting time, but mainly there’s a lot of changes in South Carolina with the CON laws and so that will work in favor of practices being able to expand and grow their revenue streams through ambulatory surgery centers in an appropriate manner. I mean, they can’t be too careless with the growth, but I see it as a great opportunity for independent practices maybe dive into that a little bit more as well.
Jason Crosby:
Craig, you were not only in another state pre-COVID, you were in your current state as well and you’ve since gone to another group, so you’ve got a really good pre-post-COVID environment experience with multiple groups. How would you say some other challenges from an administrator or CEO’s role, would you say, has evolved to where now you’re kind of in a okay, post-pandemic this is just how things are going to be where they weren’t a few years ago. Other challenges that may be that the COVID situation calls to you as an administrator, lots of folks having staffing issues maintaining staff training, expansion strategy, things of that nature. What are some of those things you can speak to?
Craig Kilgore:
Number one problem across the board is staffing, and it started with the stimulus money that came out and people were made whole during the time, which was great. I mean, it had to be done or else it could have been a catastrophic event, but so people were paid during that time period. Then, as soon as that period ended and employers were needing all kinds of people to work, some people chose not to go back to work and or found other industries to work in, and so healthcare was hit by this inflationary pressures that were generated by the COVID time period. So wages for medical assistance in front office people escalated very rapidly, and again you had the impact of the volume not coming back as quickly, but yet the cost of doing business continued to increase, and so it put a lot of pressure on practices during that time period, and we really haven’t seen any relief in the wage escalations, and so what was normal in 2019 is just a memory now, and the cost of hiring and retaining staff is just tremendous, and it’s not the glamorous positions that it used to be to work in a medical office. So it’s kind of like it’s really hard work and sometimes you have to put up with patients that are unhappy or confused, and so it’s a huge problem.
Jason Crosby:
And, like you said, it’s across the board, across different industries. et’s keep going down that path. As far as evolution and impact into the market, especially in this post pandemic space, how has the payer environment also evolved or maybe become more challenging due to COVID?
Craig Kilgore:
Well, it was already, you know, complicated in prior to COVID in terms of getting any significant or material increases from payers, but it’s actually gotten a lot more difficult. Related to increases but, just like I said, I think is impacting how much their customers, the employers, are having to spend on health care. They’re trying to keep the unit cost as low as they possibly can and so it’s more difficult, probably, than ever. The other factor I think that’s happening, and at least in South Carolina probably, and other parts too, is the consolidation of payers. There’s just not that many now. I mean, you have the blues, you have UnitedHealthcare, you have Cigna to some extent, but not really. And so you really, from a commercial payer standpoint, you really I mean lots of times you only have maybe two major commercial payers Blue Cross and a little bit of UnitedHealthcare. But that’s probably one of the biggest factors also is the lack of competition in the commercial payer market.
Jason Crosby:
Let’s speak a little bit more on that as well. You’ve got 30 plus years in the independent practice setting and of course every few years you’ve get the tug of war between those that fight to employment and trying to remain independent and it’s quite a struggle for folks in your role to maintain that independent practice setting. What role would you say that the payers should have in trying to preserve that status as an independent practice setting?
Craig Kilgore:
Well, you would think it would be. They would embrace private practice groups and try to help support them in every way possible, compared to paying more to health systems for the employed positions. But it’s an industry that just doesn’t follow normal economic guidelines. As we already know. I mean healthcare, particularly on the medical, on the physician practice side, doesn’t always follow. It’s not necessarily supply and demand related issues, but the number of physicians that are employed now, compared to any time in the past, I think I saw something. I don’t remember the statistic, I hate to quote numbers, but it’s just the increasing number of physicians that are now employed either by a hospital system or a private equity is just increasing to the point where the physicians that are coming out of training, their fellowship programs, they are not looking to go into practice. Some of it is the risk associated with being your own company and the exposure that you have financially to actually making the investment and then growing the practice. They would prefer to have a job where they have an income and they have hours and they don’t want to take the risk associated with private practice.
Jason Crosby:
You being in the specialist setting where primary care of course can sort of partner and team up in the ACO type of model. You being a specialist a little bit more challenging integrated clinically networks have become of course a very popular model as well and I know you’ve got some background and working in that sort of setup and structure. Maybe speak to that as far as your independent specialist experience in the CIN and how that maybe can help others thrive as well.
Craig Kilgore:
Yeah. So going back to my days in Tennessee, so Holston Medical Group started this primary care group, then grew a specialty practice and eventually became an ACO and they are doing very well. You know they are now, you know, a delivery system, all contained in the multi-specialty group. So so that model has been embraced by the payers. You know about Medicare and so it took it took a long time, you know, for that actually to to change the you know the reimbursement focus from unit cost for primary care over to care management. But it’s really happened and it’s done. It’s works very well. You know. For specialists, you know the specialists are really kind of a not tightly integrated in CINs. We can be a member of multiple CINs. You know we don’t have to have a exclusivity with any particular CIN and so that gives the specialist a lot more. You know flexibility and I just don’t. I mean there may be, there may be, some CINs that are hospital owned and you know their medical practice is a closed practice, which I’m sure there are. But you know, for private practices in the specialty area, you know the biggest thing that we can that we compete on is our accessibility, and so we’re more accessible than the closed systems. We’re equal to their quality, if not higher, and we bring a better value. And so the cost of our. Your procedure is done in ambulatory surgery centers are, you know, 20 to 30 percent less than the same procedures done in, you know, hospital outpatient departments or inpatient hospitals.
Aaron Higgins:
You know, a lot of our clients have participated in CINs and tend to be on the larger side. It seems that the smaller doctors shy away from those. So I guess, in your opinion, what are these sort of challenges that a smaller practice might be facing right now? How could that be a part of a CIN? Maybe they are trying to avoid being bought out? What are the challenges that they’re seeing from these bigger groups?
Craig Kilgore:
I think one thing is, and it’s just a matter of the, sometimes the smaller practices will not. Maybe they don’t have a type of person that understands how to contract with payers or how to maximize their contracts with the CIN, or sometimes they might not be doing a great job on their revenue cycle, which is so critical, and so it’s just and I understand the conundrum, I mean they don’t think they can afford to hire somebody that has experience and talent to better manage their practice. But yet, if they don’t, then they’re going to struggle, and I think that’s a that’s a real, very common problem with smaller, smaller groups is is not attracting the level of experience and education not necessarily education, it’s really experience that they need to successfully run their practice, whether it’s CIN or just a PPO network or whatever. I mean it all requires really understanding what kind of contract that you’re getting into. So, yeah, I don’t think it’s unique to just CIN, so I think it’s just, in general, just practice management.
Jason Crosby:
In terms of the challenges you see more with the smaller practices because, to Aaron’s point, we see it with a lot of our smaller hospital clients as well, sort of that that gap of resources that’s available to them in-house is far more limited than the larger systems. Naturally, as you would, you would think, and so it sounds like it obviously translates on the practice setting side as well what, what are some ways or initiatives? Or you know, if you’ve outsourced, what are some ways you’ve helped overcompensate, or you’ve seen the practice that you’ve been associated with compensate for those gaps and resources or talent or function, or whatever the case may be. What type of initiatives would you put out there that you guys have tackled?
Craig Kilgore:
You know, I think it’s a great question. So it’s kind of a you know it’s. It’s both on the physicians and also the practice. Leadership is networking and participation in professional associations. So whether it’s MGMA tremendous resource there for your practice administrators to lean on and become, you know networks and they have specific specialty networks or whatever you know that you can join in their message boards or really helpful. I know with ENT it’s an organization called Ascent and it’s an administrators only network of about a thousand members. I was the president of that in ENT, you know, for well last year, yeah, and so it’s a great organization. And so you know, I encourage people to. You know they some people don’t really try to to learn, but I think that’s huge. I also think for the physicians. You know sometimes they they don’t think they get a lot of value out of their specialty associations, but I encourage them to really, you know, reach out because they’re they can be very helpful. You know, I don’t know all of them, but but I do think that the ones, the, the ones I’m familiar with you’ll provide a lot of great resources for practices. And so you know, I think too, I think sometimes the resources are out there, you know, it’s just that you have to make an effort, you know, to go find them.
Jason Crosby:
Very good point. Yeah, I’ll tell you one of our IPAs that we work with, probably the greatest benefits of even being on the IPA is the administrator networking. Yeah, the lunches, the meetings, that what are you doing about this? What are you doing about that? Just the dialogue and being able to meet each other is of tremendous benefit.
Craig Kilgore:
Yeah, even you know, speaking to that, here in Charleston, prior to covid, you know we had a network of at least 15 to 20 independent groups, multi specialty primary care and specialty groups that would get together. Not, I mean it wasn’t we didn’t have a formal organization, but it was just kind of a networking and sharing. You know, of course that was another casualty of covid. Yeah, that kind of disintegrated and, yeah, some of those groups are now home by hospital systems, which is the trend that we’re seeing. I mean, a lot of fairly significant practices now are hospital employed versus independent. That just you know me being a private practice, you know guy, really I really hate to see that.
Jason Crosby:
You’ve been listening to Beyond the Stethoscope, Vital conversations with SHP. This has been a production of strategic health care partners.
Aaron Higgins:
Your hosts are Jason Crosby and me, Aaron C Higgins. This episode is produced and edited by Nyla Wiebe, and our social media content producers are Boost by Design.
Jason Crosby:
Our executive producers are Mike Scribner and John Crew.
Aaron Higgins:
For more information about SHP, the services we offer, including the back library of episodes, episode transcripts, links to resources that we discussed, and much more, please visit our website at Thank. com. hank you for listening.