Honesty, integrity, and ethics are the three guiding principles that drive Jose Carreras to excel professionally and personally. As the COO and vice president of ProMD Practice Management, Carreras has always been aggressively motivated to lead and succeed.

Under his guidance, Carreras has helped his South Florida practice management company develop a niche in improving a medical practice’s operations. His firm distinguishes itself from other billing companies by examining an office’s operations from a total management perspective as well as combining billings and collections with practice operations.

“We provide ala carte billing services for physicians using their own practice management system,” says Carreras, “as opposed to a billing company that makes you use their system. While this makes it more efficient for the billing company because they’re using the same system for all clients, we don’t believe that it’s the best for the doctor because that doctor doesn’t own his data.”

Usually a doctor has two choices: to do billings and collections internally to maintain control or outsource the work and lose control of the data. ProMD provides the best of both of these worlds because physicians can still outsource billings and collections to a company which has this expertise without giving away control.

“We’re going to do it using that doctor’s practice management system,” says Carreras, “by tapping in remotely through the Internet into that doctor’s system. At anytime that doctor can audit us. If at any point, they’re not happy with us, the data remains in their system. So every month we really have to prove our worth to every doctor to whom we provide a service to because we can easily be terminated. With a regular billing company, it would hurt the day-to-day operations if he or she had to change it.”

By providing billing and collection services with an operations perspective, ProMD is not just collecting data; it is also identifying trends and looking at maximizing the performance from an operations standpoint.

“We provide practice assessments where we perform an operational assessment of an existing practice to identify strengths and opportunities,” says Carreras. “If the physician is not satisfied with our findings and recommendations, we do not charge for the assessment.”

ProMD uses benchmarks to evaluate a Practice’s performance established by the Medical Group Management Association (MGMA).

“We want to ensure that we meet and surpass the industry’s benchmarks in billings and collections,” says Carreras. “As of today, our collection rates are over 90% in 6 months and over 95% in over 9 months. Both surpass the industry standards.”

Those who know Carreras shouldn’t be surprised by his firm’s success. Success follows him wherever he goes. In fact, in 2006, he was nominated and selected Best Practice Administrator by the readers of the Florida Medical Business Journal.

Carreras attributes his values, drive, and determination to his professional background and education. He has been involved in the healthcare industry since 1982. He started out at Jackson Memorial Hospital, where he remained for 11 years. During his tenure there, he earned his bachelor’s degree and then a master’s in healthcare administration, where he was on the national dean‘s list throughout the program.

“My master’s degree, combined with my hands-on management experience, has made me the type of manager which I am today,” says Carreras. “I try to instill in my managers the same management techniques I learned to create a culture in the company that looks after our employees and makes them feel that they have ownership of the products and services that we provide.”

During his second phase of his career, Carreras helped manage medical centers. Later he went to work for United Healthcare in its Sunrise office as its director of operations overseeing its claims resolution unit, the provider appeal unit, and risk arrangements. Carreras then went to work for the private sector as a practice administrator for South Florida Prenatal Medicine for six years before ProMD was spun off from this organization.

“We pulled out the management component of the medical practice and created a management company which was ProMD,” says Carreras.

Ask Carreras about his career influences, and he quickly credits ProMD’s founder, Dr. Jorge Gomez.

“His vision inspires me to grow as a professional and to grow ProMD because he was the visionary of ProMD,” says Carreras. “We are where we are today because of his vision of providing an innovative, proficient and focused company that has the best interest of maximizing the physician’s practice performance and profitability.”



Florida is a state with a rich diversity of cultures and ethnic groups. The state has long been associated with Cuban and Haitian peoples. However, these days Florida’s residents include migrant workers from Central America, Vietnamese and Hmong peoples, and even one of the United State’s largest populations of Palestinians, concentrated in the city of Jacksonville.

What kind of challenges does this diversity pose to physicians, most specifically orthopedic surgeons? Dr. Patrick Hutton, an orthopaedic surgeon and member of the Diversity Advisory Board of the American Academy of Orthopaedic Surgeons (AAOS) is someone who cares deeply about providing quality care to diverse populations. He explains, “The fallacy is that treating all patients the same is identical to giving everyone equal treatment. You have to take into account the fact that an explanation for example of knee surgery, which may be clearly understood by most patients, could leave an Hispanic person with an incomplete understanding of the proposed procedure. Then there’s the factor of what kind of care that patient has received in the past, his or her preconceived notions and bad experiences. Patients with varied cultural backgrounds often walk into our offices with fearful, or at the very least, different expectations of treatment, as compared to many middle class people who’ve had basically good care their entire lives.”

Dr. Hutton is a past president of the Florida Medical Association. It was during his tenure there that he started to focus on healthcare access for the underinsured. He began to understand the real disparity that exists in healthcare for minorities and diverse ethnic groups. AAOS’s Diversity Advisory Board interested him because the group conducts free training to orthopaedic surgeons. Culturally Competent Care: An Orthopaedist’s Responsibility is a free seminar being offered to orthopaedic residents across the country. Dr. Hutton and Dr. David Font-Rodriguez are two orthopaedic surgeons who are heavily involved in that effort in Florida.

“We’ve divided the orthopaedic programs in Florida. I’ll be conducting the training in northern Florida orthopaedic programs, while Dr. Font-Rodriguez is covering schools in the south. Each school will get a visit from one of us during their five year residency cycle”, Hutton explains. The program is conducted with a grand rounds format, with both didactic and interactive elements. Presenters discuss various patient scenarios that require cultural competence. At session’s end, residents receive a free “Cultural Competency Challenge CD-Rom,” and “Culturally Competent Care Guidebook,” created by the AAOS.

Chairman of the Diversity Advisory Board, Dr. Ramon Jimenez, outlines what he considers the basic ingredients of culturally competent care: curiosity, awareness, sensitivity and communication. Dr. Hutton describes how he carries out those qualities in his orthopaedic practice. “Doctors have to be willing to accept the things patients do that give them a sense of well-being – as long as what they’re doing doesn’t hurt them in any way. For instance, if patients treat injuries with a hot soak in Epsom salts because it’s grandma’s old remedy, let them do it. Even if it realistically doesn’t improve the condition, it still means something to the patient’s well-being.”

He’s also observed that some African American male patients may be reluctant to take medications to treat hypertension due to possible side effects. “They can also be unwilling to participate in clinical trials because of what happened during the Tuskegee experiment. Doctors need to be sensitive to why people have those fears.” In addition to conducting the Cultural Competency seminars, Hutton continues to learn about diversity first hand. He regularly volunteers in a healthcare clinic his church runs for migrant workers.

When asked how doctors can be expected to exercise sensitivity and awareness in the age of managed care Hutton suggests, “During the very first patient visit, doctors should really try to get to know the patient and create an understanding of who that person is. Push through to make a connection on the first visit and you can build on that in later visits. We’ve found that a good first interview can make a big difference.”

Across the country, AAOS has found residents to be very receptive to the seminars, and they give the program good marks. The rewarding part of championing the cause of culturally competent care, for Dr. Hutton, comes with reaching out to younger people to teach them, “It’s all part of giving back some of what I’ve learned from my patients and mentors,” he says.



As the elderly population increases and the trend towards outpatient care continues over the next several decades medical office buildings (“MOBs”) will be in consistent demand across the country. However in Florida, where new construction will outpace absorption in the near term, the operating environment for MOBs will probably decline over the next twelve months.

This growth in the elderly population is expected to increase demand for cardiologists, gerontologists and neurologists. Also, continued use of imaging technology will increase demand for radiologists. It has been reported that population growth in the 55+ age segment alone will necessitate an additional 25 million square feet of medical office space by 2014. According to a recent National Ambulatory Medical Care Survey, each person visits his/her physician 3.16 times per year on average; and in the 65+ population, the average nearly doubles to 6.15 times per year. As the 65+ population grows, we will see an increasing demand for physician care and MOB space.

What is the impact of Healthcare reform on MOBs? Several scenarios have been explored using different assumptions. The estimates range from 14 million square feet to 62 million square feet in addition to the aforementioned 25 million and on top of the current supply of 552 million square feet.

The shift to outpatient care positively impacts the MOB market. Outpatient facilities represented 78% of all surgical procedures in the US during the first decade of the 21st century vs. only 20% during the 1980’s. Patients prefer the convenience and payers prefer the lower cost of outpatient facilities which are often located in MOBs. This shift towards outpatient care is further strengthened by Medicare increasing the number of ambulatory and outpatient procedures that are eligible for reimbursement.

Healthcare employment is probably the best indicator of demand for facility utilization, managing a landlord’s expectations of lease rates and the time necessary to lease up new buildings. Since the start of the recession in December of 2007, employment in the healthcare sector has increased by almost 600,000 jobs while total unemployment has increased by 8.2 million.

Finally, operating expenses should probably increase 2-3% over the next twelve months based on historical and projected MOB inflation.

As has been stated elsewhere, while no property type is recession proof, MOBs have proven to be recession resistant.