Innovator Case Studies: Innovator Case Studies: Physician Practices - PDF document

Innovator Case Studies: Innovator Case Studies: Physician Practices Physician Practices Barbara L. McAneny, M.D. Lee S. Schwartzberg, M.D., FACP Chief Executive Officer, New Mexico Medical Director, The West Clinic Oncology Hematology Consultants, Ltd. New Mexico Oncology New Mexico Oncology Hematology Consultants, Ltd Hematology Consultants, Ltd Barbara L. McAneny, M.D. Chief Executive Officer, New Mexico Oncology Hematology Consultants, Ltd. 1

New Mexico Cancer Center New Mexico Cancer Center 3 Who are we? Who are we? • Physician Owned and operated • Fiercely Independent • Rapidly growing • One Partnership, Two corporations 4 2

NMOHC NMOHC • Started in 1987 with 2 doctors • Now 9 Medical Oncologists, • 5 Radiation Oncologists • 2 Cancer Centers, 3 Clinics • 3 PAs • 200 employees 5 NMOHC NMOHC • 4 Linacs, with IMRT • Stereotactic radiosurgery • Imaging with Pet CT, CT, MRI, bone density • Infusion • Lab • Clinical Trials • Rehabilitation • Nutritional Support • Psychological Support 6 3

New Mexico Cancer Center New Mexico Cancer Center Foundation Foundation • Patient grant support for the non-medical expenses of having cancer • Education • Art! • Community sponsorships • Social service 7 The Art! The Art! 8 4

Art Everywhere Art Everywhere 9 NMOHC: The future NMOHC: The future • Adding 3 Medical Oncologists • Adding 3 new clinic sites • Adding IGRT • Adding Gamma Camera, ? Breast imaging • Surgery Center • Rental space for Related specialties 10 5

Surgery Center Surgery Center 11 Surgery Center Surgery Center 12 6

Principles Principles • Practice Outlives the doctors • Hire only Future Partners • Reserve 25% profit for reinvestment • Pay as incentive for work, but no churning or making money off other doctor’s work • Be a good employer • Be a good citizen • Plan for today, tomorrow, 5 years and 10 years 13 Structure Structure • NMOHC owns only AR, perishable supplies and inventory and EHR • NMCC owns all the facilities, equipment • Buy in is structured for ease of adding partners, • Buy out is share only of the equity generated 14 7

Where are we Going? Where are we Going? • Diversifying Income streams • Non-Oncology Doctors? • Interdependency with other Doctors? 15 Our Market Our Market • 24% uninsured • Diverse Demographics in a large Rural state • Medicare + Managed Care • Statewide Market • 4 Payers • Dominant Payer owns a hospital and employs physicians • Functional loss of 2 hospitals • University competition • Fewer doctors in Independent practice 16 8

Our Solutions Our Solutions • State wide presence • Patient Satisfaction • Advertising • Rehabilitation Center (Pre-hab?) • Surgery Center • Support of our referral base • Rental space • Independent Doctors of New Mexico, Inc 17 Independent Doctors of New Independent Doctors of New Mexico, Inc.: Goals Mexico, Inc.: Goals • Make and keep Independence financially viable for small practices • Bring new health plans to New Mexico • Bring a new hospital to New Mexico 18 9

Financial Viability Financial Viability • Group Contracting – Must avoid Anti trust – Financial and Clinical Integration – Development of appropriate software for integration and transparency – Common quality measures • Group Purchasing • Passive Income 19 Legal Structure: An IPG Legal Structure: An IPG • One Clearinghouse, one billing number • Shared redistribution pool – 80% immediately delivered to the practice – 20% in the pool • 8% shared equally • 8% for overhead and RVUs • 4% for Quality measures 20 10

IPG IPG • Clinical Integration • IT support for the practices • Insurance company approval • Transparent computer system 21 Decreased expenses Decreased expenses • Group purchasing • Practice supplies • Administrative support 22 11

Passive Income Passive Income • GPO Ownership • Whole hospital exception to the Stark Law(we hope) • Ownership of MOBs 23 Future Work Future Work • Partnership with the hospital in the face of the changing Stark Law • Encouraging physician courage • Insurance company contracting • Service Development – Health Insurance – Liability Insurance • Clinical Integration development while maintaining independence 24 12

Wish Me Luck! Wish Me Luck! 25 The West Clinic The West Clinic Lee Schwartzberg, M.D., FACP Medical Director, The West Clinic 13

History of The West Clinic History of The West Clinic • Solo practice begun by Bill West, 1979 • Kurt Tauer joined 1985 • Lee Schwartzberg joined 1987 • New office with radiologist 1989 • 5 Medical Oncologists 1991 • 2 Gyn Oncologists 1995 27 About 10 Years Ago… About 10 Years Ago … • The West Clinic Owners Decided that the West Clinic would outlive their careers • That a large “one stop shop” facility would be constructed • Reality…“A Mantle of Responsibility has landed on The West Clinic” 28 14

The West Clinic Vision & Mission The West Clinic Vision & Mission “No Stone Unturned” “The West Clinic is a World-class Center of Excellence for Oncology, Hematology, Radiology, and other Advanced Medical Care” 29 Reminder Reminder We will Arrive at our Destination Either by Default or by Design 30 15

Four Design Design Turning Points Turning Points Four • Late 90’s – Outlive Careers – Large Facility • 2001 – Growth Pains – Needed Infrastructure – Hats Over the Wall • 2002 to 2006 – Design & Response Strategy – Unparalleled Growth – Infrastructure Development & Implementation – Beginning of Serious Exogenous Threats – Response and Action • 2007 Onward – Onset of Serious Exogenous Threats – Significant Opportunities – Continued Growth & New Alliances – Completely New Models - CHANGE 31 Clinic Locations Clinic Locations • One site not adequate in Memphis metro • Three large clinics in proximity to hospitals – 50,000 sq ft flagship – 12-15,000 sq ft full service x 2 • Three smaller clinics in surrounding areas – 2000-5000 sq ft – Partially staffed by MDs; NP model • One new oncology/cardiology clinic planned • Real Estate: own or lease? 32 16

33 Current West Clinic: Current West Clinic: Provider Staff Provider Staff • 14 Medical Oncologists • 5 Gynecologic Oncologists • 4 Radiologists • 2 Endocrinologists • 1 Pain & Palliative Care • 2 Hospitalists • 1 Rheumatologist • 12+ Nurse Practitioners • 1 Psychologist • 12 Cardiologists 34 17

Current West Clinic Current West Clinic • 375+ Staff • 10+ Sites • 150,000+ Patient Encounters • At least 75,000 venipunctures • Tens of thousands of Radiology Body Parts • 25,000+ Chemotherapy Treatments • 400,000+ Phone Calls • Millions of E-Mails • Hundreds of Thousands of Phone Calls • Tens of Thousands of Claims & Payments • Hundreds of Patients Consented for Clinical Trials 35 Management Management • Pharmacy Operations Director • Chief Executive Officer • Electronic Medical Records • Chief Operating Officer Director • Chief Financial Officer • Information Technology • Financial Services Director Director • Human Resources Director • Marketing & Development • Radiology Director Director • Clinic Operations Director • Business Office Director • Administrative Services • Research Director Director • Purchasing Director • Patient Services Director • Health Informatics and Quality Director • More Managers and Supervisors 36 18

What Did Work What Did Work • Radiology • Gyn Oncology • Research • Management Structure • Integrated Offices • Marketing 37 What Didn’ What Didn ’t Work t Work • Merging with other groups • Radiation Oncology – CON – Hospital Politics • Dispensing pharmacy 38 19

Hospital Alliances Hospital Alliances • Radiation Oncology • Clinical programs generally more successful – Cancer Genetics Program – Autologous Stem Cell Transplant Program – Hospice and Palliative Care Program – Cancer Institute/CCOP 39 A Handful of West Clinic Firsts A Handful of West Clinic Firsts • Large Comprehensive Facility • Interdisciplinary Care in the Community Setting • Advanced Imaging in the Office • Interventional Radiology in the Outpatient Setting • CTA • Championing Supportive Care and QoL • SOS & The e-tablet • Wings Cancer Foundation 501(c) 3 foundation • The Journal of Community Oncology • The Community Oncology Alliance • Serious Clinical Trial Research in the Community Setting • Robust Community Research Network (ACORN) • International Foot print 40 20

Advanced Imaging Advanced Imaging 41 Imaging: History of Innovations Imaging: History of Innovations • History – First CT scanner 1989 – Full time radiology 1990 – Nuclear Medicine 1992 – Interventional radiology 1999 – MRI,US, angiography 2001 – PET 2002 – PACS system/filmless 2003 – PET/CT 2004 – Teleradiology with GI group (1) 2004 – CT in 3 main offices sites 2005 – CT angiography 2006 – Teleradiology with GI group (2) 2006 42 21