A new prac­tice rou­tine

Modern Healthcare - - Special Report - Vince Gal­loro

For car­di­ol­o­gist Matt Phillips and his prac­tice part­ners, what they could ac­com­plish on their own wasn’t enough. Six years ago, Phillips be­came pres­i­dent of Austin (Texas) Heart, which has 47 car­di­ol­o­gists and 25 physi­cian ex­ten­ders. They prac­tice in 14 hos­pi­tals that are part of eight sys­tems across a 16,000-squaremile chunk of cen­tral Texas.

“We met and wanted to be stan­dard-set­ters in qual­ity,” Phillips says. “It’s not so easy to achieve that vi­sion.” The physi­cians started build­ing the ad­min­is­tra­tive and clin­i­cal in­fra- struc­ture to make their vi­sion a re­al­ity. They started a re­search depart­ment, hired a full­time qual­ity-as­sur­ance nurse and learned some busi­ness prac­tices from Dal­las-based South­west Air­lines.

Austin Heart’s physi­cians en­gage in an in­ten­sive peer re­view of each oth­ers’ work, Phillips says. Austin Heart has an elec­tronic health record, but now the physi­cians want an even bet­ter sys­tem, he says. Its physi­cians spend 6% of their time main­tain­ing and im­prov­ing this in­fra­struc­ture—time not spent see­ing pa­tients, Phillips says.

Two years ago, Phillips says, the physi­cians de­cided that, “If we were re­ally go­ing to set the stan­dard, we were go­ing to need more re­sources than we had.” So Austin Heart started a two-year process that ended with the sale of the prac­tice to St. David’s Health­Care in Austin, ef­fec­tive Dec. 31, 2009. St. David’s is a six-hospi­tal joint ven­ture that brings to­gether for-profit HCA with two not-for-profit part­ners—St. David’s Foun­da­tion and Ge­orge­town (Texas) Health­care Sys­tem.

Seek­ing shel­ter

Austin Heart is but one ex­am­ple of the trend of physi­cians throw­ing in their lot with hos­pi­tals. A sur­vey last fall by the Amer­i­can Col­lege of Car­di­ol­ogy, as well as sur­veys by the Med­i­cal Group Man­age­ment As­so­ci­a­tion, in­di­cates the strength of this trend.

Among car­di­ol­o­gists in pri­vate prac­tice, 38.1% said they will re­spond to a re­cent CMS fee-sched­ule rul­ing by pur­su­ing in­te­gra­tion with a hospi­tal sys­tem. Only 33% ex­pect to re­main in pri­vate prac­tice without a merger into some other or­ga­ni­za­tion, whether a hospi­tal or other physi­cian prac­tice, ac­cord­ing to the sur­vey of 801 car­di­ol­o­gists con­ducted be­tween Oct. 31 and Nov. 17, 2009.

Mean­while, among re­spon­dents to the MGMA’s an­nual Physi­cian Com­pen­sa­tion and Pro­duc­tion Sur­vey, hospi­tal-owned group prac­tices have grown from 25.6% in 2005 to 49.5% in 2008. In that lat­ter year, hos­pi­talowned prac­tices ex­ceeded physi­cianowned group prac­tices for the first time, ac­cord­ing to the MGMA.

The prospect of bun­dled pay­ments and penal­ties for read­mis­sion of pa­tients pro­vides a carrot-and­stick set to bring hos­pi­tals and physi­cians to­gether, says Dave John­son, a se­nior manag­ing di­rec­tor for Ziegler, a con­sul­tancy. “If sud­denly out­comes mat­ter and con­sis­tency mat­ters, then care co­or­di­na­tion be­comes a big­ger part of the pic­ture, and nei­ther hos­pi­tals nor physi­cians can do that alone,” John­son says.

While health­care re­form has stalled in Wash­ing­ton, physi­cians see the reg­u­la­tory pres­sure that could come to bear on physi­cian-owned fa­cil­i­ties, John­son says. They al­ready have faced lower re­im­burse­ments for their out­pa­tient surgery cen­ters com­pared with hospi­tal-based surgery cen­ters.

John Deane, CEO of South­wind, a Nashville­based physi­cian prac­tice man­age­ment con­sul­tancy that is now a divi­sion of the Ad­vi­sory Board Co., says the well-re­ported changes in the ex­pec­ta­tions that to­day’s med­i­cal school gradu-

John­son: Pol­icy pro­pos­als bring docs, hos­pi­tals to­gether.

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