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Innovator Case Studies: Innovator Case Studies: Physician ...

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Innovator Case Studies: Innovator Case Studies: Physician ... Innovator Case Studies: Innovator Case Studies: Physician ... Document Transcript

  • Innovator Case Studies: 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 Hematology Consultants, Ltd Barbara L. McAneny, M.D. Chief Executive Officer, New Mexico Oncology Hematology Consultants, Ltd. 1
  • New Mexico Cancer Center 3 Who are we? • Physician Owned and operated • Fiercely Independent • Rapidly growing • One Partnership, Two corporations 4 2
  • 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 • 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 Foundation • Patient grant support for the non-medical expenses of having cancer • Education • Art! • Community sponsorships • Social service 7 The Art! 8 4
  • Art Everywhere 9 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 11 Surgery Center 12 6
  • 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 • 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? • Diversifying Income streams • Non-Oncology Doctors? • Interdependency with other Doctors? 15 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 • 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 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 • 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 • 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 • Clinical Integration • IT support for the practices • Insurance company approval • Transparent computer system 21 Decreased expenses • Group purchasing • Practice supplies • Administrative support 22 11
  • Passive Income • GPO Ownership • Whole hospital exception to the Stark Law(we hope) • Ownership of MOBs 23 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! 25 The West Clinic Lee Schwartzberg, M.D., FACP Medical Director, The West Clinic 13
  • 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… • 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 “No Stone Unturned” “The West Clinic is a World-class Center of Excellence for Oncology, Hematology, Radiology, and other Advanced Medical Care” 29 Reminder We will Arrive at our Destination Either by Default or by Design 30 15
  • Four Design Turning Points • 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 • 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: 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 • 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 • 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 • Radiology • Gyn Oncology • Research • Management Structure • Integrated Offices • Marketing 37 What Didn’t Work • Merging with other groups • Radiation Oncology – CON – Hospital Politics • Dispensing pharmacy 38 19
  • 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 • 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 41 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
  • Imaging • Successes – Remarkable clinical utility – Real Time scanning/interpretation/result delivery – Interventional – Revenue stream • Challenges – Declining reimbursement – Insurance redirection – Pre-certification – Scheduling 43 Wings Cancer Foundation 44 22
  • 1996 Wings Cancer Foundation is Born! Sandy Patterson & Brenda Wiseman Co-Founders of Wings Cancer Foundation “We are trying to meet as many patients as possible & help give you the emotional support & encouragement that we believe to be so important when you are fighting cancer” - Sandy Patterson, 1996 45 1998 501 (c) 3 Established The Wings Cancer Foundation supports thousands of patients, families, caregivers and friends regardless of where treatment is received 46 23
  • Wings Services Provided • Clinical Research • Nutrition Counseling • Corner Boutique • Partnering Program • Crisis Intervention • Speakers Bureau • Exercise / Strength • Support Groups • Hospital Visitation • Tai Chi / Balance • Individual Support • Volunteer Program • Labyrinth Garden • Workshops • Lending Library • Yoga / Relaxation 47 Volunteer Program Today Over 200 Volunteers! 48 24
  • Imagine a place… of hope Lending Library 49 Imagine a place… of hope WingsGallery 50 25
  • Imagine a place… of hope Labyrinth Garden 51 2002 Launched Website www.WingsCancerFoundation.org 52 26
  • Research 53 ACORN Site Value Proposition • ACORN eliminates duplication and waste, enhances productivity and efficiency by utilizing technology, and harnesses investigator/site clinical expertise 54 27
  • ACORN Site Model 55 West Clinic: ACORN Proof of Concept Change from 2003 to 2006 Staff Halved Grant Margin Accruals Doubled Increased 3 fold 56 28
  • Patients Consented/Enrolled by Study Phase 250 213 200 170 150 100 72 41 40 50 27 20 17 12 9 0 I II III IV No Phase Consented Enrolled 57 International 58 29
  • An Introduction to Singapore The Singapore Advantage Springboard to Asia: 2.8 billion market within 7,000 MNCs, >50% with 7-hour flight radius Bridge to traditional main regional functions markets of US, Europe & Japan Open immigration policy: 4 mil population, of which 1 mil are non-Singaporeans English speaking workforce: • Best Asian City for Business 97% literacy • #1 in Asia for IPR Protection, • #1 Globally in Labour Force Evaluation Measure • #1 for Physical Infrastructure • 2nd most profitable place for investors • #46 in 2004 Cost-Of-Living Survey 59 Current Status International • Singapore West Excellence Cancer Center Launched 10/06 – Steven Tucker, MD – Ben Low, MD – Wen-Sen Shieh, MD – Nancy Bailey, NP • West Clinic Shanghai Launched 10/07 – In conjunction with Kanglian Hospital – Recruiting full time US trained physician 60 30
  • INTERNATIONAL International # 1 ORGANIZATIONAL STRUCTURE 2007-2008 61 Concluding Thoughts • Entrepreneurial approach keeping patient- centered, quality based focus results in successful program • Think both big and little • Invest in critical HR when growing • Keep it enjoyable for the long term 62 31
  • Contact Us Barbara L. McAneny, M.D. Lee S. Schwartzberg, M.D., FACP Chief Executive Officer Medical Director New Mexico Oncology The West Clinic Hematology Consultants, Ltd. 100 Humphreys Blvd. 4901 Lang Av., N.E. Memphis, TN 38120 Albuquerque, NM 87109 Tel: 901.683.0055 Tel: 505.336.4206 lshwartzberg@westclinic.com mcaneny@nmohc.com 63 32