PRACTICAL CONCERNS: New Hospital-Physician Alignments in Marin County

Jon Friedenberg

Major changes in healthcare are inevitable—and soon. But no one knows exactly what those changes will look like. That’s why Marin General Hospital (MGH) is pursuing new physician and hospital alignments that we hope will strengthen our ability to deliver high quality, cost-effective care in any environment, while helping ensure that patients and physicians still have the choices they want.

In 2010, for example, MGH formed the nonprofit Prima Medical Foundation with Marin IPA and Sonoma Valley Hospital. The Foundation (which contracts exclusively with the locally owned Prima Medical Group) enhances the stability of the local medical community. Equally important, it allows Marin physicians to maintain autonomy and practice medicine in the way they want while continuing to put the patient first when making decisions.

Prima Medical Foundation is one of the cornerstones of our hospital-physician alignment strategy. While the original goal was to provide a solution to the ever-growing shortage of primary care in our area, the Foundation soon realized there was an equally important need to address the full spectrum of medical and preventive care. Today, Prima Medical Group has more than 60 physicians in Marin and Sonoma counties, and that number is expected to grow. Specialties include family medicine, internal medicine, pediatrics, obstetrics & gynecology, pulmonary & critical care medicine, and general surgery.

Proof that Prima is having the desired effect is the Foundation’s enhanced ability to bring new physicians into the community, such as the recent addition of three new surgeons to Prima’s general surgery practice. Prior to the recruitment of this multispecialty team, much of the trauma coverage at Marin General Hospital was provided by an out-of-county physician group. Scheduling follow-up care was difficult, and such care was often delivered by a physician other than the operating surgeon. Now, the new surgeons and others based in Marin provide full trauma coverage for the hospital.

 

The economics of private medical practice—particularly in Marin—have become a key driver of our strategy. Changes in reimbursement are making it extraordinarily difficult for private practice physicians to survive financially. The fact is the current reimbursement model is broken for primary care physicians, and even specialists find the economics challenging. Through 1206(b)clinics and the Prima Medical Foundation, MGH can help cover the rent, billing, collections–all the operational and management tasks for local physicians serving these offices. We can free them up to focus more on medical care and less on administration.

Recognizing that expanded capabilities are critical to our future, the hospital launched its own Spine & Brain Institute in collaboration with the Mt. Tam Spine Center and the UCSF Department of Neurosurgery. We have also developed a co-management agreement with physicians in Marin Specialty Care for their oncology and urology services, and we are in discussion with several other physician groups about aligning with the hospital via either Prima or our 1206(b) clinics.

Complementing our physician alignment strategy is our hospital alignment effort. To that end, we have signed a management services and affiliation agreement with Sonoma Valley Hospital, which is also served by the Prima Medical Group. Our partnership will enable both administrations to share more physicians, and possibly reduce our IT, billing and marketing services costs. By doing so, we strengthen our ability to compete with corporate giants. We also can develop an integrated model of care that shares capabilities—whether management or medical—to make us more cost-effective through economies of scale, while increasing patient services. We hope to reach similar agreements with other hospitals in the future.

These initiatives improve access to care and reduce costs, and they offer the possibility of enhancing the quality of care. Overall, quality in Marin is already high, but that doesn’t always extend to the quality of the patient experience. Here, we see huge opportunity for improvement. Ensuring that everyone can access the same information in real time—results of tests as well as bedside observations—means patients and providers spend less time repeating the same tests and chasing paper records. Shared information ensures stronger physician collaboration, including multi-disciplinary consults, without requiring the patient to travel from office to office repeatedly.

The changes described above aren’t unique to Marin. They are occurring all over the country as hospitals and providers race to prepare for the national and statewide changes ahead. All over the Bay Area, physicians and hospitals are aligning to achieve economies of scale, better integration and quality of care, and the ability to offer patients the care they want without leaving their home communities. Throughout the country, private practice physicians and community hospitals are fighting to remain independent from giant corporate networks. The transition of Marin General Hospital to local control has accelerated these changes locally.

I believe the best healthcare in the United States is provided by those who are accountable solely to the community they serve—and our community is no exception. Whatever the future holds, Marin General is committed to providing both local physicians and patients with that choice. Physicians who align with us can get the benefits of being part of a larger organization without losing their autonomy and the ability to run their practices as they see fit. Likewise, their patients can continue to access high quality care without having to leave their community.

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Mr. Friedenberg is the chief fund and business development officer for Marin General Hospital.

 

Email: friedej@maringeneral.org