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Thursday, Mar 28, 2024

Providence Attracts Droves of Physicians to Partnership

Carmody Like most people, physicians often resist change, which is what some doctors did when Providence Health & Services presented them with an opportunity to join with the hospital in a 50-50 partnership aimed at improving care and reducing costs. “Many said, ‘You can’t trust the administration; that it will never work,’” said Dr. Raymond Schaerf, a cardiothoracic surgeon from Burbank. “You have no idea how people griped.” Which is why Schaerf was so surprised when 668 doctors—more than double the expected number of 250 — signed up to join Providence Partners for Health (PPH), a joint venture equally owned by doctors and the Providence hospitals. If all goes according to plan, the partnership, which officially launched this month, will allow these doctors and the hospitals to coordinate patient care and share equally in the financial benefits of any cost savings. Each of the 668 physicians contributed $1,000 to the limited liability corporation that is half owned by doctors and half by five Providence hospitals in Southern California. With the hospitals’ matching contribution, PPH has almost $1.4 million to invest in a handful of new hires to lead the organization along with technology and data analysis, which PPH believes will be the key to creating best practices and care coordination. “The response was huge,” said Kerry Carmody, chief operating officer of Providence Southern California, who will lead PPH. “It gives us tremendous energy into the new year with a group who is turned on by the opportunity to focus on quality care.” As the new entity begins its work to identify and standardize best practices, it is also making plans to attract another round of doctors with a new subscription offering in eight months, Carmody said. “As this gets off the ground and becomes better known and we start to make a difference in how we provide care, I think others will want to join us,” he said. “A number of physicians wanted to join, but they were too late.” A big attraction for many doctors was the ability to take advantage of new information technology resources that will be part of PPH, Schaerf said. Many individual practitioners still lack electronic medical records, not necessarily because of the cost, but the learning curve the installation presents for their office staff. Under the terms of the partnership, Providence will underwrite a significant portion of the cost of EMR and educate doctors and their staff in its use, Carmody said. Schaerf said that’s an even bigger benefit since productivity in a physician’s office can decline 20 to 30 percent following an EMR installation. The group also will have the ability to take advantage of new information technology investments by Providence Health, including the hospital’s multi-million investment in predictive analysis tools, Carmody said. The hospital is pumping millions into a data analysis system by Microsoft. The system, Amalga, will be able to take patient outcomes data generated by Providence and compare to it national outcomes data. For example, Carmody explained, Amalga will be able to tell whether one set of practices leads to better patient outcomes than another — based not just on that one doctor’s experience, but on that of thousands. “It will give us deeper, faster and more active data analysis which will help us design better processes.” Indeed, the first person PPH is hiring behind its new director is a data analyst whose job will be sift through information from the doctors and help them identify best practices for the treatment of numerous diseases ranging from diabetes to heart disease. Carmody said he plans to launch a number of quality initiatives in the coming months to improve and standardize treatment and to measure the outcomes. The potential for such collaboration is what convinced Dr. Omaran A. Abdeen, a nephrologist from Mission Hills, to sign up. “It’s not only good for the doctors and the hospital,” he said, “it’s good for the patient.” While not all doctors like to take a standardized approach to the practice of medicine, Abdeen said most physicians value the opportunity to “share ideas and expertise and discuss the best treatments. They wish they could do it more.” At the same time, he said, the structure of this organization allowed doctors to keep their individual practices and remain self-employed, something they also value. “The beauty of this vehicle is that it allows them to keep their independence, while also sharing ideas,” he said. The rationale behind PPH was the need for a more efficient model of care that drives down costs amid a climate of declining reimbursements, which will gather steam as the Patient Protection and Affordable Care Act takes full effect in 2014. While that mandate may yet be challenged, the trend of declining reimbursements per patient is already a reality, Carmody said. “It’s happening; it’s not a hypothetical. We can’t continue to do things the same way… We have to do it better, cheaper and more competitively.” One aspect of the model is that doctors will be able to share in any cost savings the entity manages to deliver. This is what gives specialists the incentive to order fewer tests and reduce their costs. The idea is similar to that of Accountable Care Organizations (ACOs) being tried across the country and here in the San Fernando Valley. It remains to be seen, however, if this model, or the ACO, can actually deliver on that promise. A January report by the Congressional Budget Office found that many Medicare demonstration projects that rely on financial incentives to improve quality and efficiency of care have not reduced Medicare spending. “In nearly every program involving disease management and care coordination, spending was either unchanged or increased relative to the spending that would have occurred in the absence of the program,” CMO concluded. Dr. Abdeen is not deterred by such concerns. He said physicians have the option of backing out of the Providence partnerships if they don’t find it has value. But he said he is convinced the model has legs. “At the end of the day, coordination will be good for doctors and hospitals, but the most important beneficiary will be the patient.”

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