At Shore Medical Center, CEO Ronald W. Johnson is addressing the dramatic change in the way hospitals nationwide are being reimbursed for services, particularly for their Medicare patients. The trend has led hospitals such as Shore to adapt their business and treatment strategies. Shore Physicians Group has more than 20 doctors and specialists treating patients at six locations in Somers Point, Egg Harbor Township, Ocean City and Northfield. Shore has created the first of a planned network of UrgentCare locations in Northfield. Johnson talks about urgent care and how it fits into Shore Medical Center’s business and clinical strategy.
Q: Why did Shore Medical Center branch out like this with these UrgentCare locations?
A: Market timing is everything. The Affordable Care Act is forcing changes in the reimbursement system across the country, and our reimbursement system is going from a fee-for-service reimbursement system to a value-based purchase system. You need access points. And you need to align your resources to take care of the community in the most appropriate ways.
We think the market timing is right now to expand our whole ambulatory strategy, of which UrgentCare is one of many. We see tremendous synergy having primary care and UrgentCare in the same location as we have in Northfield.
We see many people in our community that do not have primary-care physicians. UrgentCare is a way to provide patient access in the evenings and weekends when it may not be possible, even if you do have a primary-care physician, to get into an office in a timely way.
Q: How are these services different from those you provide at Shore Medical Center? Some patients already have a primary-care physician. Why would this model appeal to them?
A: Certain patients do have primary-care physicians already. But in many cases, they have limited hours. If somebody has a primary-care physician, this offers an access point for something to be taken care of quickly — an earache, a stomach ache, a child gets off the bus at 3:30 and is feeling (ill) and you don’t want to wait until the next day but can’t get an appointment that quick. It offers access for that type of patient.
For patients without primary care, this might be the only outlet they have. And it’s an affordable option, especially as you watch insurance premiums having huge co-pays, huge deductibles. This offers a very affordable outlet for people with those types of insurances.
Q: Who are the typical patients using this model?
A: You have a lot of people in this marketplace with chronic diseases, such as diabetes or coronary artery disease. This may be a way for them to get treatment in an urgent manner, an unscheduled manner, when they need something like that. If they do have a primary-care physician, UrgentCare can take care of the person and make sure they get back to their primary-care physician with full documentation of what happened.
I think that offers the community some great alternatives.
The synergy of having primary care and UrgentCare at Northfield is that if a patient doesn’t have a primary-care physician, we can quickly get them one for continuity of care long term. As the Affordable Care Act gets more traction, you’ll hear the catchphrase “collaboration of care” and coordination of care across the continuum. That will be more important than ever.
One of the things that is a huge discriminator at our Northfield site is our approach to technology. That, for us, means an electronic health record for all Shore Physicians Group members and UrgentCare. We can look at quality data, cost data and constantly improve our care. That is one thing that is distinctive.
Shore Physicians Group is part of our Advanced Medical Home project. The coordination of care and the measures of quality and the efficiencies being put in place with payers are very positive in improving the care that physicians are giving.
The concept is you’re able to have primary care and basic radiology studies, lab, coordination of specialists in one place.
Q: Under the Affordable Care Act, more South Jersey residents will be eligible for public health insurance. How does Shore’s model prepare you to treat these newly insured patients?
A: One of the hopes of the Affordable Care Act is that there are more insured patients. There are several issues in New Jersey — such as the expansion of Medicaid — that will provide additional access for different parts of our community.
I don’t know if we’ll see a huge influx of new patients. That’s my hope.
This model we put in place clearly is an affordable alternative that provides high-quality care for those patients with high deductible plans, high co-pays.
UrgentCare by itself is just an access point. It’s the coordination of care, the continuum of care, the hand-offs and how we measure our clinical performance that will be tremendously important.
Q: In announcing the creation of the physician group and the opening of UrgentCare, you talked about your advanced technology. What are some examples?
A: The technology we speak of is about managing data for the coordination of care. That’s the pure magic.
Like many other well-equipped sites, we have access to radiology that can be read remotely, we have all the diagnostic and lab tools. With physicians being co-located, we have a multidisciplinary group. It’s primary care, general surgery, gynecology — many disciplines in one space.
All of the physicians both in UrgentCare and Shore Physicians Group sites have full access to all the data that the hospital has, including historical radiology images through something called a PACS system (Picture Archiving and Communications System). We have an acute-care or hospital-based electronic-based health record here. Physicians can log in and see what the last episode was in the hospital.
Inside the practices of Shore Physicians Group and UrgentCare, we have the same electronic health records. So we can pull data. What’s the best practice for treating certain chronic diseases? How do you best manage a diabetic or coronary artery disease or congestive heart failure patient?
What we envision is the technology of imaging and labs and procedures is there as expected. But the power is truly in managing the data and providing better and better quality of care to reduce the variation in practice and have evidence-based medicine in place.
We have empowered physicians as leaders. They’re making decisions about clinical care. And they’re participating as this reimbursement system flips to a value-based purchasing system. Advanced Medical Home and other vehicles will allow us to share the fiscal benefit of the reduced costs with the physicians.
Q: How does your development of urgent care fit into the long-term strategy of Shore Medical Center?
A: UrgentCare in Northfield is really only one portion of a fairly robust ambulatory strategy for us. We believe the market timing is wholly appropriate as we approach the flip in (Medicare’s) reimbursement system from a volume-based reimbursement to a value-based reimbursement.
You see an ambulatory presence that will become more robust over time. UrgentCare is one piece. Shore Physicians Group is another piece. Shore Physicians Group at the end of 2012 was 20 physicians. We’ll be 45 by the end of this year, and within three years we’ll be at 75 or 80 physicians.
That’s going to provide the ambulatory footprint. This summer, we’re going to be rolling out some very innovative care models that augment this care strategy.
If you want to talk about the possible future of health care, it could very well be a robust ambulatory strategy driven by physician leaders that has an acute-care hospital in this integrated delivery system for the very ill, highly acute patients that need surgery and the ICU and the emergency room.
Understanding that there are different levels as patients and families make health care choices with their high-deductible, high-co-pay plans — they’ll be making economic choices — that’s going to be the key: getting the right resource to take care of patients in the right level of care in the right venue.
Q: Why did Shore Medical Center take longer than AtlantiCare in developing urgent care? Do you see AtlantiCare’s urgent care as a competitor?
A: I can only speak for Shore. Every health care system in the country is making decisions about timing the market. We believe we’ve timed our UrgentCare presence and our ambulatory strategy, of which UrgentCare is only one component, very well.
If you start to think of 2014 being the first trigger for the Accountable Care Act, we believe our timing in the marketplace is very well positioned to serve the community and help us be a long-term sustainable and vibrant organization.
Q: Will your satellite doctor’s offices and UrgentCare help take some pressure off Shore Medical Center for charity care? Can uninsured patients get treatment at these offices instead of going to the emergency room?
A: UrgentCare site is really about access. Alone it won’t affect things like charity care, but it provides a much more affordable option. Think about the individual who has a chronic disease and no primary-care physician who needs some type of episodic care. They now have an alternative to go to the emergency department, which is probably too high a level of acuity at a very high price point to take care of that patient.
At UrgentCare, it’s a much more affordable alternative. We accept cash payment at point of service. In some ways it’s an alternative outlet for high-quality care, whether you have good insurance or have challenges with co-pays or deductibles.
Q: With this new focus on outcome-driven results, do you expect to see improvements in the overall health of Atlantic County and South Jersey? How do you measure that?
A: Part of the Accountable Care Act is forcing health systems to manage your data in different ways. People who are able to gather that data and turn it into information for clinical and business decisions will be the winners in the marketplace. Part of the byproduct of all of this change in health care is the chaos we’re currently going through. Nobody has a crystal ball for the future. But I believe a data-driven organization is what the government is asking us to be. That will lead to better public health.
Employers drive much of this. A lot of times, the employer helps focus individuals on the ownership of their own health issues. They provide discounts to health care if they work out or if they stop smoking.
I think depending on how assertive employers are, that’s going to help some of this change in health care. But the end result will be a better quality of care and a healthier community.
Q: Where will Shore Physicians Group go next? Are you looking at expanding geographically or adding more specialties?
A: Shore Physicians Group has 20 physicians. We’ll be at 45 by the end of the year and 75 to 80 physicians at the three-year mark. We have a handful of locations, but we are looking at five other locations in the area. Some will have UrgentCare and primary care in the same area.
As far as specialties, because we absolutely believe and put a governance structure in place that is physician-led on these issues, the physicians in Shore Physicians Group and in partnership with the UrgentCare sites are going to decide when and how many of what specialties to add. Right now we have everything from plastic surgery and reconstruction to gynecology to general surgery to primary care to family practice. In January alone, we signed seven new physicians.
You’ll see a physician-led expansion that makes sense based on the specialties that they need and discuss among their colleagues.
Q: Is there anything else you wanted to say about your plans?
A: Everything we’re doing as an integrated delivery system is focused on caring for this community, shepherding and stewarding the resources we’re given, and we’re getting better every day. Whether it’s expansion of a site, our advanced ICU capabilities, we are partnering with physicians. We are allowing physicians a tremendous amount of input into our clinical and business decisions. And I think that’s going to position us very well for the future.
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