Reform driving new physicians organization

As health care reform moves forward, West Michigan doctors are facing more choices about banding together or working for hospitals in order to prepare for changes in reimbursement and meet the national push for higher quality and lower costs.

“Physicians will have to make a choice,” said David Silliven, executive director of the Physicians Organization of West Michigan and the Physicians Organization of Michigan, the newly created joint venture with the University of Michigan Health System.

“Their practices have to change to adhere to how health care is going to be financed and supported going forward,” Silliven said. “It’s not a question if a physician is going to align. The question is who are you going to align with?”

The latest choice is POM, the Physicians Organization of Michigan, which was announced to local doctors last week. A joint venture of POWM and UMHS, POM aims to connect independent doctors statewide without being tied to a particular hospital by employment or affiliation. Its members will primarily be other regional physicians organizations.

POM will provide services such as access to a clinically integrated network of physicians with an electronic health record system, support for business functions and systems to track quality benchmarks. It will contract with POWM to provide many of its services, Silliven said.

The new organization starts with the 1,600 members of the multi-specialty faculty physicians group at UMHS and the 570 members of POWM. It will seek to pick up other physician organizations and independent doctors as members, he said.

“Physicians have a lot of options out there for how to align. This is providing physicians another option,” Silliven said.

For West Michigan doctors, options now include hospital employment, such as the Spectrum Health Medical Group; hospital-specific affiliation, such as the clinical integration organization formed by Saint Mary’s Health Care and Advantage Health; and now POM, as a “hospital agnostic” umbrella for independent doctors, said Dr. David Spahlinger, executive director of the University of Michigan faculty group practice and senior associate dean for clinical affairs at the U-M Medical School.

“This is kind of an alternative model,” Spahlinger said.

Bob Woolford, executive director of Grand Rapids Ophthalmology and a past president of the Michigan Medical Group Management Association, said large specialty practices work with many hospitals and may be reluctant to be closely associated with one or the other.

“It presents some difficulty, yet the whole health care reform effort is based largely on these accountable care organization concepts,” Woolford said. “My goal is to play in all the ponds.”

Dr. Randall Clark, POWM board president and a family practice physician in Grand Rapids for 22 years, said he expects POM’s clinical benefits, such as tracking and measuring quality benchmarks, will benefit patients, as well.

“We are going to provide opportunities across the state that are not currently in place,” Clark said. “UMHS is a large organization and very good referral center, but this is new territory for them. They found a natural partner in us to expedite their process.”

The federal government is attempting to jump start technology development in medicine with additional reimbursements for doctors who participate in Medicare and Medicaid. These physician alliances also are setting the stage for accountable care organizations, in which multiple health care providers will share a single payment for a patient’s care.

Many doctors are unwilling to take on the cost and expertise required to implement technology such as EHRs, health information exchanges and e-prescribing.

Hospitals hired half of all new doctors in 2009, according to the Medical Group Management Association, as doctors look for an alternative to the traditionally long work hours and to the debt and responsibility associated with establishing or joining a small practice. The American Medical Association reported that one is six doctors now works for a hospital.

In her State of the Health System speech in September, UMHS CEO Dr. Ora Hirsch Pescovitz outlined a strategy to take the block M health care brand statewide. Pescovitz said that the system is pursuing five strategic themes, including to grow and expand the UMHS geographic presence.

In September, UMHS joined with Metro Health and Trinity Health, the parent company of Saint Mary’s Health Care, to create Pennant Health Alliance. That organization is aimed at helping hospitals with physician alignment and recruitment, health information technology, revenue cycle management and group purchasing.

The U-M and Metro Health also have a joint venture in radiation oncology at the Cancer Center at Metro Health Village.

U-M has been running a large ACO pilot program, Spahlinger said, and has found that it takes a large number of Medicare patients, perhaps as many as 25,000 to 30,000, for the ACO concept to work in the real world. POM is setting the stage for an ACO for independent doctors, he added. Even with 1,600 doctors, the U-M system Medicare patient roster hits at about 18,000, he said.

“I think it’s a complicated thing, to get to an ACO,” Spahlinger said. “But the first step is not necessarily physician-hospital integration, but it is physician integration, acting as if you are a multiple specialty group of physicians.”

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