Outpatient, other facilities part of effort to attract, serve patients
In a matter of weeks, the 131-year-old St. Helena Hospital will unveil the results of more than $26 million in construction: a three-story, highly advanced cancer and outpatient services center.
Even before the opening, the facility tucked in the hills overlooking Highway 29 has attracted experts from some of the long-established medical groups in the North Bay, bringing together caretakers that for a long time were separated. The 12,600-square-foot center includes state of the art diagnostic and chemotherapy equipment, as well as space for outpatient surgeries and medical offices.
The 181-bed hospital is one of many in recent years that has insulated itself with doctors as a way to secure more referrals and increase revenues. At the same time, the shift from care in separate venues to a more centralized model has encouraged coordination, which, according to some, is the key to prevention and better health care.
Legal restrictions prevent the direct employment of doctors with hospitals. Groups associated with hospitals are done so through medical foundations, special outpatient department licenses and hospital privileges, and do not mean that the physician can only refer to that facility.
Sonoma County Medical Association President and Sebastopol family practice physician Dr. Richard Powers said medicine has changed more in the last few years than any other time in his 35 years in health care. He remembers a time when professionals didn’t have to worry about making a living doing what they loved, and providers cherished the autonomy of running their own practice.
Dr. Powers said although the independent practice provides a personalization that is sometimes lost in alternative settings, intrinsically the model separates providers into primary, specialty and inpatient venues, and over the years has caused divisions between the caretakers.
“I believe in the long-term connection of patients and their doctor — I have seen five generations of some families — and that is definitely something I feel is lost in the bigger groups,” he said.
“I think continuity is also a really important concept with prevention and this medical home model and is something we haven’t done as well in the past. ... What happens in the next five years will be dramatic change in terms of organization and delivery of medicine, and I am anxious to see what happens.”
He said reimbursement is such that it pays doctors more for the number of procedures, rather than the outcome, but he is glad more scrutiny is returning to wellness.
Bringing doctors back together
At the same time, as doctors have struggled to maintain a solo practice, hospitals have lost revenues to surgeries that increasingly take place in the outpatient setting. Hence the genesis of connecting the two: doctors handing over business operations to a larger organization and hospitals finding ways to siphon referrals.
“The system of health care is clearly evolving. The doctors drive how patients move through the system, and hospitals know if you oversee the doctors, you in some ways control where the patients go,” said Rita Scardaci, director of the Sonoma County Department of Health Services.