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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.

The agency is currently preparing an analysis of the local doctor population, assessing how many are practicing in the county, who they are seeing and with what groups they are aligned. [See story on p. 1.]

“For the doctors who are having trouble just staying afloat by themselves, the model provides financial stability,” Ms. Scardaci said.

The trend is also built on competition but not entirely among hospitals. The physician-owned Northern California Medical Associates has held onto to its doctors’ sovereignty but still participates in the competition for patients. The initially all-specialty practice in the last year has focused a majority of its efforts on recruiting primary care doctors, which now account for 40 percent of the practice.

“It’s a symbiotic business relationship in simplest terms. Our specialists realized they needed primary care in the group to secure their business. … It has become an environment where we were competing for new recruits and patients, which is really too bad,” said NCMA Executive Director Ruth Skidmore.

Many, including the county-organized Sonoma Health Action council, agree that better coordinating patient care will reduce the cost of health care and keep patients healthier. Whether providing the venue through new hospital and medical group facilities will result in this kind of work is yet to be seen.

“There are a lot of practices where there are a lot of services in one building, but it is a different thing to actually live this intense level of coordination,” said St. Helena Hospital’s Senior Radiation Therapist Patti Mitchell Johnson. Along with the new center, the group is implementing a unique position called a “nurse navigator” meant to guide the patient from diagnosis through treatment.

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Submit items for this column to D. Ashley Furness at afurness@busjrnl.com, 707-521-4257 or fax 707-521-5292.