GREENBRAE -- Marin General Hospital has finalized the addition of a sixth medical practice to an expanding network of clinics it will now operate, a development seen as pivotal for the hospital as it looks for ways to attract and retain physicians amidst an increasingly consolidating, reform-driven health care landscape.

Since returning to the publicly controlled Marin Healthcare District in 2010, Marin General has acquired Cardiovascular Associates of Marin and San Francisco Medical Group, the San Rafael Medical Center, North Marin Internal Medicine, West Marin Medical Center, Marin Medical Group, and the Soluna Sausalito Medical Clinic. A total of 29 physicians are now associated with Marin General via the new clinics.

Individually, the practices are small, but taken together it represents a significant infusion of physicians associated with Marin General. And it could better enable the hospital and its physicians to form accountable care organizations, known as ACOs, that are now permitted under the Affordable Care Act and overseen by the Centers for Medicare & Medicaid Services, said Jon Friedenberg, the district's chief fund and business development officer.

"We will be in a better position to deal with those changes if we are aligned with our local physicians than we would be if we were not," Mr. Friedenberg said. "If all the consultants are correct and we end up with bundled payments and ACOs, we'll be in a much better place." 

Accountable care organizations are viewed by many as a more cost-effective way for providing a range of specialty and primary care by integrating once-disparate factions of health care, including physicians, hospitals, HMOs and insurance carriers.

Under the 1206(b) provision of the state health and safety code, health care districts are permitted to acquire medical group assets and contract with physicians. The Marin district is taking full advantage.

The recent clinic acquisitions are in addition to other efforts, such as the formation of the Prima Medical Foundation with the Marin-Sonoma IPA and strategic alliances with other hospitals in the North Bay, all of which will help the involved parties adapt to a rapidly evolving business environment, Mr. Friedenberg said.

Even without the impacts of health care reform, health care district officials said the alignments made sense and will help provide both efficient and integrated care.

"There is tremendous benefit to the greater Marin community in integrating these premier practices with Marin Healthcare District and Marin General Hospital," said Lee Domanico, CEO of of the district. "Residents can be assured that their primary and specialty health care needs are met close to home through our newly broadened network of physicians."

The group of cardiologists was the biggest of the recent acquisitions, with 14 physicians. A cost figure for acquiring the six practices was not immediately available, but  Mr. Friedenberg said each is expected be a significant revenue source for the hospital.  Smaller practices, likewise, stand to benefit from the integration, as they would not have the ability to form ACOs or negotiate higher reimbursement rates with insurance carriers. 

Additionally, the integration between the six practices and Marin General, as well as the relationships with Sonoma Valley and Palm Drive hospitals in Sonoma County, will likely spur further movement toward integrated information technology systems or electronic health records, Mr. Friedenberg said, possibly allowing the district to meet so-called meaningful use standards that mean bonuses and savings from CMS.

"IT is certainly one of the biggest issues," Mr. Friedenberg said. "The physician alignment we're doing facilitates IT integration between the clinics and the hospital, and that's one of the key features of health care reform. In order to integrate, you've got to have some kind of alignment." 

In the 18 months since the health care district severed its management agreement with Sutter Health, the hospital has taken several steps to ensure it remain viable amid some of the region's health giants. While the efforts include alignment with other providers and physicians, the goal is not to compete with the Kaisers or Sutters, health care district officials maintain. Rather, it's to adapt to the shifting landscape and to reduce costs while providing quality care, and it's likely to continue. 

"I think that there's more to come," Mr. Friedenberg said. "It's not a Marin trend, it's a national trend. What you see happening is irreversible. There is national momentum and we're not immune to it, and I think if we do it right, were the doctors have the freedom, we do IT integration, there is a genuine opportunity to reduce costs and improve results at the same time."