NOVATO -- Responding to continuous growth over the last two years, the Marin-Sonoma IPA is moving into a larger space at Hamilton Landing in Novato, from about 12,000 square feet to more than 20,000 square feet.

Joel Criste, chief executive officer of the independent physician association, said the move from 3 Hamilton Landing to 4 Hamilton Landing is a direct result of the IPA's significant move into nearly every corner of Sonoma County in the last year, a move that prompted a name change after it grew to include about 580 physicians across its two-county network.

"We have expanded our service area to include the entire Sonoma County area and are working toward additional contracts and services, and we required additional space and we've had a very good experience at Hamilton," Mr. Criste said, adding the larger space could accommodate future expansion if need be.

The growing Novato location is ideally situated for an organization that has physicians across both counties, given its proximity to both Highways 101 and 37. The IPA, which has 45 employees, will continue to seek growth opportunities in areas that have yet to be determined, Mr. Criste said.

"We do look at potentially other geographic areas for expansion," he said.

The IPA has approximately 280 physicians in its network in Marin County, in facilities that include Marin General and Novato Community hospitals. It also had existing relationships with Sonoma Valley and Petaluma Valley hospitals. Last year, the IPA expanded further into Sonoma County, just about doubling its size by bringing on physicians from Santa Rosa Memorial Hospital and others in Sebastopol and Healdsburg, for a total of about 300 doctors across the county.

Marin-Sonoma IPA also handles administrative work for the Prima Medical Group, a 55-member physicians group in the same building that two years ago formed a foundation with Marin General and the IPA. Prima has grown from about 25 to 55 physicians over an 18-month period in Marin and at Sonoma Valley Hospital, according to Mr. Criste.

The Prima Medical Group has not expanded its geographic service area, but could do so in the future. “That’s been reported on the list of things under consideration," Mr. Criste said.

Palm Drive Hospital in Sebastopol, which recently entered into an affiliation with Marin General and Sonoma Valley hospitals, has cited the possible inclusion of Prima physicians as a potential boon to the cash-strapped district hospital. Likewise, Sonoma Valley Hospital, another district hospital, has credited its relationship with Prima as a positive development in attracting patients.

On a similar note, smaller, stand-alone hospitals across the North Bay – and across the country, for that matter – have struggled to attract and retain physicians in light of fierce competition from health care giants such as Kaiser Permanente and Sutter Health. The expanding IPA has been described as one helpful step in keeping smaller hospitals viable by aligning with the network rather than a health system or closing altogether.

Marin-Sonoma IPA is also hoping to become an accountable care organization, or ACO, a designation under the Affordable Care Act that offers Medicare bonuses for organizations that integrate care. Mr. Criste said the IPA was hoping for the ACO designation from the Centers for Medeicare and Medicaid Services by Jan. 1, 2013.

"I think it's fair to say the Marin-Sonoma IPA is actively pursuing ACO designation," he said. "The key advantage is the physicians organizing to apply improved systems of care to Medicare beneficiaries, much like they have to with HMO beneficiaries.

Although the ACA hangs in the balance of a forthcoming U.S. Supreme Court decision on the law’s constitutionality, Mr. Criste said the model of an ACO would likely continue with or without health care reform. Uncertainty certainly does abound, though.  

“What we’re pursuing is what’s written in the law, so it’s hard to say what activity we’d pursue absent that,” he said. “The focus of Marin-Sonoma IPA is to be a coordinated, integrated organization – regardless of the payer source. We’d continue to pursue these activities absent health care reform, but health care reform does assist in the organizing and the financing.”