Practice integration: 'No obstacles'

Practice integration: 'No obstacles in our way'

Published with the approval of MedAxiom from its "2013 Perspectives: A Year in Review" report.

“Integration has actually changed my life very little,” said Paul Freier, MD, FACC, a cardiologist with the Adventist Health Midwest system. “The hospital system has always said they had no interest in changing my life, and that’s true. We had a successful practice because of the way we ran it. The hospital has seen no reason to interfere with it.”

Freier’s practice integrated with Adventist Health two years ago, after operating as an independent practice for more than a quarter of a century. He notes that his practice still has 15 cardiologists on staff, the same number as before. “We determine our own call schedule, and our own daily work schedule. We get no interference from the hospital. I think, for the most part, this is the model. Other doctors with whom I’ve spoken tell me they have had the same experience,” Freier stated, noting that the quality of care he and the other cardiologists provide has remained at its high level.

“From that standpoint, our expectations have been met,” Freier said, while adding that integration has changed several of his practice’s operating methods. “Our nurses, secretaries, medical technicians are now employees of the hospital system, and not of our practice. We have to live by the rules of the hospital, but we knew this going in; our work with MedAxiom prepared us.

“When we were Illinois Heart and Vascular, we had our own work-related policies; now, we have to live by the hospital’s policies. We can’t decide what health insurance plan we want, but have to use Adventist policies. We also rely on their HR procedures, and I liked our HR policies better. As part of the hospital system, we’re also part of a bigger bureaucracy. I liked the old way better, but there was no way around this…we knew it was coming.”

Freier said it helps that his practice was in what he calls “a good position” before integrating with the larger healthcare system. “We were way ahead of the hospital on things like meaningful use and PQRI. We felt that in many ways the health of our group was dependent on the health of the hospital. The hospital was having challenges with accurately collecting data and meeting core measures. The problem wasn’t the quality of care, but more with ways the hospital was collecting and managing its data,” he noted. Freier and his team believed it was important to help the hospital by implementing a clinical co-management agreement: “That was the main impetus, and we found it was much easier to do the agreement if they employed us.”

Going in, Freier said the practice insisted on a leading and management role for the healthcare system’s cardiovascular service line. In the two years since integration, Freier’s practice has made significant progress helping the hospital and his practice move toward compliance with meaningful use requirements, stressing that the quality of data collection and reporting has been upgraded. “We’re not at 100 percent yet, but we didn’t expect to be. Without our help, however, the hospital would have been in the same situation they were two-and-a-half years ago,” he commented.

Freier said he hesitates to provide advice to other cardiologists who are considering the integration of their practice with a larger healthcare organization. He does, however, strongly urge doctors to weigh both the pros and cons of the situation, and cautions that even the best situations may produce unexpected results. “Even though we’re employed by the hospital, it is unwilling to cede any power or authority to us. This is where our vision and the hospital’s do not always match. They treat us as having competing interests, and don’t always feel like we have their best interest in mind.” Freier explained that when his practice was newly integrated, both he and hospital administrators realized a needed service line administrator who worked for the hospital would need to be hired. “We wanted and needed to be involved in the hiring decision,” Freier said. “They involved us, but only after we made a point of making our feelings about this known.”

He recommends initially clarifying the level of input that the acquiring healthcare group is prepared to grant to the practice that is being absorbed. “I would have to say that if you’re going into negotiations, and your hospital isn’t ready to involve you, you should be asking whether you want a co-management agreement.” But Freier noted that some cardiologists may see a hospital assuming full control as a benefit, saying that "having a seat at the table" is not worth their time.

Overall, Freier said his experience has been beneficial -- he would do it again. His practice’s patients have not seen any change in the quality of care they receive from their doctors. The doctors’ workload has not changed, although they had hoped for an increase in referrals from the hospital; still, “if you asked most of the doctors in our group, they’d say we’re being paid more under integration than if we were still an independent practice.”