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  1. 1 Innovator Case Studies:Innovator Case Studies: Physician PracticesPhysician Practices Barbara L. McAneny, M.D. Chief Executive Officer, New Mexico Oncology Hematology Consultants, Ltd. Lee S. Schwartzberg, M.D., FACP Medical Director, The West Clinic New Mexico OncologyNew Mexico Oncology Hematology Consultants, LtdHematology Consultants, Ltd Barbara L. McAneny, M.D. Chief Executive Officer, New Mexico Oncology Hematology Consultants, Ltd.
  2. 2 3 New Mexico Cancer CenterNew Mexico Cancer Center 4 Who are we?Who are we? • Physician Owned and operated • Fiercely Independent • Rapidly growing • One Partnership, Two corporations
  3. 3 5 NMOHCNMOHC • Started in 1987 with 2 doctors • Now 9 Medical Oncologists, • 5 Radiation Oncologists • 2 Cancer Centers, 3 Clinics • 3 PAs • 200 employees 6 NMOHCNMOHC • 4 Linacs, with IMRT • Stereotactic radiosurgery • Imaging with Pet CT, CT, MRI, bone density • Infusion • Lab • Clinical Trials • Rehabilitation • Nutritional Support • Psychological Support
  4. 4 7 New Mexico Cancer CenterNew Mexico Cancer Center FoundationFoundation • Patient grant support for the non-medical expenses of having cancer • Education • Art! • Community sponsorships • Social service 8 The Art!The Art!
  5. 5 9 Art EverywhereArt Everywhere 10 NMOHC: The futureNMOHC: The future • Adding 3 Medical Oncologists • Adding 3 new clinic sites • Adding IGRT • Adding Gamma Camera, ? Breast imaging • Surgery Center • Rental space for Related specialties
  6. 6 11 Surgery CenterSurgery Center 12 Surgery CenterSurgery Center
  7. 7 13 PrinciplesPrinciples • Practice Outlives the doctors • Hire only Future Partners • Reserve 25% profit for reinvestment • Pay as incentive for work, but no churning or making money off other doctor's work • Be a good employer • Be a good citizen • Plan for today, tomorrow, 5 years and 10 years 14 StructureStructure • NMOHC owns only AR, perishable supplies and inventory and EHR • NMCC owns all the facilities, equipment • Buy in is structured for ease of adding partners, • Buy out is share only of the equity generated
  8. 8 15 Where are we Going?Where are we Going? • Diversifying Income streams • Non-Oncology Doctors? • Interdependency with other Doctors? 16 Our MarketOur Market • 24% uninsured • Diverse Demographics in a large Rural state • Medicare + Managed Care • Statewide Market • 4 Payers • Dominant Payer owns a hospital and employs physicians • Functional loss of 2 hospitals • University competition • Fewer doctors in Independent practice
  9. 9 17 Our SolutionsOur Solutions • State wide presence • Patient Satisfaction • Advertising • Rehabilitation Center (Pre-hab?) • Surgery Center • Support of our referral base • Rental space • Independent Doctors of New Mexico, Inc 18 Independent Doctors of NewIndependent Doctors of New Mexico, Inc.: GoalsMexico, Inc.: Goals • Make and keep Independence financially viable for small practices • Bring new health plans to New Mexico • Bring a new hospital to New Mexico
  10. 10 19 Financial ViabilityFinancial Viability • Group Contracting – Must avoid Anti trust – Financial and Clinical Integration – Development of appropriate software for integration and transparency – Common quality measures • Group Purchasing • Passive Income 20 Legal Structure: An IPGLegal Structure: An IPG • One Clearinghouse, one billing number • Shared redistribution pool – 80% immediately delivered to the practice – 20% in the pool • 8% shared equally • 8% for overhead and RVUs • 4% for Quality measures
  11. 11 21 IPGIPG • Clinical Integration • IT support for the practices • Insurance company approval • Transparent computer system 22 Decreased expensesDecreased expenses • Group purchasing • Practice supplies • Administrative support
  12. 12 23 Passive IncomePassive Income • GPO Ownership • Whole hospital exception to the Stark Law(we hope) • Ownership of MOBs 24 Future WorkFuture Work • Partnership with the hospital in the face of the changing Stark Law • Encouraging physician courage • Insurance company contracting • Service Development – Health Insurance – Liability Insurance • Clinical Integration development while maintaining independence
  13. 13 25 Wish Me Luck!Wish Me Luck! The West ClinicThe West Clinic Lee Schwartzberg, M.D., FACP Medical Director, The West Clinic
  14. 14 27 History of The West ClinicHistory of The West Clinic • Solo practice begun by Bill West, 1979 • Kurt Tauer joined 1985 • Lee Schwartzberg joined 1987 • New office with radiologist 1989 • 5 Medical Oncologists 1991 • 2 Gyn Oncologists 1995 28 About 10 Years AgoAbout 10 Years Ago…… • The West Clinic Owners Decided that the West Clinic would outlive their careers • That a large "one stop shop" facility would be constructed • Reality…"A Mantle of Responsibility has landed on The West Clinic"
  15. 15 29 The West Clinic Vision & MissionThe West Clinic Vision & Mission "No Stone Unturned" "The West Clinic is a World-class Center of Excellence for Oncology, Hematology, Radiology, and other Advanced Medical Care" 30 ReminderReminder We will Arrive at our Destination Either by Default or by Design
  16. 16 31 FourFour DesignDesign Turning PointsTurning Points • Late 90's – Outlive Careers – Large Facility • 2001 – Growth Pains – Needed Infrastructure – Hats Over the Wall • 2002 to 2006 – Design & Response Strategy – Unparalleled Growth – Infrastructure Development & Implementation – Beginning of Serious Exogenous Threats – Response and Action • 2007 Onward – Onset of Serious Exogenous Threats – Significant Opportunities – Continued Growth & New Alliances – Completely New Models - CHANGE 32 Clinic LocationsClinic Locations • One site not adequate in Memphis metro • Three large clinics in proximity to hospitals – 50,000 sq ft flagship – 12-15,000 sq ft full service x 2 • Three smaller clinics in surrounding areas – 2000-5000 sq ft – Partially staffed by MDs; NP model • One new oncology/cardiology clinic planned • Real Estate: own or lease?
  17. 17 33 34 Current West Clinic:Current West Clinic: Provider StaffProvider Staff • 14 Medical Oncologists • 5 Gynecologic Oncologists • 4 Radiologists • 2 Endocrinologists • 1 Pain & Palliative Care • 2 Hospitalists • 1 Rheumatologist • 12+ Nurse Practitioners • 1 Psychologist • 12 Cardiologists
  18. 18 35 Current West ClinicCurrent West Clinic • 375+ Staff • 10+ Sites • 150,000+ Patient Encounters • At least 75,000 venipunctures • Tens of thousands of Radiology Body Parts • 25,000+ Chemotherapy Treatments • 400,000+ Phone Calls • Millions of E-Mails • Hundreds of Thousands of Phone Calls • Tens of Thousands of Claims & Payments • Hundreds of Patients Consented for Clinical Trials 36 ManagementManagement • Chief Executive Officer • Chief Operating Officer • Chief Financial Officer • Financial Services Director • Human Resources Director • Radiology Director • Clinic Operations Director • Administrative Services Director • Patient Services Director • Pharmacy Operations Director • Electronic Medical Records Director • Information Technology Director • Marketing & Development Director • Business Office Director • Research Director • Purchasing Director • Health Informatics and Quality Director • More Managers and Supervisors
  19. 19 37 What Did WorkWhat Did Work • Radiology • Gyn Oncology • Research • Management Structure • Integrated Offices • Marketing 38 What DidnWhat Didn''t Workt Work • Merging with other groups • Radiation Oncology – CON – Hospital Politics • Dispensing pharmacy
  20. 20 39 Hospital AlliancesHospital Alliances • Radiation Oncology • Clinical programs generally more successful – Cancer Genetics Program – Autologous Stem Cell Transplant Program – Hospice and Palliative Care Program – Cancer Institute/CCOP 40 A Handful of West Clinic FirstsA Handful of West Clinic Firsts • Large Comprehensive Facility • Interdisciplinary Care in the Community Setting • Advanced Imaging in the Office • Interventional Radiology in the Outpatient Setting • CTA • Championing Supportive Care and QoL • SOS & The e-tablet • Wings Cancer Foundation 501(c) 3 foundation • The Journal of Community Oncology • The Community Oncology Alliance • Serious Clinical Trial Research in the Community Setting • Robust Community Research Network (ACORN) • International Foot print
  21. 21 41 Advanced ImagingAdvanced Imaging 42 Imaging: History of InnovationsImaging: History of Innovations • History – First CT scanner 1989 – Full time radiology 1990 – Nuclear Medicine 1992 – Interventional radiology 1999 – MRI,US, angiography 2001 – PET 2002 – PACS system/filmless 2003 – PET/CT 2004 – Teleradiology with GI group (1) 2004 – CT in 3 main offices sites 2005 – CT angiography 2006 – Teleradiology with GI group (2) 2006
  22. 22 43 ImagingImaging • Successes – Remarkable clinical utility – Real Time scanning/interpretation/result delivery – Interventional – Revenue stream • Challenges – Declining reimbursement – Insurance redirection – Pre-certification – Scheduling 44 Wings Cancer FoundationWings Cancer Foundation
  23. 23 45 1996 Wings Cancer Foundation1996 Wings Cancer Foundation is Born!is Born! "We are trying to meet as many patients as possible & help give you the emotional support & encouragement that we believe to be so important when you are fighting cancer" - Sandy Patterson, 1996 Sandy Patterson & Brenda Wiseman Co-Founders of Wings Cancer Foundation 46 1998 501 (c) 3 Established1998 501 (c) 3 Established The Wings Cancer Foundation supports thousands of patients, families, caregivers and friends regardless of where treatment is received
  24. 24 47 Wings Services ProvidedWings Services Provided • Clinical Research • Corner Boutique • Crisis Intervention • Exercise / Strength • Hospital Visitation • Individual Support • Labyrinth Garden • Lending Library • Nutrition Counseling • Partnering Program • Speakers Bureau • Support Groups • Tai Chi / Balance • Volunteer Program • Workshops • Yoga / Relaxation 48 Volunteer Program TodayVolunteer Program Today Over 200 Volunteers!
  25. 25 49 Lending Library Imagine a place… of hope 50 WingsGallery Imagine a place… of hope
  26. 26 51 Labyrinth Garden Imagine a place… of hope 52 2002 Launched Website2002 Launched Website www.WingsCancerFoundation.orgwww.WingsCancerFoundation.org
  27. 27 53 ResearchResearch 54 ACORN Site Value PropositionACORN Site Value Proposition • ACORN eliminates duplication and waste, enhances productivity and efficiency by utilizing technology, and harnesses investigator/site clinical expertise
  28. 28 55 ACORN Site ModelACORN Site Model 56 West Clinic: ACORN Proof ofWest Clinic: ACORN Proof of ConceptConcept Accruals Doubled Staff Halved Grant Margin Increased 3 fold Change from 2003 to 2006Change from 2003 to 2006
  29. 29 57 Patients Consented/EnrolledPatients Consented/Enrolled by Study Phaseby Study Phase 41 27 213 170 72 40 12 9 20 17 0 50 100 150 200 250 I II III IV No Phase Consented Enrolled 58 InternationalInternational
  30. 30 59 An Introduction to SingaporeAn Introduction to Singapore 2.8 billion market within 7-hour flight radius Bridge to traditional main markets of US, Europe & Japan The Singapore Advantage Springboard to Asia: 7,000 MNCs, >50% with regional functions Open immigration policy: 4 mil population, of which 1 mil are non-Singaporeans English speaking workforce: 97% literacy • Best Asian City for Business • #1 in Asia for IPR Protection, • #1 Globally in Labour Force Evaluation Measure • #1 for Physical Infrastructure • 2nd most profitable place for investors • #46 in 2004 Cost-Of-Living Survey 60 Current Status InternationalCurrent Status International • Singapore West Excellence Cancer Center Launched 10/06 – Steven Tucker, MD – Ben Low, MD – Wen-Sen Shieh, MD – Nancy Bailey, NP • West Clinic Shanghai Launched 10/07 – In conjunction with Kanglian Hospital – Recruiting full time US trained physician
  31. 31 61 International # 1International # 1 INTERNATIONAL ORGANIZATIONAL STRUCTURE 2007-2008 62 Concluding ThoughtsConcluding Thoughts • Entrepreneurial approach keeping patient- centered, quality based focus results in successful program • Think both big and little • Invest in critical HR when growing • Keep it enjoyable for the long term
  32. 32 63 Contact UsContact Us Barbara L. McAneny, M.D. Chief Executive Officer New Mexico Oncology Hematology Consultants, Ltd. 4901 Lang Av., N.E. Albuquerque, NM 87109 Tel: 505.336.4206 mcaneny@nmohc.com Lee S. Schwartzberg, M.D., FACP Medical Director The West Clinic 100 Humphreys Blvd. Memphis, TN 38120 Tel: 901.683.0055 lshwartzberg@westclinic.com