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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., FACPMedical Director, The West Clinic

New Mexico Oncology New Mexico Oncology Hematology Consultants, LtdHematology Consultants, Ltd

Barbara L. McAneny, M.D.Chief Executive Officer, New Mexico

Oncology Hematology Consultants, Ltd.

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New Mexico Cancer CenterNew Mexico Cancer Center

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Who are we?Who are we?

• Physician Owned and operated• Fiercely Independent• Rapidly growing• One Partnership, Two corporations

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NMOHCNMOHC

• Started in 1987 with 2 doctors• Now 9 Medical Oncologists, • 5 Radiation Oncologists• 2 Cancer Centers, 3 Clinics• 3 PAs• 200 employees

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NMOHCNMOHC• 4 Linacs, with IMRT• Stereotactic radiosurgery• Imaging with Pet CT, CT, MRI, bone density• Infusion• Lab• Clinical Trials• Rehabilitation• Nutritional Support• Psychological Support

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New Mexico Cancer Center New Mexico Cancer Center FoundationFoundation

• Patient grant support for the non-medical expenses of having cancer

• Education• Art!• Community sponsorships• Social service

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The Art!The Art!

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Art EverywhereArt Everywhere

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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

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Surgery Center Surgery Center

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Surgery Center Surgery Center

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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

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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

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Where are we Going?Where are we Going?

• Diversifying Income streams• Non-Oncology Doctors?• Interdependency with other Doctors?

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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

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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

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Independent Doctors of New Independent 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

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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

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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

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IPGIPG

• Clinical Integration• IT support for the practices• Insurance company approval• Transparent computer system

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Decreased expensesDecreased expenses

• Group purchasing• Practice supplies• Administrative support

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Passive IncomePassive Income

• GPO Ownership

• Whole hospital exception to the Stark Law(we hope)

• Ownership of MOBs

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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

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Wish Me Luck!Wish Me Luck!

The West ClinicThe West Clinic

Lee Schwartzberg, M.D., FACPMedical Director, The West Clinic

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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

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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”

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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”

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ReminderReminder

We will Arrive at our DestinationEither by Default or by Design

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Four Four 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

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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?

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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

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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

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Management Management • 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

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What Did WorkWhat Did Work

• Radiology• Gyn Oncology• Research• Management Structure• Integrated Offices• Marketing

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What DidnWhat Didn’’t Workt Work

• Merging with other groups• Radiation Oncology

– CON– Hospital Politics

• Dispensing pharmacy

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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

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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

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Advanced ImagingAdvanced Imaging

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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

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ImagingImaging• Successes

– Remarkable clinical utility– Real Time scanning/interpretation/result delivery– Interventional– Revenue stream

• Challenges– Declining reimbursement– Insurance redirection– Pre-certification– Scheduling

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Wings Cancer FoundationWings Cancer Foundation

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1996 Wings Cancer Foundation1996 Wings Cancer Foundationis 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 WisemanCo-Founders of Wings Cancer Foundation

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1998 501 (c) 3 Established1998 501 (c) 3 EstablishedThe Wings Cancer Foundation supports

thousands of patients, families, caregivers and friends regardless of

where treatment is received

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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

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Volunteer Program TodayVolunteer Program Today

Over 200 Volunteers!

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Lending Library

Imagine a place… of hope

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WingsGallery

Imagine a place… of hope

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Labyrinth Garden

Imagine a place… of hope

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2002 Launched Website2002 Launched Websitewww.WingsCancerFoundation.orgwww.WingsCancerFoundation.org

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ResearchResearch

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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

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ACORN Site ModelACORN Site Model

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West Clinic: ACORN Proof of West Clinic: ACORN Proof of ConceptConcept

Accruals Doubled Staff Halved Grant MarginIncreased 3 fold

Change from 2003 to 2006Change from 2003 to 2006

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Patients Consented/EnrolledPatients Consented/Enrolledby Study Phaseby Study Phase

4127

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7240

12 920 17

0

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100

150

200

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I II III IV No Phase

Consented Enrolled

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InternationalInternational

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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

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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

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International # 1International # 1INTERNATIONALORGANIZATIONALSTRUCTURE 2007-2008

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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

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Contact UsContact UsBarbara L. McAneny, M.D.

Chief Executive OfficerNew Mexico Oncology

Hematology Consultants, Ltd.4901 Lang Av., N.E.

Albuquerque, NM 87109Tel: 505.336.4206

mcaneny@nmohc.com

Lee S. Schwartzberg, M.D., FACPMedical DirectorThe West Clinic

100 Humphreys Blvd.Memphis, TN 38120Tel: 901.683.0055

lshwartzberg@westclinic.com