The CMO title in Dr. Tom Raskauskas”™ previous job stood for chief medical officer, but it might as well have been chief marketing officer given how the Michigan transplant is spending his days in Bridgeport.
St. Vincent”™s Medical Center has created a new physician-hospital organization dubbed St. Vincent”™s Health Partners, which will increase reimbursements for doctors that get good clinical results, and increase doctors”™ leverage in negotiating contracts with insurance carriers.
Physicians own 50 percent of St. Vincent”™s Health Partners, with St. Vincent”™s Medical Center owning the other half. The board is chaired by Dr. George Goldfarb, president of the medical staff at St. Vincent”™s Medical Center, with the Bridgeport hospital part of Ascendent Health.
Raskauskas is CEO of St. Vincent”™s Health Partners, having previously served as chief medical officer of Meridian Health Plan, a multistate HMO in Michigan with some 300,000 people under its umbrella.
St. Vincent”™s Health Partners dubs itself a physician-hospital organization or PHO, and is not pioneering the concept. PHOs date back more than two decades and Danbury Hospital”™s was the first to trigger an investigation by the U.S. Department of Justice, in 1995, with DOJ allowing the PHO concept to stand but serving notice it would come down hard on any price fixing or other monopolistic behavior.
The St. Vincent”™s move comes even as Shelton-based PriMed and other physician groups form their own accountable care organizations or ACOs, under the auspices of the Affordable Care Act, which similarly look to provide better reimbursements for doctors who perform well under the federal Medicare program.
Raskauskas cites statistics suggesting 38 percent of all medical spending dissipates in various wasteful procedures or processes.
“If you see 10 different doctors, you are going to get 10 different treatments,” Raskauskas said. “Some are better and some are worse, but they all get paid the same.”
An OB-GYN physician who has delivered by his estimate more than 3,000 babies, Raskauskas has signed up 150 doctors to date, but he says the sheer number is less important than building an organization that features a broad array of primary care doctors and physicians.
Doctors have to pay up front to join, so it is clear that they do see this as their best option.
“I went into a doctor”™s office (in mid-July) to introduce myself and discuss the concept,” Raskauskas said. “I feel that I gained his trust because he joined that day. ”¦ He”™s a primary care (doctor) and wants to stay independent, and one of the things our organization is hopefully going to provide is some assistance to doctors that want to stay independent in this crazy world of health reform and increased regulation.”
And those that see their reimbursements suffer because they do not hit the quality of care marks specified under the plan?
“They will be paid less,” Raskauskas said. “Unless they don”™t start understanding all the quality metrics and how health reform is coming, one of two things is going to have to happen: either they need to change the way they practice or they”™re going to lose contracts and go out of business.”
“It”™s a shared vision on where we all think health care is going, and they want to be part of that vision,” Raskauskas added. “They want to create their future rather than sitting on the sidelines and having it forced upon them.”
