Six months ago, Premier Medical Associates in Monroeville, then the region's largest independent physician group, loomed as the big prize between dueling health giants Highmark and UPMC in the race to bring independent physician groups into their respective folds.
Highmark won that battle early this year when it acquired the 63-physician multispecialty group, thus avoiding a major setback for the insurer and its partner-in-waiting, the West Penn Allegheny Health System.
The loss of some or all of the 100,000 people whose doctors are part of Premier Medical -- and whose patients often use West Penn Allegheny's Forbes Regional Hospital -- would have been devastating for West Penn Allegheny, which was already experiencing declining patient volume at its other hospitals.
But to hear Premier CEO Mark DeRubeis, the bitter public contract battle between UPMC and Highmark had little or nothing to do with the group's decision.
In fact, at the public hearing about the Highmark-WPAHS partnership two weeks ago, Mr. DeRubeis referred to troubles in Pittsburgh's health care arena as "a dangerous distraction" from the real problem -- the national health care crisis.
"Health care in general is grossly inefficient and just too expensive," he said, and Western Pennsylvania's higher-than-average hospital use has driven up costs here even more than other regions.
"As a native Pittsburgher, it pains me to know that, as a region, we're not even keeping pace with the rest of the country. That speaks to inefficient care," Mr. DeRubeis said in an interview at Premier Medical's headquarters on Northern Pike last week.
As to the Highmark-UPMC dispute, he said simply that "if this got resolved tomorrow, we've still got a real big problem on our hands."
Mr. DeRubeis frequently turns to a favored phrase when talking about health care: "bending the cost curve." But he doesn't mean simply cutting costs, or pushing patients out of the hospital before they're ready.
One cost-saving efficiency that Premier has implemented, for example, is the use of hospitalists -- physicians who oversee the care of Premier patients while they're in the hospital. That allows primary care physicians to stay in the office seeing other patients, rather than spending part of the day traveling to and from the hospital. Premier has one hospitalist at UPMC Shadyside, but the majority are at Forbes Regional Hospital.
Unlike other commodities, Mr. DeRubeis explained, more medical care does not necessarily mean better care -- just look at the Pennsylvania Health Care Cost Containment Council report last week showing that 13.5 percent of hospital patients are re-admitted for some health problems within 30 days, often for an infection they got during their first hospital stay. The cost for all those readmissions is almost half a billion dollars.
Premier Medical Associates, Mr. DeRubeis said, uses a model that is unique in Pittsburgh but common in most other regions: a large group of doctors who coordinate and collaborate to provide care that is both high quality and highly efficient.
In the simplest terms, he said, they follow a "chronic care," rather than an "acute care," approach. Instead of treating a diabetic patient's infected toe, for example, their emphasis is on preventing the infection in the first place. As a result, Premier says its rate of hospitalization for diabetic patients is 48 percent lower than the national average.
"Our job is to keep you out of the hospital."
Getting those results requires a team of highly collaborative doctors and nurses and a teamwork mindset that, Mr. DeRubeis allowed, is not to every physician's taste. But the team approach offers leverage, he said, to build everything from strong information technology resources to developing a common protocol that lessens the odds that a diabetic patient will end up in the hospital.
Rather than being paid more for seeing more patients, Premier physicians are expected to fall within a range when it comes to patient volume -- enough to be productive and keep the business viable, but not so much that it could compromise care.
"If care is delivered more efficiently, then we will get better care at less cost."
It is the group's unique-to-here model, Mr. DeRubeis said, that favored an affiliation with Highmark rather than UPMC. Premier Medical may no longer be independent, but the group wanted to retain its identity. "When you look at UPMC, the model is very clear. They would have wanted us to meld into that model."
As the rhetoric between UPMC and Highmark has heated up, Mr. DeRubeis said Premier "just sort of rose above all that" and focused on improving patient care while also reducing costs. He doesn't expect that to change now that it is part of Highmark's organizational chart.
But UPMC spokesman Paul Wood questioned whether Premier physicians will continue operating as they have now that they are aligned with Highmark.
"The acquisition of Premier by Highmark will undoubtedly result in Premier doctors steering their patients into the financially distressed West Penn Allegheny Health System, and this will come at the expense of their patients' own desire to seek care at UPMC hospitals," Mr. Wood said.
"If that isn't true, then there's no good reason that Highmark spent $70 million of their subscribers' funds to acquire Premier Medical."
Highmark spokesman Aaron Billger said the $70 million number is inaccurate but declined to provide what the actual purchase price was. "The physicians of Premier Medical Associates practice at West Penn Allegheny hospitals, including Forbes Regional, as well as at UPMC facilities, and they will continue to do that after the affiliation," he said.
While Premier will continue its close ties with Forbes Regional, Mr. DeRubeis acknowledged the group does not plan to use the new UPMC East hospital when it opens this summer. But he pointed out the Highmark affiliation will allow Premier to reach many more people, spreading the word about what he believes is more efficient, less costly care that is also high quality.
"My job is to focus on the things we can control. What we can control here is how we take care of our patients."homepage - businessnews - health
Steve Twedt: firstname.lastname@example.org or 412-263-1963.