Supreme court ruling won't stop push to control health costs

 

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The Brooklyn-raised ear-nose-and-throat doctor, who has been Summit's chairman for 12 years, knows many health care scholars cheer on networks like Pennsylvania-based Geisinger Health System, believing their use of salaried doctors limits hospitalizations, expensive tests, even excessive end-of-life care. But that's not Summit's business model, and LeBenger's job is to find a way to make his business work in a post-reform world — mending fee-for-service rather than ending it. Summit charges higher fees, yes, but delivers a lower total cost by reducing how much care people need to stay healthy, he says.

"I'll get the patient better, sooner," he said. "Our rates may be higher, but we don't overutilize, and we can prove it."

Running essentially a large corporation built on fee-for-service medicine, the Summit Medical chairman's changes aim to justify Summit's rates by helping patients reduce how much care they need to stay healthy. Since the Affordable Care Act is built to accommodate fee-for-service, a lot of health care's future will reflect his formula: using size and scale as an alternative to moving doctors onto a hospital payroll.

"The Affordable Care Act reflects a lot of what we're doing," Chief Financial Officer Rob Booth said. "Electronic medical records and a multispecialty environment where there is collaboration and quality management because there's enough scale to make the investment."

Make no mistake: Summit is big. When it took over the Berkeley Heights campus of Dun & Bradstreet, it had to expand it. It has 1,200 employees and 134,000 patients — aided by acquisitions that brought in 27 doctors since 2010, part of the 81 new docs added in the last five years. In parts of New Jersey, its market share is 40%. It plans more mergers this year to deepen its share in other counties, LeBenger said.

The goal is end-to-end medicine, nearly eliminating out-of-network testing and referrals that cost insurers extra. Summit has doctors in 70 specialties, its own same-day surgery center, even its own urgent-care center, a kind of junior emergency room. Only 6% to 7% of Summit's urgent-care patients are admitted to hospitals, LeBenger said, vs. the 13% to 15% of ER patients the Centers for Disease Control says were admitted in the U.S. in 2008.

Booth claims Summit can deliver 20% lower costs when its doctors provide more than half of a patient's care.

The strategy also demands management and supervision of individual doctors by the firm itself.

Summit has an in-house quality assessment team, whose tasks include reviewing care to make sure hospital stays are kept as short as possible; an electronic medical records system to coordinate care, prevent mistakes that require more treatment and to emphasize generic medications. It even commissioned New York University's business school to create a medical-economics and management course for SMG doctors The intense focus on studying practice patterns lets Summit sign contracts with insurers that let them gain rewards for saving payers money, said Pegeen Butterfield, a nurse who is Summit's director of care management.