San Diego Business Journal

Several organizations on the San Diego Business Journal’s Medical Groups list are expanding as they grapple with issues from the uncertainties of health care reform, and limited Medicare and Medicaid reimbursements to the implementation of electronic medical records.

No. 1 on the list, Southern California Permanente Medical Group, comprised of Kaiser Permanente physicians, has 840 local physicians and takes care of more than 505,000 patients throughout San Diego County. All medical and surgical specialties including tertiary care are part of its group which provides care for members at 21 medical office buildings.

Dr. Paul Bernstein, area medical director for the San Diego Medical Service Area, said by email that Southern California Permanente Medical Group has grown by more than 20,000 patients in the last year and has hired more than 70 doctors, and just completed the opening of its new Garfield Specialty Center.

“We have broken ground for our new outpatient surgery center in San Marcos and will soon break ground for our new Medical Office Building and Women’s Center in Carmel Valley,” Bernstein said.

For the Records System

While Bernstein says some of the biggest challenges in the industry are the uncertainties of health care reform and the continued decrease in Medicare, Medicaid and Medi-Cal funding, he lauds the use of the group’s advanced electronic medical records system, known as KP Health Connect. He says that the system allows the patient’s information and treatment plan to be available to all of the treating physicians in the hospital, in the office by the patient’s primary care doctor and by any of the specialists.

“Diagnostic imaging tests (such as CT scans and MRIs) and lab studies are immediately available for viewing,” Bernstein said. “All of the patients’ medications are also closely coordinated this way to minimize the chance for errors. This is important in providing the highest quality coordinated care.”

He says that a focus on health and preventive care sets the medical group apart from other fee-based groups.

UC San Diego Health System, listed at No. 4 on the Medical Groups list with 358 local physicians, is organized around its clinical care, teaching and research missions.

Tom McAfee, president of the UCSD medical group, said its group is comprised of about 700 doctors. However, they dedicate a portion of their time to research, teaching and training medical students and residents so the group has the equivalent of 350 to 400 full-time clinical care physicians. Of those, he estimates 10 percent are primary care physicians and the rest of the doctors deliver a broad range of specialty services such as orthopedics, cardiology, oncology and radiology.

McAfee agrees that one of the biggest challenges faced by health care providers is compensation issues such as declining reimbursements and caring for uninsured patients.

“Medicare reimbursements are not increasing and they’re threatened to decrease each year,” he said. “Medi-Cal reimbursement in California is the second lowest in the U.S. It doesn’t cover the overhead expense of caring for patients. Fifty percent of our patients don’t generate enough revenue to cover the cost of care.”

Investing in electronic medical records is also a challenge. Although McAfee says its EPIC system brings office efficiencies, allows patients access to medical records and improves their communication with doctors, it’s an expensive undertaking.

“The cost of converting over, even with incentives the government is providing, is almost cost prohibitive,” he said.

Meanwhile, McAfee says UC San Diego Health System is growing its clinical operations, and is moving forward on its plans to open the Jacobs Medical Center a 10-story, 509,500-square-foot facility adjacent to UC San Diego Health System’s Thornton Hospital. Construction is scheduled to get under way in early 2012 and be completed in June 2016, with an opening set for December 2016. The Jacobs Medical Center will add 245 patient beds within three new specialty hospitals: the Hospital for Cancer Care, the Hospital for Women and Infants, and the Hospital for Advanced Surgery.

Ranked No. 2 on the list is Scripps Clinic Medical Group, a California professional corporation comprised of 451 physicians practicing in more than 40 medical and surgical specialties at 11 locations serving San Diego County and the region.

Coordinating Efforts

According to a Scripps spokesperson, in July 2000, Scripps Clinic entered into a long-term relationship with Scripps Health, a nonprofit public benefit corporation, to provide medical care to patients of Scripps Clinic and Scripps Green Hospital. The efforts of the 451 physicians as well as nursing and support staff are coordinated through an Executive Management Team comprised of medical group leadership and senior administration from Scripps Clinic and Scripps Green Hospital.

Dr. Robert Sarnoff, president of Scripps Medical Group, says the medical group will rise to the challenges facing the health care industry.

“A challenge facing us, and others in the health care industry, is achieving the highest quality and most cost-effective outcomes for patients,” Sarnoff said. “That’s especially true in light of health care reform. We will do what it takes to meet this challenge.”