Many health systems are aggressively acquiring physician practices, but there may be an I.T.-driven alternative to a spending spree, according to Gaurov Dayal, M.D. In a talk at HIMSS12, Dayal outlined the “alignment without acquisition” strategy underway at Adventist Health Care, a Rockville, Md.-based delivery system of five hospitals where Dayal serves as chief medical officer.

Dayal points out that previous waves of physician practice acquisitions—most notably in the early 1990s—backfired when physician productivity dropped. By aligning with group practices, rather than owning them outright, Adventist hopes to avoid such pitfalls. “We don’t limit physician independence,” he says. “And you can’t hire all the physicians you need.”

So rather than purchasing practices, Adventist is subsidizing the purchase of an ambulatory EHR for them by capitalizing on the relaxation of Stark rules, which once prohibited such a strategy because of anti-competition issues.

The health system foots the bill for almost half the cost of the EHR, Dayal says. It has signed up about 200 physicians in the program, with most opting to purchase a system from eClinicalWorks. With some 2,000 physicians affiliated to Adventist, it is a large pool of potential users. Because of that, Adventist was able to negotiate favorable pricing from the vendors.

Adventist is looking to strengthen ties with physicians because of looming changes in reimbursement models. One goal will be reduced readmission rates, an effort Dayal says depends on better follow-up care and improved data sharing between the hospitals and the physicians. Adventist is preparing to launch a health information exchange, which will connect the practices to the hospitals’ inpatient system, from Cerner, push out lab and radiology results, and also link to a broader statewide information exchange under development. Standardized order sets will also figure in improved care, he adds.


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