A Merger in Maine
One year ago, no one knew what would happen when two large cardiology practices in Maine, each with three geographically diverse offices, merged with an integrated healthcare system. As state regulation restricted advance preparation, there was little time for planning following approval of the merger. Both practices were faced with declining reimbursement and potential staffing reductions. Despite these challenges, all of the physicians and staff arrived at their place of work on Feb. 1, 2012, and became part of a larger integrated organization.
Overnight—or so it seemed—the physicians and staff faced many changes including new roles, new responsibilities, an EHR conversion, changes in clinical protocols and new leadership to name a few. Maine Cardiology Associates and Cardiovascular Consultants of Maine, in all of their locations, became Maine Medical Partners MaineHealth Cardiology. One year later, MaineHealth Cardiology sets its sight high with a vision of becoming the cardiovascular leader in Northern New England.
Our success was achieved by creating a shared vision and by setting clear goals, both strategic and tactical. From the first day, we enlisted physician and administrative support to lead the cause and we involved the entire staff to create a continuous cycle of improvement. We believed that if we built a solid foundation and infrastructure, the rest would fall into place. And fortunately, we were right.
Challenges of the Merger
We needed to develop a new identity after the integration with a larger health system. We developed a new governance structure, along with a vision, mission, core operating set of values, steps for success and a business plan. All of our decisions were built around the framework of “putting the patient first”—and all decisions were determined around patient care. There was a significant amount of work to accomplish and the governance structure and vision/mission guided us through the rough spots.
Changing from a private practice to a hospital setting affected everyone, including staff and physicians. The staff experienced an enormous amount of change—from systems to workflow. There is no doubt that change can be disruptive, but in our case, change was met with enthusiasm and engagement. We invested a significant amount of time and resources to provide additional staff training and included employees in decision-making related to patient care and service. We also added several new positions to the practice including: quality improvement specialist, care transition nurse, clinical manager, nuclear lead (technologist), echo lead (sonographer) and vascular lead (sonographer).
Physicians faced an enormous challenge because we too had to create a new identity. In private practice, we were the business owners, decision makers and primary providers of direct patient care. The merger changed all of that. We no longer had to manage the day-to-day operation of the practice and the results have been positive. The integration has allowed physicians to focus on what we do best—provide high-quality patient care. And now as part of a larger health system, we are able to make capital investments in clinical equipment, program development, patient education and expanded services in previously underserved communities. All of this has been a positive result for our patients, staff and physicians.
For our patients, the objective was to have the integration as seamless as possible. We managed to improve new patient access to a cardiologist in some offices by as much as 67 percent. New IT systems, such as an electronic health record, allowed us to provide patients with a higher level of service— routing prescriptions directly to a pharmacy, for example. We interfaced and standardized everything, which has provided greater efficiency and responsiveness to our patients. We also implemented and planned new services, which allowed us to add physician resources to those communities that need it most. Patients still have access to their same cardiologist at the same location. We also invested in cross-training our staff, which allows us to bring additional resources to meet patient demand. Staff who previously worked in a single office may need to travel to our other office locations, but this allows us to place staff where we need them most.
Unexpected Benefits
The hospital also has been able to make technology investments, including converting to an electronic health record, adding cardiac PET imaging, acquiring radiation reduction software for all SPECT cameras and automated nuclear medicine dosing software, as well as participating in a pilot across the U.S. for imaging appropriate use (Medicare imaging demonstration).
Even billing has improved. We treat all patients regardless of their ability to pay; patients have access to beneficial programs through the larger health system, including access to medication and financial assistance. And now we can provide patients in more rural areas with greater access to clinical subspecialists—especially in the area of vascular medicine and electrophysiology.
The unexpected challenges came in the form of the amount and depth of change. But by keeping our focus on patients, we were able to create the necessary infrastructure needed for success. We didn’t have the luxury of time, but due to everyone’s commitment and determination, we were able to transform separate entities into one cohesive practice. Communication was the key. We are not done—through a continuous cycle of improvement we have made great strides and are looking forward to achieving so much more.
Dr. Cohen is the past president of the American Society of Nuclear Cardiology, and Cheryl Lombard is the director of cardiovascular practice operations.