Evan Goldfischer, MD, MBA
It’s not uncommon for a business to use a superlative in its name, but Premier Medical Group in Poughkeepsie, NY, truly lives up to its moniker. The multispecialty practice has three divisions— gastroenterology (GI), urology/women’s health, and the recently added internal medicine—representing nearly a dozen specialties. It has 13 offices in six towns in the Hudson Valley area.
The practice’s goal is to become a “medical home,” according to Evan Goldfischer, MD, MBA, director of the research department for the practice and co-CEO (along with Sunil Kunhara, MD), by offering patient-centered, comprehensive, team-based, coordinated, accessible quality care.
Goldfischer, along with urologic oncologist Naeem Rahman, MD, discussed with Urologists in Cancer Care how the practice has grown and where it is headed.
The Power of the Pod
Nearly 5 years ago, the foundation for Premier was set when two practices—GI Associates and Hudson Valley Urology—merged, bringing 18 specialists together. “The thought at that point was that we could share resources: imaging equipment, pathology labs, etc,” Goldfischer explained. “By coming together, we could wield a lot more influence with contractors and hospitals.”
Indeed, the 29-physician practice is now affiliated with six hospitals in its area, including Vassar Brothers Medical Center, where Rahman is medical director of the robotics program.
But Premier’s leaders realized that more growth and expansion would be necessary to maintain a foothold in the rapidly shifting healthcare environment. Their first step was to invest in infrastructure, including adopting an electronic medical records system, implementing a protocol to maintain quality control, and establishing a marketing department, Goldfischer said.
The biggest change came in August 2013 when Premier merged with New Century Medical Associates, a 12-person internal medicine group (six MDs, six mid-level providers).
“We decided to take in primary-care doctors so that we would be able to firm up our referral sources,” Goldfischer said. “We are working toward becoming a medical home. We represent 11 specialties at this point: internal medicine, pediatrics, family medicine, urology, GI, pathology, anesthesiology, endocrinology, nephrology, pulmonology, and women’s health.”
The “pod model” that separates the specialties is the basis for Premier’s salary scale. Each specialty is an independent pod, and after each pays an overhead, it makes its own financial arrangements. “The urologists work with an equal share between partners; the GI group has some base salary with productivity bonuses; and the internal medicine group has a larger base salary with smaller productivity bonuses. Each group has figured out what works for them, and then all the pods are overseen by our financial department,” Goldfischer said.
What this pod model offers patients is “one-stop shopping,” with all their physicians located in a single practice. In addition, those physicians have access to all of a patient’s medical records, eliminating the problem of missed or conflicting healthcare information. Patients who visit Premier only for their urology care can also get much of what they need without going anywhere else, Goldfischer said. “Everybody can subspecialize. As a result, our providers are very good at what they do, so when a patient is referred for subspecialty treatment, whether it’s from a Premier primary-care physician or an outside provider, they can be assured that they’ll get the highest quality of care.”
But that doesn’t mean Premier views itself as completely insulated; in addition to building relationships with hospitals, the group has made it a point to establish strong relationships with other practices in its area. So for the practice’s urologic cancer patients who are referred to oncologists and radiation oncologists outside of Premier, the continuity of care is maintained.
“We’ve developed very strategic relationships with certain oncology and radiation oncology practices, and because of that, these groups are getting all of our business.” In turn, these cancer patients tend to come back to Premier for their post-treatment care, Goldfischer said.