North Shore Hematology Oncology has found a niche for itself by focusing on ways in which it can compete against local giants.
Jeff Vacirca, MD
All independent medical practices face much larger competitors these days, and among them is North Shore Hematology Oncology Associates of East Setauket, New York. The 22-physician organization must duke it out with 9 separate hospitals. It also must convince patients to choose it over such prestigious institutions as New York University Langone and Memorial Sloan Kettering.
All of those competitors have many advantages over North Shore: larger facilities, more specialists, fancier equipment, broader name recognition, and a greater ability to negotiate with payers. Yet North Shore has found a niche for itself by focusing on ways in which it can compete.
“Huge practices have huge offices, often located inside huge hospitals, which strike many patients as impersonal and confusing and bureaucratic,” says Jeff Vacirca, MD, who joined North Shore 12 years ago and became its CEO 5 years later.
“Our offices mostly measure a few thousand square feet. You enter a few steps from where you park and you get your treatment a few steps from where you enter. There’s no question about where to go, and everyone knows you when you walk in because you’re not one of 5000 patients.” says Vacirca.
Through its many small offices, North Shore has the strategic advantage of location. The practice will soon have 11 outposts, dotted all over its coverage area, so most potential patients in that market are no more than a short drive away from the nearest office. Institutional competitors, on the other hand, operate large regional offices, so many of their potential patients are 15 or 20 miles away. That might not seem like a huge distance to readers in much of the country, but Vacirca reports that such drives can take an hour or more in his crowded corner of Long Island.
“An hour there and an hour back, fighting Long Island’s traffic all the while, is a chore for anyone, but it’s a huge burden to undertake for a very sick person made weak by chemotherapy, particularly when the reward for that effort is exactly the same treatment they would have received closer to home and, most likely, an inferior level of patient care,” said Vacirca.
“The biggest challenge that small practices have to fight is the perception that the mega-health conglomerates offer superior treatment, but now that patients have access to the Internet, that’s pretty easy to do,” Vacirca said. “They can see for themselves that there’s a standard of care for every cancer diagnosis, so we are going to provide them the exact same treatment protocol they’d get from Memorial Sloan Kettering. Writing an order for chemotherapy is not the hard part. The thing that separates caregivers is the level of support they provide to help patients when the chemotherapy is making them feel terrible.
Independent practices obviously have less to spend on marketing than regional health conglomerates, but North Shore gets the word out by participating in a wide range of community events that emphasize its local roots. It supplements such efforts with a variety of traditional advertising.
“We use a mix of newspaper, radio and local cable advertising to let everyone know that we’re here, providing care that’s comparable to any place in Manhattan let alone any place on Long Island,” said Nicole Gregory, who oversees both the marketing and patient advocacy efforts at North Shore.
“We also launched a significant social media presence a couple of months ago, and we have found that to be a great way not only to get the word out about our practice but also to increase our engagement with existing patients,” said Gregory, whose weekends often illustrate the effort that community engagement can entail. She spent the Saturday before her interview at North Shore’s annual Patient Appreciation Day and the Sunday running a Tough Mudder race with dozens of colleagues to raise money to help cancer patients with financial hardships.
All small practices try to emphasize the personal touch to gain some competitive advantage over major medical groups, but North Shore decided 5 years ago that the key to its success lay in improving customer care in a wide variety of ways designed to improve patient satisfaction as well as patient health.
North Shore committed itself to seeing all patients who call for an initial consultation within 48 hours, to keeping no patient in the waiting room more than 15 minutes beyond a scheduled appointment time, to letting patients walk in whenever they feel sick, to seeing those walk-in patients promptly, to opening its largest office 365 days a year, and to having a staff physician speak to every patient who calls outside of office hours.
The first 2 commitments provide little, if any, medical benefit to patients. People are rarely so sick that a 2-week delay hinders treatment and never so sick that an hour in the waiting room spells their doom. That said, both commitments have helped North Shore attract and retain business. The prospect of waiting 1 or 2 weeks to get complete information about a tentative cancer diagnosis adds to patient anxiety, and the prospect of routinely waiting 30 or 40 minutes beyond appointed times can be aggravating.
The rest of those commitments improve both patient satisfaction and patient health, and they reduce overall healthcare costs as well. Practices that make it hard for patients who feel lousy to get care effectively send those patients to the emergency department (ED), and 70% of cancer patients who seek emergency care get admitted to the hospital. North Shore’s walk-in policy and its 7-day service reduces the need for the ED, as does its policy for off-hours calls.
Patient Visits Versus Hospital Stays
“Now that our physicians can pull up patient records anywhere, they can diagnose many problems over the phone. Rather than having to send all patients to the ED as a precautionary measure, they can correctly reassure most patients that it’s safe to wait till morning,” said Vacirca. “That saves our patients a lot of trips to the hospital and increases their quality of life. It’s hard to describe just how much patients prefer an office visit and home rest over a 2-day stay in the hospital.”
It’s also hard to describe how much less an office visit costs, both for patients themselves and the organizations that insure them. North Shore doesn’t share in any of those cost savings just yet, but the practice is interested in experimenting with payment models such as the oncology medical home, which reward caregivers that produce good outcomes at relatively low costs.
Such ambitions would be difficult without robust computer software designed to do everything from managing records to automating billing to preventing errors. Vacirca finds computers to be more cumbersome than paper, but he actually showers praise upon his software. Indeed, he believes that good software reduces the relative advantages that large practices have over small ones by allowing the tiniest practices to do all sorts of sophisticated things that once required extensive manpower.
The biggest single advantage may be that his software automatically tracks cancer trials that are enrolling patients and tells North Shore physicians which patients appear eligible for which trials. Determining trial eligibility and placing patients in trials used to be very labor intensive. In many cases, it required a research department. Now, according to Vacirca, independent practices can match the access to novel treatments that major research institutions provide, and that negates what may have been their biggest real advantage.
The other change that allows North Shore to compete more directly with major cancer centers is its increasing size. North Shore remains tiny compared with the Goliaths of the industry, but it has grown from 12 physicians to 22 since Vacirca became its CEO. Looking forward, Vacirca believes that the addition of a few more doctors—most likely through mergers with other independent practices—will allow North Shore to offer more to patients without sacrificing any of the benefits that come with being an independent practice.
“We are already a full-service practice. We have 19 medical oncologists, 3 radiation oncologists and a CyberKnife that allows us to perform many operations in-house. We treat every type of cancer with the full gamut of therapeutics,” Vacirca said. “Nevertheless, if we find that the right practices wish to join our group, we’d definitely be interested in getting even better coverage of our service area and acquiring expertise in particular areas, and, in turn, we can offer those practices the advantages of some size in combination with considerable ongoing autonomy.”