SPK: Women’s Health Care Group of Pennsylvania is a single specialty limited liability corporation comprised of 15 different practices (divisions) and 46 physicians who are all ob/gyns and work at six different hospitals: Lankenau, Bryn Mawr, Paoli, Riddle, Phoenixville and Pottstown. Among the 46 doctors, we have five maternal fetal medicine specialists and three reproductive endocrine/infertility physicians. We have offices in over 20 different sites, a governing board, an executive administrator and approximately 250 employees. About a third of our physicians came from either the Jefferson Health System or the Penn Health System – the doctors were employed by those systems from where they transitioned to form this group. We have integrated many back office functions such as one common billing system, benefits plan, payroll process and retirement plan for all our employees. We have a risk management committee, a quality committee, a coding and compliance committee and we’re in the midst of developing clinical pathways to pursue the most economical, safe and efficient ways to treat and diagnose common problems in obstetrics and gynecology.

SPK: Some may have administrative functions in other entities, but nobody in the group has any medical practices outside of the group – their clinical responsibilities are all full-time at WHCGPA.

SPK: Because many ob/gyns were leaving Pennsylvania, we noticed there was becoming a real shortage of obstetricians in our area. We also found it was very hard to recruit new physicians out of training to this area – largely due to the malpractice crisis that we’re facing. We felt there had to be a way for physicians to form a group to capitalize on economies of scale such as purchasing malpractice insurance at a more reasonable rate to make our area more attractive for ob/gyns to stay in practice. We also felt that physicians were obligated to provide better quality care and to reduce medical errors. The planning phase took 18 months and we went live on January 1, 2005.

We already have many accomplishments, foremost we have been able to retain our physicians and add new physicians. When we first started we were at 39 physicians and we will have 48 members by the end of the summer. We’re determined to improve patients’ access to care, quality and efficiency through protocols that we’re developing. Another major goal is risk reduction. We have a liability committee with the objective to identify common reasons why ob/gyns are involved in litigation and to develop safer protocols to reduce these risks. Should less than optimal outcomes present, they will be reviewed by our committee and the care rendered will be analyzed to determine if opportunities exist for improvement. Physicians involved will be informed and their performance will be monitored carefully.

SPK: Of the 46, approximately 39 are doing deliveries.

SPK: Some of our high risk specialists that had stopped doing deliveries are now doing them again. We do about 6,000 deliveries a year.

SPK: Yes, one of our physicians has a satellite office in center city. I don’t know whether we will evolve towards Philadelphia, but in its initial formation, our group was made of select suburban doctors who knew each other and were familiar with each others’ practice capabilities.

SPK: This is currently under consideration by our board. As divisions find they need additional physicians, we encourage their growth. In terms of new divisions, if we see a group that may add new services or add value to our membership, we would consider that – specifically, urogynecology or gynecologic oncology. We already have physicians in the two subspecialties: infertility and high risk pregnancy.

SPK: Yes, we have a billing committee that works closely with all of our payors and we do credentialing for each of our physicians.

SPK: We’re able to look at risk management and quality parameters by collecting data across all our divisions. We are also trying to make more efficient use of the health care dollar. We’ve been able to purchase malpractice insurance as a group and look into partnering with our malpractice company in some creative ways. We have efficiencies in supply and medical equipment purchasing as well as employee benefits. We are also in the process of opening ancillary centers for women’s health care – our first center is scheduled to open early October in Oaks, Pa. Currently there are patients from the Pottstown Hospital area who are driving long distances to obtain perinatal consultations – up to 20 miles or more each way. We’re improving access to care for those patients with our center in Oaks where we will do high-risk consultation, genetic counseling, pregnancy ultrasounds and DEXA scans for diagnosis of osteoporosis. Also we’re going to have our fertility specialists offer services in the center as well as other complementary women’s services still to be determined – for example, a weight loss program and a urinary stress incontinence center. Our corporate office will be there as well.

SPK: Since we began operations only seven months ago, we have been very busy getting organized and have not been able to draw any conclusions at this point. However, this is a major initiative for our entity and we have some ideas to develop. We are starting to work with some payors to look at parameters that would provide for more efficiency in spending health care dollars. We have contracts with all of the major payors and most of the smaller payors in this entire marketplace. They are group contracts and every physician in the group is a provider for that one fee schedule. Furthermore, we are developing a research program to help us maintain our leadership in delivering contemporary and cutting-edge medicine.

SPK: As a group, with some of the quality and risk parameters and efficiencies that we have, we are able to add more value for the payors. With one of the large payors in our marketplace we are developing a partnership for a pay-for-quality-type program. I’m unable to make any comments about our contracts but we believe we have established fair and reasonable arrangements with the payors in this marketplace.

SPK: From our inception, we have made every effort to become integrated while allowing a degree of operational autonomy at the divisions. These are not individual practices that just got together for the purpose of increased reimbursement – our mission has many more important reasons that guided our formation.

SPK: Yes there are, and that is something for which we did have legal consultation upon the formation of this group. As for thresholds – I don’t think anybody knows a particular number or percentage – everybody has a different idea about it. We did a demographics analysis and found that our entity employs about 8 BD percent of the obstetricians practicing in the five-county area: Philly, Bucks, Chester, Montgomery and Delaware counties.

SPK: We have partnered with a company called Pennsylvania Health Providers Insurance Exchange (PA HPIX), a licensed malpractice insurance provider in Pa. They were able to look at the claims experience of each of our members and develop some risk management programs with us thereby saving each physician about 20 percent compared to some other traditional carriers in our marketplace. In the future, we are hopeful that we will be able to reduce our premiums through deductibles and other risk sharing strategies that PA HPIX is offering to us. These would be ways in which physicians themselves can be at risk for part of the loss if there are payouts. The primary malpractice company would have less exposure and therefore the physicians would pay less premium. We will probably need two years of claims experience before we can pursue these strategies.

SPK: Our entity has given our divisions stability and therefore we can present a more attractive opportunity to a physician coming out of training. If there are more physicians in a division, each physician will have a more reasonable workload. We already have some divisions, working at the same hospital, that cross-cover each other and thereby decrease the on-call for each physician. We are hopeful that more divisions will do the same at other hospitals.

SPK: I don’t think so. Before joining WHCGPA, my particular practice was owned by the Jefferson Health System and we had a salary structure that was based on productivity. The salary model that we use at WHCGPA is the same in that respect and salaries are determined by productivity.