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EMA » News » EMA/St. Vincent's Partnership Featured in Crain's New York Business
EMA/St. Vincent's Partnership Featured in Crain's New York BusinessDate: September 29, 2004Crain's New York Business, the leading business publication in New York City, recently reported on the EMA/St. Vincent's partnership. Following is the full text of the article, which appeared in the September 27 - October 3, 2004 issue.
Jersey doctors enter NY ERBeleaguered St. Vincent's Hospital turns to outsourcing; veteran staffers ousted As Dr. Michael Gerardi sees it, New York hospitals' emergency departments have badly lost their way, and he's the pilot who can guide them back to their moorings. Starting Nov. 1, he'll have his opportunity to do just that. In the first such case involving a large hospital here, financially troubled Saint Vincent Catholic Medical Centers is outsourcing the operations of one of its emergency departments. The system is turning over medical care and billing at its flagship emergency room at St. Vincent's Hospital Manhattan to Emergency Medical Associates of Livingston, N.J. "St. Vincent's has great prestige, but the system is under fire," says Dr. Gerardi, an EMA vice president and practicing ER physician. "We're not carpetbaggers. We just want to run it properly." Under the contract, Dr. Gerardi's company will bring in a crew of New Jersey doctors to replace most of the current staff of 16 physicians headed by Dr. Eduardo Gonzalez and Dr. Richard Westfal, respected veterans who have more than 25 years at St. Vincent's. Any St. Vincent's doctors who do remain will have to be rehired by EMA. Neither the company nor the hospital would comment on the details of the contract, including its length, but the logic behind the step is clear. It hinges on hopes for cost savings, revenue increases and an enhanced ability to attract new patients. Switching staff For starters, the EMA contract will save the hospital the cost of paying Dr. Gonzalez and Dr. Westfal, who likely earn more than $250,000 each, based on national averages. St. Vincent's may also save on malpractice insurance, since EMA, like most practice management companies, is self-insured. The biggest near-term financial gains, though, will probably come from EMA's ability to deliver the maximum reimbursement from third-party payers, including Medicare and Medicaid. EMA will also try to generate more business by making emergency room visits as patient-friendly as possible, training staffers to treat patients like customers, and carefully tracking wait times. In the longer term, the hope is to increase hospital admissions. "A compact, well-organized turnkey system can improve services and revenue," says Donald Malafronte, a Roseland, N.J.-based hospital consultant. "I imagine New York's other hospitals will be watching this closely to see if it works." Beyond New York, the outsourcing of management and staffing of medical departments has been commonplace for years. EMA itself has contracts with 17 hospitals, most of them in New Jersey. New York remains the exception. "Most hospitals want to run their own ERs," Mr. Malafronte says. "New York's mega-institutions are more concerned with teaching, and they want direct control of their emergency departments." Outsourcing has also generated controversy. "Some emergency medicine doctors treat people who work for these companies as pariahs, and see the companies as enslaving physicians," says Dr. John Milne, who tracks the outsourcing controversy for the American College of Emergency Physicians. "I don't see them as the Evil Empire, but they have a reputation for cutting salaries and hiring less-qualified doctors." Certainly the change is a bitter pill for the longtime staff at St. Vincent's. "There's always room for improvement in things like patient registration and getting tests back quickly, but I feel our doctors have done as good a job as anyone possibly could," says Dr. Westfal. Still, the situation at St. Vincent's had grown so dire that the decision to hire EMA was among the first made by a turnaround team from Speltz & Weis. The consultants were brought in last year after a long string of losses at the hospital system. Stanching system losses that are projected to climb to $74 million this year means attracting new patients-especially those with insurance-and collecting as much as possible from third-party payers. Since 60% of St. Vincent's admissions come through the doors of the hospital's ER, that was the logical place to target for improvement. Too late now "We had actually started to look at the emergency department before the takeover (by the consultants)," says Will Grice, SVCMC's vice president for operations. Now, finding a new course will be up to Dr. Gerardi and company. He has already vowed to use EMA's 25 years of experience to help make the department more efficient and increase the number of patients seen, while continuing to meet the hospital's standards for high-quality care. "In New York's emergency departments, people wait hours to be seen," says Dr. Gerardi. "At EMA, we've got that down to an hour and a half." He also hopes to make the hospital more attractive to commuters who work downtown but go home to New Jersey or Connecticut when they need medical care. "People can get the most mundane thing treated, like a sore throat, and then come back when they need something major," he says.
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