Integrated health care

Health-care reform may be slow-moving on the national level, but it’s poised to happen locally inside the walls of Greater Regional Medical Center.

Beginning Jan. 1, 2010, Creston Medical Clinic’s four family physicians, physician’s assistant, two general surgeons, nurses and many of the remaining staff members will become Greater Regional employees.

While Creston Medical Clinic will remain its own separate entity, the move will solidify the relationship between physicians and the medical center and put both the clinic and Greater Regional ahead of future changes in the medical field.

“We’ve been looking at this for years,” said Dr. James Mansour. “This is just the culmination of it.”

Benefits

The integration will help Creston Medical Clinic recruit physicians, and current physicians’ work will be competitive when it comes to Medicare and Medicaid reimbursements.

“The clinic and all individual private practitioners cannot compete against the United States federal government,” said Mike Brentnall, Creston Medical Clinic administrator.

Because the federal government recognizes critical access medical centers like Greater Regional incur higher operating costs, Greater Regional will be reimbursed 15 percent more than the clinic would get for many of the costs relating to Medicare and Medicaid patients after the integration.

Greater Regional Clinic Services Director Brian Schon believes this is important in a state that reimburses private physicians at a low level already.

“Physicians are already at the low-end of the totem pole in Iowa,” Schon explained. “That makes it hard to sustain independent medical practices, to be able to recruit new people to rural Iowa.”

Schon said this move will also help attract new physicians to southwest Iowa because most of the state’s physicians work in medical centers or hospitals. Greater Regional has the ability to pay physician’s debts after residency over a period of time, and be reimbursed for the costs.

Looking at the big picture, Mansour said this is the way health care is moving in the United States, adding it will reduce costs to be part of a larger team.

“The future of medicine is integrated health-care delivery,” he said. “It is not the private physician in his office. That is not the future of medicine in the United States, and particularly in rural America. If we are going to survive and provide health care for people, we have to be integrated.”

Patients

After the integration, Creston Medical Clinic patients should not notice much of a change, according to Schon.

“If we do this right, they’re not going to see a thing different,” Schon said. “This ought to be very smooth.”

The clinic will remain in its current location inside Greater Regional, and most of the staff will be the same. Some positions already filled by Greater Regional employees may be cut.

“Part of my job is to sort that out over the coming weeks,” said Schon. “There may be a few positions that don’t make that transition ... that is not the intent of this integration, to reduce the workforce.”

Schon expects patient costs to remain the same.

Another positive is patients can get all their medical work done in one location. The plan is for Greater Regional and Creston Medical Clinic to make joint decisions regarding what health-care plans will be accepted.

“I don’t think there’s going to be a lot of significant changes simply because the hospital is now involved,” said Schon.

Looking ahead, Mansour, Brentnall and Schon agree the integration will allow both the clinic and Greater Regional to remain viable in what could be a changing medical world.

“How does a practice of medicine in southwest Iowa continue through Creston? It has to be through a hospital,” said Brentnall.