“It was a busy day, and a long day.”
That’s how physician Danny Perry, MD, describes a typical day after he opened his family medicine practice in Timberville in 1977.
“I was in solo practice,” says Dr. Perry, who came to Virginia from Texas. “I borrowed money to build the building I worked in, so I was in debt. I was also some 14 or 15 miles from the hospital. I’d get up at 5 a.m. every morning, go to the hospital and make rounds, and be back at the office by 8:30 or 9, where I’d see patients all day.”
Evenings could be just as busy, as he was often called back to the hospital to see emergency room patients and new hospital admissions.
“I was either stupid or naive for starting a practice by myself that far away from the hospital, and for borrowing the money to do it,” he says with a laugh. “But I guess that’s the way it had always been with doctors, especially in rural areas. My wife, who grew up here in the Valley, used to tell me about how Dr. Asa Graves over in Lacey Springs would go to the hospital, make rounds, deliver babies and do all sorts of procedures, and then go back to his office and see people, sometimes until midnight—and that was pretty typical.”
It wasn’t just patient care that kept doctors occupied—there was also the business side of running a private practice.
“When I went into practice in 1988, I opened my own shop, with little business training,” says OB-GYN physician Edward Sandy, MD, MBA. “Like most other physicians then, I was successful not so much because the business was easy, but because the regulatory and payment environment wasn’t as complex and adversarial as it is today. I could deal with the ‘business’ of the practice in one afternoon, and the rest of my time would be devoted to my patients.”
Fast-forward 30 or 40 years, and today’s healthcare providers still have long, busy days. But in many ways, when Dr. Perry and Dr. Sandy started their practices, it was a simpler time to be in the industry. During the past three or four decades, medical science has seen an explosion of new knowledge and technology, as well as the division of many medical specialties into multiple subspecialties.
Likewise, the business side of providing health care—of running an individual practice, a group practice or even a hospital—has grown in complexity, prompting individual physicians, physician groups and hospitals to join forces in order to more easily handle the additional challenges.
Originally from Timberville, Dr. Sandy returned to the Valley two years ago after a career in Pittsburgh, where he served as associate professor and vice chair of obstetrics and gynecology at the University of Pittsburgh. He came back to serve as president of the Sentara RMH Medical Group (SRMG), an entity that began in 2010 in large measure as a response to the increasing complexity in the healthcare industry. Dr. Sandy and his colleagues are very interested in helping the local community understand just what the purpose of the SRMG is.
Keeping the Focus on Patients
One major purpose behind the SRMG is “to help physicians focus more on the business of medicine, and less on the business of business,” explains Philip Hackett, the group’s executive director. “We help take some of the administrative burdens off of the doctors, allowing them to focus on the profession for which they trained.”
The SRMG accomplishes this by purchasing medical practice assets and employing office staff as part of its team. One example is the former Springbrook Family Medicine practice in Broadway, which became part of the SRMG in 2011. More recently, Springbrook joined the Sentara Timber Way Health Center, which opened in 2016 in the Broadway-Timberville area. Dr. Perry’s former practice also has become part of Sentara Timber Way. In many cases, as with Springbrook, the physicians and office staff also become employees of the SRMG. In others, the physicians remain independent.
In 2016, the practice of Harrisonburg Medical Associates (HMA), located on Evelyn Byrd Avenue in Harrisonburg, joined the SRMG as Sentara Evelyn Byrd Health Center. In this case the physicians remained independent, while the office staff and nurses transitioned to the SRMG, followed by the cardiology providers with HMA, who transitioned to the SRMG in fall 2017.
“This is a development that started some years ago, when doctors began realizing they didn’t have the time or expertise to negotiate with insurance companies and keep up with all the federal and state laws and mandates that keep coming out,” says Dr. Perry, who came out of retirement recently to see patients several days a week at Sentara Luray Health Center, another SRMG family medicine practice. “Most physicians just don’t have the time to stay on top of all of that.”
Dr. Sandy likes to make the same point when he meets new doctors who are considering a career with the SRMG.
“I tell them they don’t have to be concerned with things like making payroll, which was something I worried about when I was in private practice,” he says. “I tell them: ‘You and your staff are going to be paid, the bills are going to be paid, and the lights are going to stay on. You don’t have to worry about any of that—your only concern is to practice the best medicine that you can.’”
Improving Access to Medical Care in the Community
When family physician Mark Mast, MD, first entered private practice in 2001, he joined the staff of Springbrook Family Medicine. Today he is employed by the SRMG and works at Sentara Timber Way Health Center.
“Going with the Medical Group, as we did at Springbrook, definitely has had advantages,” he says. “Before that, when my partner and I were expanding our practice at Springbrook, there were certain extra services we had to minimize because we didn’t have the capital to offer everything we wanted—we didn’t have a large group behind us supporting us financially.”
For instance, Springbrook would have liked to offer vaccines for Medicaid patients because of the large population of those patients in the Broadway service area. But the extra staffing that would have been required to offer the vaccinations, and the extra overhead to offer certain other vaccines for children, were too much to take on for a group of two physicians.
“That balance of wanting to serve an underserved area, but not having the resources to do so, was a personal struggle for us,” Dr. Mast recalls. “Once Springbrook transitioned to the Medical Group, we could get all the vaccines we needed for Medicaid patients out here.”
The SRMG also has brought additional medical resources like X-ray, lab and therapy services to Timber Way, to Sentara East Rockingham Health Center in Elkton and to the new primary care practice being built in Bridgewater in partnership with Carilion.
Having X-ray, lab and therapy services in a primary care practice is very convenient for both patients and healthcare providers, according to Dr. Mast. “It’s especially helpful for people with limited access to transportation,” he notes. “We don’t have to send them into Harrisonburg just to get a chest X-ray—they can get it done right here during the same appointment.”
Hospitalists a Key Part of Efficient Health Care
In addition to those SRMG providers in both primary and specialty care who work in outpatient settings, the SRMG also includes physicians, called hospitalists, whose practice is based solely within the hospital. With the rise of this new hospital-based medical specialty several decades ago, some patients wondered why their doctors were no longer attending to patients in the hospital.
However, the issue wasn’t that hospitals were barring outpatient physicians from seeing their patients when they were admitted to the hospital. Instead, over the past two decades, more and more doctors have been willing to turn over care of their hospitalized patients to hospitalists for practical reasons, such as time constraints and the increasing specialization in all areas of medicine, including hospital-based care.
“The breadth and depth of medical knowledge has increased exponentially,” says Dr. Sandy. “Many hospital-based interventions that we do today to care for inpatients have become so complex that no one person can know it all. I think most outpatient clinicians would agree that it’s better for everyone if they focus on their office practice, providing patient care there, and leave the hospital-based care in the hands of those who are dedicated to doing just that.”
It’s certainly a more efficient process in general, saving physicians—especially those in outlying areas like Timberville, Mount Jackson and Luray—from having to come to the hospital, according to Dr. Perry. “The hospitalist model has really freed up the physicians who rely on them,” he says.
One Electronic Medical Record System
All SRMG providers share Epic, the electronic medical record system used in the hospital and throughout the entire Sentara system. For Dr. Mast, sharing Epic has been one of the chief advantages of joining the SRMG.
“Epic makes continuity of care much easier,” notes Dr. Mast. “There are many times when a patient I’m seeing doesn’t really understand what the specialist has done, or doesn’t remember all the details of what another doctor may have told them. But now I can instantly see everything that another provider who uses Epic has ordered, as well as all their discharge instructions and notes, because we all share one common medical record.”
Hackett notes that Epic has resulted in enhanced delivery of care, due to the ease of sharing information among providers.
“I don’t want to imply that you have to see a physician who is using Epic if you want to receive excellent care,” says Hackett. “We still have many independent doctors in our area who are also providing excellent care and who collaborate very effectively with providers in the Medical Group. But there’s also no question that Epic has enhanced our physicians’ ability to collaborate on patient care.”
A Great Team Looking to the Future
The four medical groups within the Sentara Healthcare system, including the SRMG, all collaborate regularly, sharing best practices and seeking new ways to improve the patient experience and patient outcomes. As health care continues to evolve in the years ahead, these groups will develop and adapt accordingly.
“There’s no question that where we are today is nowhere close to where we want to be in a year or two,” says Dr. Sandy. “Maybe we will be using telemedicine more by then, or perhaps we’ll have some of our specialists providing care several days a week at outlying practices. And wouldn’t it be great if patients could open the Sentara app on their smartphones and get an appointment with their doctor—or even a virtual visit, without an appointment at all?”
In fact, Sentara already has such an app for its Hampton Roads practices, and Dr. Sandy foresees that same technology becoming available in the near future for patients of the SRMG.
“We’re evaluating, questioning current paradigms and looking at new ideas all the time,” Dr. Sandy says. “Improving the patient experience and enhancing access—that’s the focus of the entire organization. We want to continue having the right care with the right providers in the right places. And as health care changes, so will our models of providing care.”
SRMG leaders speak highly of their team.
“I’ve been to a lot of places and worked with many hundreds of doctors and other providers,” says Hackett, “but I believe here we have the best team of providers I’ve ever seen. Their commitment and talent are exceptional, and all of our clinical scores reflect that.”
Dr. Sandy concurs. “We have very talented providers, and we offer a full range of services for a 238-bed hospital,” he says. “We have staff and management in the Medical Group who are very committed to the Sentara mission of improving health every day, and I’m proud of them all.”