In This Section      
 

Expanding the Circle of Excellence: A Conversation with Paul Scheel

See more in:

Expanding the Circle of Excellence: A Conversation with Paul Scheel

Expanding the Circle of Excellence: A Conversation with Paul Scheel

Date: 11/30/2015

Paul Scheel is vice president for transformation for the Office of Johns Hopkins Physicians and also serves as the director of the Division of Nephrology at The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center. He recently spoke with BestPractice editor Christina DuVernay about new employment models that allow Johns Hopkins Medicine to hire more physicians and expand its network of care.

I understand that Johns Hopkins Medicine is seeking to expand its network of affiliated physicians. What does this mean, and why are we doing it?

We are looking for high-quality doctors, both primary care providers and specialists, to affiliate with us.

We are doing this for three reasons: Johns Hopkins HealthCare needs adequate numbers of high-quality doctors to be part of its provider network throughout the state of Maryland. Our community hospitals need groups of physicians to care for people in the community and admit them to our hospitals when necessary. Finally, our academic hospitals need relationships with physicians in Baltimore and beyond for tertiary and quaternary care referrals.

What are you doing to attract these physicians?

We hired the management consulting firm Kaufman Hall to ask physicians in the community: “If you had to partner with someone, what would that look like?”

The physicians wanted a partnership, yet also some autonomy. We created a model in response to their answers.

What did you come up with?

We call it a net collections model. Johns Hopkins purchases the hard assets at the physician practice. The physicians in the practice become our employees. But we allow them to manage their practice as they always have, with oversight by a Johns Hopkins board. They also manage their own books. A percentage of their income goes to the academic department with which they are affiliated.

These agreements cover a fixed time span. However, the physicians can walk away at any time as long as they buy back their equipment and other fixed assets. One caveat is that they cannot join another health system for two years.

Our goal is to make it so they do not want to leave us.

What is the draw for the physicians? Why are they signing up for this?

Physicians in practice realize that reimbursement is changing. We are moving away from fee-for-service to more of a population health model. Quality physicians want to be part of a quality organization that places a strong emphasis on patient outcomes.

Will the model of private practice even exist five years from now? Nationally, there is a trend toward the employed-physician model, which is in our favor. We are able to choose very high-quality physicians for our insurance products, our community hospitals get the physicians they want, The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center get physicians to refer them their tertiary and quaternary cases, and our community physicians can continue to deliver the high-quality care they are accustomed to delivering.

Expanding the Circle of Excellence: A Conversation with Paul Scheel Farewell, Heads in Beds
For a century or so, the prevailing business model for most hospitals was to keep the hospital full.