CEO SUMMARY: When Ascension Wisconsin wanted one pathology group to serve its needs statewide, North Shore Pathologists responded to the request for proposal by focusing on how pathologists can improve patient care through a patient-centered model. Other pathology groups responded with proposals that emphasized the financial aspects of the relationship. Focusing on patient care won the statewide contract for North Shore, quadrupling its case volume.
ONE CHALLENGE THE ANATOMIC PATHOLOGY PROFESSION FACES is how pathologists who get paid fee-for-service for each case will be paid as healthcare adopts value-based reimbursement more widely.
In Milwaukee, North Shore Pathologists (NSP) is demonstrating a way for pathologists to thrive amid the changeover to this new form of payment. But doing so involves what might be called the marriage of preparation and opportunity.
Preparing for Opportunity
This was the theme The Dark Report covered in 2015 when reporting on how NSP had gained a seat at the table in 2012 when executives in the state’s health systems were forming the first accountable care organizations. (See, “Pathologists Contribute to Care in Wisconsin ACO;” TDR, March 30, 2015.)
Two years later, preparation met opportunity again, but this time, the opportunity for NSP was much bigger and so was the reward. In an interview with The Dark Report, NSP President Guillermo G. Martinez-Torres, MD, explained what happened in 2017 when Ascension Wisconsin wanted a single pathology group to serve its needs throughout the entire state.
Statewide Health Network
Ascension is one of the largest nonprofit healthcare providers in Wisconsin, with 23 hospitals, more than 110 physician clinics, and about 900 clinician employees. Thus, their request for proposal (RFP) two years ago was a big growth opportunity for the different pathology groups that wanted the contract.
When Ascension issued the RFP to provide pathology services statewide, North Shore Pathologists responded. NSP won the contract by focusing on how pathologists can improve patient care through a patient-centered approach and by following the tenets of the quadruple aim.
Years ago, the Institute for Healthcare Improvement adopted the triple aim, saying providers should aim to improve the health of populations, enhance the experience of care for individuals, and reduce the per capita cost of care. Since then, other organizations have added a fourth aim: attaining joy in work.
By contrast, other pathology groups responded to the same RFP by addressing the potential financial aspects of the relationship. In other words, NSP’s competitors focused on what most pathologists and other providers would assume to be most important to a large, statewide health system: cost control and revenue enhancement.
Response to the RFP
But the emphasis in NSP’s proposal as to how pathologists could contribute to improving patient care through the quadruple aim was not the only factor that helped them win the Ascension contract. Martinez-Torres surmised that NSP was chosen, in part, because Ascension’s executives were familiar with them through NSP’s support of the system’s ACO. Ascension knew the six-physician group could serve its needs in an environment where value-based care was becoming the predominant form of reimbursement.
It didn’t hurt NSP’s chances that Martinez-Torres was Chair of Pathology and Laboratory Medicine and Medical Staff President at Columbia St. Mary’s Hospital, an integral part of the Ascension system.
Also, it was timely in November 2017 that Martinez-Torres received the first Raymond C. Zastrow Award from the Wisconsin Society of Pathologists for his leadership, service, and efforts advocating for pathologists, not only in Wisconsin but nationwide.
Statewide Pathology Service
As Martinez-Torres explained, Ascension recognized that providing pathology services in such a large state with different pathology groups would be challenging.
“Ascension knew that having different groups throughout the state with different voices and different agendas would be more difficult than having one group for all of its pathology needs,” he said. “Instead of multiple groups, it wanted a single provider of pathology services for the entire state.
“Early in 2017, Ascension put out an RFP and North Shore Pathology responded,” he added. “The review process took months. At the end, in September 2017, we were awarded the exclusive contract for pathology services for the entire Ascension Wisconsin ministry. At that point, Ascension had 27 hospitals and more than 100 physician clinics, doctors’ offices, and other providers throughout the state.
“In 2017, NSP was a mid-size pathology group,” noted Martinez-Torres. “Thus, to win that kind of a contract was very exciting, but also a bit scary because it was and is an amazing opportunity to work with such a wonderful partner.
“To meet Ascension’s needs, our pathology group had to handle quadruple our existing volume,” he added. “We needed to quadruple our staff from where we were before winning this RFP.”
Need for More Pathologists
Prior to submitting its answers to Ascension’s RFP, the group had six pathologists, three PAs, and a practice manager. “But to respond effectively to the RFP we needed more than three times the number of pathologists and a much bigger staff,” Martinez-Torres explained. “Right now, we have 21 pathologists, seven PAs, and a practice manager.”
Four of those pathologists came from Racine County Pathology Associates in Racine, Wis., and three more came from the Butte des Morts Pathology group in Appleton and Oshkosh.
NSP has since added eight pathologists to the staff, four of whom came from AmeriPath, and it plans to add more pathologists to serve the remaining northern portion of Ascension Wisconsin, he said.
“During the entire RFP process, we reached out to the other independent groups that were providing services to Ascension Wisconsin and they agreed to join us and participate in responding to the RFP,” explained Martinez-Torres. “That is how North Shore Pathologists was able to integrate those other groups.
Swift Response Required
“To prepare for the quadrupling of our pathology volume, we needed to act swiftly,” he continued. “So, we brought those pathology groups in, and as of Jan. 1, 2018, those other groups became part of North Shore Pathologists. Because they already worked at Ascension hospitals, there was little disruption.”
Ascension didn’t share with NSP why it was chosen over the other pathology groups that responded to the RFP. Also, Ascension did not respond to The Dark Report’s request for comment.
“All we know is that Ascension reviewed the proposals and assigned a numeric score to each of the responses and awarded the contract to the group with the highest point total. Beyond that, they didn’t share their reasoning with me,” said Martinez-Torres.
But after NSP won the contract, Martinez-Torres heard informally from some of Ascension’s administrators that NSP not only focused on improving patient care, but the administration also thought that NSP shared Ascension’s mission, vision, and values, and that this aspect of NSP’s response was a winning strategy.
Evaluation of Presentations
“I heard comments about how Ascension evaluated the presentations that our team and the other groups made,” he stated. “Feedback was that there was a very stark difference in the way the pathology groups responded.
“Outside of that comment, I don’t know why we were chosen,” Martinez-Torres admitted. “But I will say that when you make a patient-centered argument, there is still a financial component to that point of view, which I thought resonated with the administrators, perhaps because Ascension is a nonprofit organization.”
In looking back on why NSP was chosen, Martinez-Torres acknowledged that he considers himself blessed to be working for an organization that focuses on providing care that leaves no one behind, especially in this age when so many healthcare providers have a narrow focus on cost control and revenue enhancement.
But then he added this comment, which may be the key lesson for all pathologists: “Of course we’re going to make money. However, at the same time, we cannot forget about why we’re here,” he said. “We are in healthcare because everything we do revolves around the patient. Patients count on us to be their advocates to the best of our ability.
“Most patients don’t know who pathologists are,” concluded Martinez-Torres. “But they put all their trust in us because everything we do and say drives their treatment and can change their lives forever.”
Pathologists throughout the United States should recognize the strategic lessons to be learned from how North Shore Pathologists successfully won the contract to provide pathology statewide services to Ascension Wisconsin. This is the future of healthcare in the United States.
First, Ascension Wisconsin is responding to a major trend: the need for an integrated healthcare system that covers an entire metropolitan area or even a state. Employers and health insurers want to contract with providers who can deliver clinical care that eliminates silos and helps patients manage chronic conditions while reducing healthcare costs.
Second, in assembling its statewide network of hospitals and clinics, Ascension Wisconsin wants providers who are integrated and can provide uniform, quality services everywhere that Ascension Wisconsin has facilities and patients. To meet the RFP’s requirements for integration and regional coverage, North Shore Pathologists had to approach its colleagues at other pathology groups serving the system at that time and develop an integrated pathology service that could be run as a single business entity.
Third, Ascension Wisconsin appears to have recognized that North Shore Pathology’s patient-centered approach would be a valuable asset.
Contact Guillermo G. Martinez-Torres, MD, at 414-585-1448 or Guillermo.Martinez-Torres@Ascension.org.
North Shore Pathology’s Involvement in an ACO Helped It Win Statewide AP Services Contract
IT PAYS PATHOLOGISTS TO BE READY FOR OPPORTUNITY. When 27-hospital Ascension Wisconsin issued a request for proposal (RFP) for a statewide pathology services contract, North Shore Pathologists (NSP) of Milwaukee was ready and had an established track record with Ascension.
That track record dated back to 2012 when NSP worked with other healthcare executives to form a large integrated delivery network and an accountable care organization (ACO) in Wisconsin. Today, Guillermo Martinez-Torres, MD, President of North Shore Pathologists, said that if NSP was not involved in that process six years ago, the group might not have had the success it has seen since then.
At that time, Martinez-Torres was preparing to make a presentation to a national meeting of pathologists about how pathologists can and should participate in ACOs. To help him prepare, he met with the president of Columbia-St. Mary’s Hospital, a 300-bed hospital in Milwaukee that is part of Ascension Wisconsin.
Integrated Care Network
On that day in 2012, the hospital president happened to be reviewing plans for a new ACO. “At the time, few people knew about this proposed integrated care network and ACO,” Martinez-Torres told THE DARK REPORT in 2015. “So, for me, it was an opportunity to get involved at an early stage.”(See, “Pathologists Contribute to Care in Wisconsin ACO;” TDR, March 30, 2015.)
“It was serendipity that I happened to walk into his office at that time, but I knew from my work with the College of American Pathologists that it was vitally important to have a laboratory representative at the table when discussing the formation of an ACO,” he explained. “I simply needed to take advantage of the opportunity.”
Pathologists in the ACO
As a result of being well-prepared even for such a chance encounter, Martinez-Torres earned a place for the lab in the formation of the ACO by acknowledging that pathologists have a unique value proposition to offer ACOs: the ability to collect and interpret lab data for population health management.
He also explained that the NSP pathologists were prepared to engage in value-based contracting and to move away from payment based on test volume, he said. He also commented that pathologists needed to identify future trends and prepare for them.
The experience in working with Ascension since 2012 in its integrated care programs and ACO certainly was a positive factor when NSP responded to Ascension’s RFP for a statewide pathology services contract in 2017. By winning that contract, North Shore Pathologists quadrupled its case volume and now serves a larger share of the Wisconsin market for anatomic pathology services.