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Hospital expands business reach

When Beau Everett suffered an on-the-job injury, he went to a walk-in clinic on 66th Street N because the visit was covered by workers' compensation.

But Everett said he would choose the clinic again because of what he saw on the sign:

"Convenient Care Clinics _ Affiliated with Bayfront Medical Center."

"I would come here because of the Bayfront name," said Everett, who works for Danka Industries. "I mean, they have a good reputation."

That's music to officials at Bayfront, which is charging into the health care future by purchasing walk-in clinics and independent doctors' offices throughout southern Pinellas County.

Five Convenient Care Clinics now carry the Bayfront name and a sixth is being built in South Pasadena. Bayfront also purchased a rehabilitation clinic and two independent doctors' practices in St. Petersburg. And last year, the hospital worked with the Johnnie Ruth Clarke Health Center, a low-income clinic in St. Petersburg, to open the Women's and Children's Health Center in Pinellas Park.

That's just the beginning for Bayfront, a private, not-for-profit facility that is the third-largest hospital in Pinellas. In coming years, Bayfront plans to buy many more physician practices and clinics in an effort to build a "vertical" health system stretching from the first doctor visit all the way up to complex surgery at the hospital.

In doing so, Bayfront is at the forefront of a national trend in health care _ the merging of services that traditionally have operated on their own.

"A lot of (hospitals) are talking about it, but very few are actually doing it," said Jay Wolfson, director of the Florida Public Health Information Center at the University of South Florida. "Bayfront is ahead of the curve."

Two other Pinellas County hospitals are pursuing the same tack. St. Anthony's in St. Petersburg has bought four doctors' offices and Morton Plant-Mease Health Care now owns 14 physician offices scattered around northern Pinellas. In Hillsborough County, Tampa General and St. Joseph's are making similar moves, although not as extensively, Wolfson said.

For doctors and hospitals alike, such mergers are a good way to provide the efficiency demanded in today's highly competitive health care environment. Doctors can concentrate on patient care while the hospitals can handle the business aspects of the practices in a centralized location.

Bayfront won't say how much it has spent building its new health care network, or whether the idea has yet proved a financial success. But expectations are high.

"We certainly hear about hospitals doing similar things all across the country," said Bill Erwin, a spokesman for the American Hospital Association. "This is one of the best ways of keeping down costs."

"You can only see so many patients in a day'

When Dr. Jose Guethon finished his residency at Bayfront Medical Center in 1991, he purchased a dying family practice in St. Petersburg. Within three years, the practice was thriving, but it had taken a toll on Guethon.

The 32-year-old doctor found himself spending a lot of time negotiating contracts with HMOs and PPOs, balancing the office budget and worrying about making a profit at a time when profit margins in smaller practices have shrunk dramatically.

"The one thing I have not liked in medicine is the stress," Guethon said. "And the stress isn't from seeing patients. It's from all the things they don't see that go into seeing patients."

Then Bayfront Medical Center came along with an offer he couldn't refuse. Bayfront would buy the practice and handle the business side _ billing patients, dealing with insurance companies, paying vendors and employees _ while Guethon concentrated on practicing medicine.

Now, Guethon is a Bayfront employee and receives a fixed paycheck every week. He still helps set the practice budget, manages the five office employees and decides how many patients should be seen in a day.

The arrangement has few requirements. Although he refers most patients to Bayfront, he is under no obligation to do so. In fact, Guethon remains on the staff at St. Petersburg General Hospital and Edward White Hospital and refers patients there if they prefer.

What Guethon gives up as a salaried employee is the chance to drive his income as high as he would like by working harder and seeing more patients. But it was a trade-off he gladly made.

Preferred provider organizations "are essentially discount medicine, workman's compensation is set by the state and Medicare has been cut back, so the only way to keep up is to see more patients," Guethon said. "But you can only see so many patients in a day and do a good job."

Because of those uncertainties, more and more doctors starting out in the field are choosing lifestyle over income, set hours and a guaranteed paycheck over long days and uncertain income.

"We're looking for flexible schedules," said Guethon, who's married and has two young children. "We're not looking to spend 60 hours working with patients, then spend another 20 hours managing a practice."

"The more they can earn'

So far, Pinellas County hospitals have been looking to purchase practices of doctors in the area.

But Bayfront recently took its effort to build a new alliance a step further. The hospital sent letters to 2,500 residents nationwide who are completing family practice programs and to 4,500 doctors working along the eastern seaboard.

"We are asking them what we can do to attract them to Pinellas County," said Dr. Martin Farber, Bayfront's first physician executive who was hired about six months ago to build the new outpatient network.

Part of the impetus for Bayfront's nationwide search was a study showing that southern Pinellas County is underserved by as many as 25 primary care doctors, Farber said. As many as 80,000 times a year a patient who needs to see a doctor has to wait a long time or is forced to seek treatment at emergency rooms.

In addition, the primary care doctors already in practice are distributed unevenly throughout southern Pinellas.

"Doctors tend to aggregate around where they were trained," Farber said. So while there are numerous doctors with practices near Bayfront Medical Center, far fewer doctors practice in the central part of the county near Ulmerton Road, the northern boundary of the area Bayfront considers its primary service area.

As physicians answer Bayfront's call, Bayfront is ready to negotiate.

"There are lots of different ways to do that," Farber said. "Doctors can go into practice by themselves and Bayfront can get them going. Bayfront can help its own family doctors by adding doctors to their practices. Or we can establish them in practice and pay them for a while, then tell them they are free to practice on their own."

For instance, Bayfront's arrangement with Drs. Gerald Casas and Donna Miller is different from that with Guethon. The two doctors have a practice called For Women, adjacent to a Convenient Care Clinic in Seminole.

Casas and Miller are essentially independent contractors, Farber said. The doctors receive a certain percentage of the practice revenue. Bayfront receives the rest and pays all expenses.

"It's not like an employed doctor" with a set salary, Farber said. "The more productive they are and the more services they provide, the more they can earn."

For now, doctors and Bayfront officials say, patients will notice little difference.

The Convenient Care Clinics have the Bayfront name on the sign, but the transition has been less visible at Guethon's office.

"The patients still come to see Dr. Guethon and we haven't painted the office in teal," he said, referring to Bayfront's trademark hue.

But health care analysts say that as more and more hospitals move to build alliances with doctors, the result is likely to be better quality of care.

That's partly because the alliances will have more purchasing power and will be able to operate more efficiently. But it's also because competition among the alliances will force them to keep quality high. If they can't do that, they will face the prospect of seeing business go elsewhere.

Charlie Pierce Jr., president of the Florida Hospital Association, said insurance companies are moving toward more specific ways of evaluating the quality of care such as tracking readmission, infection and death rates.

"I think when we come out on the other side of this, the consumer is going to be in a better place," Pierce said. "I think the quality is going to improve."