Successful Turnaround of a University-Owned, Community-Based, Multidisciplinary Practice Network

Michael K. Magill; Robin L. Lloyd; Duane Palmer; Susan A. Terry

doi:10.1370/afm.540

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Figure 1.
Financial bottom line (profit or loss) of University of Utah Community Clinics.

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Table 1.

Operational Changes Implemented in University of Utah Community Clinics, 2000–2005

Phase of Change (Approximate Time)	Examples of Changes
I: Draconian change (years 1–2)	Restructure organization, governance, and leadership
	Restructure financing
	Achieve “right size”: match capacity to demand, close practices not suited to fee for service or for referrals to the university
II: Innovation and performance improvement (year 3 onward)	Develop financial and management reports
	Revise physician compensation and benefits to incentivize productivity and sustainable levels
	Implement correct core principles of successful group practices
	Focus on patient experience Match the right person to the right job Standardize procedures Design facilities for efficiency and patient service Exploit technology Improve communication
	Redesign ambulatory practice operations
	Implement advanced access scheduling Reengineer the ambulatory visit to be patient centered and physician efficient Strive for lean design
	Implement robust electronic medical record through all clinics
	Establish an active clinical quality improvement program
	Develop new services and new practice sites
III: Integration with the academic mission (year 4 onward)	Teaching
	Appoint physicians as adjunct faculty to the school of medicine Standardize educational contracts with outside institutions Allow elective rotations for students (medical, physician’s assistant, other) and residents Offer a continuity clinic for pediatrics residents Integrate outpatient family medicine residency/faculty clinics in to community clinics network
	Research
	Establish a research oversight committee: health sciences center faculty, community clinics physicians and staff Develop principles and oversight for research: select research that enhances the practices without disrupting operations Track projects and direct research expense using community clinics (total to date approximately $2.5 million) Establish formal practice-based research networks: Utah Health Research Network, Utah Sports Research Network

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Table 2.

Summary Profile of University of Utah Community Clinics, 1998–2005

Characteristic	1998	2000	2005
FTE = approximate full-time equivalents; NA = data not available.
* Physician’s assistants (PAs), nurse-practitioners (NPs), and certified nurse-midwives (CNMs).
No. of primary medical practice sites	9	8	7
Total clinician FTEs	87	79	70
Physician FTEs	NA	64	61
Midlevel clinician* FTEs	NA	15	9
Staff FTEs	629	516	483
No. of patient visits	NA	216,430	263,605
No. of active patients	NA	NA	105,300

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Table 3.

Employees of University of Utah Community Clinics, 2005

Employees	No.*
* Numbers shown refer to individuals, not full-time equivalents.
† Medical doctors (MDs), doctors of osteopathy (DOs), doctors of physical medicine (DPMs), physician’s assistants, nurse-practitioners (NPs), and certified nurse-midwives (CNMs).
Clinicians^†	121
Main staff clinicians	63
Family medicine	28
Internal medicine	11
Pediatrics	7
Internal medicine/pediatrics	2
Obstetrics-gynecology	5
Gastroenterology	2
Podiatry	2
Physical medicine	1
Occupational medicine	1
Physical therapy	4
Other clinicians	58
Ski clinic (seasonal)	12
University of Utah visiting specialists	10
Moonlighters	29
Optometrists	7
Support staff	483
Total employees	604

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Table 4.

Clinical and Business Services Provided Within University of Utah Community Clinics, 2005

Clinical Services	Business Services
CT = computed tomography; US = ultrasound; DEXA = dual-energy x-ray absorptiometry.
Primary care	Administrative
Family medicine, internal medicine, pediatrics, obstetrics-gynecology	Executive leadership
	Executive medical director
Specialty care
Gastroenterology, cardiology, orthopedics, podiatry, neurology, dermatology, urology, physical medicine and rehabilitation	Executive director
	Chief operating officer
	Group medical director
Urgent care	Clinic medical directors
Vision	Clinic management team
Ophthalmology, optometry, optical	Support services
Pharmacy	Central billing services
Laboratory	Marketing
Radiology	Compliance
Plain radiography, CT, mammography, nuclear medicine, US	Payer contracting
	Facilities management
	Human resources
Travel clinic and infectious disease
Endoscopy
Physical therapy
Ski clinic
DEXA scan

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Table 5.

Research Projects Using Community Clinics, 2000–2005

Project Title	PI’s/Coinvestigator’s Home Department (School of Medicine) or Other College	Funding Source	Total Direct Costs, $
PI = principal investigator; NIH = National Institutes of Health; AHRQ = Agency for Healthcare Research and Quality; ADHD = attention deficit/hyperactivity disorder.
Cutaneous Measures of Diabetic Neuropathy	Internal Medicine	NIH	1,345,705
Time to Pregnancy in Normal Fertility	Family and Preventive Medicine	NIH	499,995
Impact of Electronic Reminders on Screening for Colon Cancer	Huntsman Cancer Institute, Family and Preventive Medicine	NIH	247,500
The Safety Check	Family and Preventive Medicine	NIH, AHRQ	200,000
Pharmacological Mechanisms of Falls and Sway in the Elderly	College of Nursing	National Institute of Nursing Research	150,000
Genital Herpes Prevention Study	Internal Medicine	NIH, industry	100,000
Insulin Glargine Treatment Patterns in the Management of Diabetes, Type I and Type II	College of Pharmacy	Industry	65,000
Effects of Various Drugs on Hypoglycemic Events	College of Pharmacy	Industry	65,000
Chronic Back Pain	Anesthesiology	Foundation	50,000
Bioterrorism Surveillance	Family and Preventive Medicine	Foundation	35,000
Determinants of Exercise in Obese and Nonobese	Family and Preventive Medicine	Department of Family and	25,000
Sedentary Pregnant Women		Preventive Medicine’s Small Grants Program
Asthma Guideline Adherence: Implications for Cost	College of Pharmacy	Department of Pediatrics	25,000
Measurement and Prevalence of Deformational Plagiocephaly	Pediatrics, Family and Preventive Medicine	AHRQ	20,000
Population Surveillance to Detect an Epidemic	Family and Preventive Medicine	Foundation	20,000
ADHD Patient Weight Distribution Study	College of Pharmacy	Industry	10,000
Developing a Research Tool to Accurately Measure Latinos’ Perceived Barriers to Health Care	Family and Preventive Medicine	Foundation	5,600
Other	–	–	12,500
Total direct costs of research using community clinics	–	–	2,876,300

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Table 6.

Income Statement ($000) by Service Line, Fiscal Year 2005 (July 2004 to June 2005)

Measure	Primary Care	Specialty Care	Central Laboratory	Pharmacy	Vision Services	Central Administration	Total
Note: Values do not add exactly because of rounding.
Total net revenue (loss)	16,884	9,537	2,335	24,214	2,922	(321)	55,570
Total expense	21,125	6,016	1,228	19,599	2,554	4,825	55,347
Net income (loss)	(4,241)	3,521	1,106	4,616	368	(5,146)	224