New Medicare organizations boost demand for DC area firm’s expertise

New Medicare organizations boost demand for D.C.-area firm’s expertise

Photo by Joanne S. Lawton

Medicare’s efforts to reduce costs with “accountable care organizations” could increase the revenue of Health Prime International, a medical practice management company led by Parag Shah.

Staff Reporter- Washington Business Journal
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Eventually Medicare hopes to save the government money with its new “accountable care organizations,” but the cost-cutting experiment is already a huge new business opportunity for little-known Health Prime International Inc.

The 9-year-old medical office support company, headquartered at National Harbor, will nearly double its 20-person domestic workforce to prepare for a new role managing the novel medical practice businesses in Maryland and possibly elsewhere, President Parag Shah said.

Health Prime is partnering with MedChi, the Medical Society of Maryland, to help run two ACOs in the region approved by the federal government on July 9 and is making 10 additional bids nationwide for Medicare approval by January. The two already-approved versions cover rural areas in western Maryland and the state’s Eastern Shore.

The ACOs, Shah said, provide a rare opportunity for the company: a chance to market its entire menu of products and services at once.

Health Prime grew by providing a bevy of disparate services to doctors’ groups — electronic medical record-keeping support, revenue-cycle management, transcription and customer service, often through its outsourced call centers in India.

But an ACO, essentially a limited purpose joint venture among independent physicians, needs most of those services at once to best compete for the risk-based revenue available under the Medicare program.

Each year, Medicare will kick back part of any savings generated if the patients seen by the doctors cost the government less than projected.

The new model starkly changes the old doctor-payment structure, where doctors were rewarded based on volume instead of quality. Under that model, Health Prime’s customers often had little incentive or wherewithal to buy the company’s efficiency-promising services. But doctors now need higher-end support tools and management services.

“Even when we offered a solution, we had to offer it piecemeal,” said Shah, a Health Prime co-owner. “By allowing the accountable care organizations, you can actually offer an end-to-end solution.”

MedChi selected Health Prime to support its ACOs because the doctors knew the company’s reputation for technological prowess and health care expertise, said Craig Behm, executive director of MedChi Network Services. The MedChi subsidiary and Health Prime co-own the ACOs, which consist of 15 doctors on the Eastern Shore and 23 doctors in western Maryland.

The partnership hopes to set up an ACO soon in Prince George’s County, and Health Prime is also working with a medical society near Fort Lauderdale, Fla., to seek Medicare approval for an ACO there, Shah said.

The ACOs that serve rural areas qualify for upfront grants of at least $430,000 to spur development. Urban and suburban ones do not.

Like the doctors, Health Prime’s expected revenue from the Medicare program is partially risk-based.

Health Prime is using the rural payments to build a practice infrastructure, but won’t profit unless the ACO is successful in saving Medicare money, at which point it would share the savings. Under the Medicare rules, the partnership can’t actually lose money if it doesn’t cut costs; it can only gain.

For now, Health Prime, which declined to disclose revenue, expects to hire 15 additional workers to support the ACO, mostly patient case managers who track patients’ chronic conditions. But if the ACO management model succeeds, Shah believes up to 50 will be necessary. Today, the company employs about 450 people, with more than 400 of them in India.

Dr. Harry Ajrawat, a Greenbelt urologist and president of MedChi, helped shepherd the new models to launch and enthusiastically endorses the shared-savings approach. He sees it as a way to return real authority to doctors, who will be able to strategize to provide more effective — rather than just more — services.

Initially, doctors and hospitals blanched at participating, because the original rules put too much risk on doctors, Ajrawat said. But the Obama administration changed its tone in 2011 and opened the floodgates. Medicare approved 89 new accountable care groups in the batch announced July 9.

“It’s giving your profession back to you,” Ajrawat said. “It’s making you the decision maker instead of having the insurance company be the decision maker.”

About ACOs

Accountable care organizations, known colloquially as ACOs, are essentially limited-purpose joint ventures among independent physicians that enjoy exemptions from antitrust and anti-kickback laws. With more freedom to communicate, policy experts believe, they could bill Medicare less by avoiding duplicative or unnecessary care and staying ahead of patients’ health problems.

Doctors continue to individually bill Medicare on a fee-for-service basis. If the Medicare beneficiaries who are assigned to the ACO collectively use less government money than projected on claims for the year, however, the ACO and Medicare will split the difference.

One less popular, high-risk/high-reward version gives the ACO 60 percent of the savings, but also would penalize the doctors if they exceed projections.

Health Prime co-owns two ACOs with MedChi, and the new venture would split the savings with individual doctors.

Ben Fischer covers health care and law.

We Need to Cultivate Relations Beyond Medicine

We Need To Cultivate Relations Beyond Medicine

President Obama and Dr VK Shah

Though his tenure as President of the American Association of Physicians of Indian origin (AAPI) comes to an end, Dr Vinod K Shah has plenty lined up to contribute to the organization, the community as well as the nations of his birth and adoption, India and the US, respectively.

Dr. VK Shah addressing the convention

A man of clear vision and motivated with the noble intent of touching and healing people’s lives – Dr. Shah’s life and mission are an example for thousands of doctors who take the Hippocratic Oath each year.

Bottom Row: Avni Shah, MD; Geeta Nayar, MD; Manish Shah; Parag Shah; Adarsh Gupta; Vipul Shah; Prakruti Shah; Parul Jani, MD; Bhargesh Mehta, MD; Chirag Parghi, MD

2nd Row: Suresh Patel, MD; Kiran Mehta , MD; Sharmila Mehta; Kiren Mathur; Krishan Mathur, MD; Ila Shah, MD; Neelam Shah; Vinod Shah, MD;
Nayan Shah MD; Jayu Shah; Dhiren Shah, MD; Avani Shah, MD; Umed Shah, MD; Shakuntala Shah; Suresh K. Gupta, MD
3rd Row: Samish Shah; Nila Patel; Kirit Patel, MD; Sushila Shah; Tarun Mehta; Sanjib Mishra, MD; Rahul Jindal, MD; Shambhu Banik, MD; Suresh C.
Gupta, MD; Pankaj Lal, MD; Rakesh Sahni, MD; Raj Samtani, MD; Pushma Samtani, MD; Bhasker Jhaveri, MD; Rita Jhaveri, MD; Beena Shah, MD;
Anil Shah, MD; Arpana Shah, MD; Amish Shah , MD; Dhara Desai; Minal Shah, MD; Madhu Mohan, MD; Mahesh Chandra, MD; Anantha Rao, MD
4th Row: Kishor Shah; Amit Sheth, MD; Milan Sheth; Sheriar Demehri, MD; Anil Kankaria, MD; Sushil Jain, OD; Genny Demehri; Asha Jain; Pradeep
Simlote, MD; Anu Simlote; Parvathi Mohan, MD; Madan Mohan, MD; Smita Patel, MD; Atul Shah, MD; Aruna Shah; Mukesh Mathur, MD; Nelson
Benjers, MD; Naresh Patel, MD; Adinath Patil, MD; Sukatu Shah; Aruna Patil, MD; Raj Patel; Shalin Shah; Vidya Sagar, MD; Megha Sagar; Savera
Sehgal; M.F.O. Lafeer, MD; Ajay Sehgal; Devendra Desai

On the occasion of completion of his one eventful year of fulfilled promises, Dr. Shah spoke with NRI Today and shared his views on milestones achieved.

"I had specific targets lined up to achieve during the year. The first was to make sure that we made enough funding available for

increasing the Residency slots for Medical students and communicate the need to the concerned authorities clearly," he says. Dr. Shah. In order to make that possible, he met President Barack Obama personally before the end of the first three months of his tenure and submitted him the document requesting increase in funding for the same. Increasing the participation of young physicians in AAPI was the second major agenda on hand. Hence he had a series of leadership seminars conducted throughout the years and recruited new AAPI members, doctors who were born and brought up in the US, the next generation of torchbearers who would take the mission and activities of AAPI forward. In this process he also got senior AAPI members involved at personal level to introduce and recruit the new members.

Dr Vinod Shah, Dr Illa Shah Dr Amish Shah standing in right Dr Arpana Shah, Dr Meena Shah and Dr Nick Khatri along with Sameer and Neelam

Third on his list was the idea of organizing a "robust convention" with maximum participation. "We gave incentive for early registration along with industry partnership program. And I am proud to say that first time in 28 years, we received full registration four months prior to the convention.  More than 2000 members have already registered, which has never happened before," Dr. Shah says.

Next, the team under Dr.Vinod Shah’s leadership developed a theme for each day of the convention. So on June 23, the first day, they have a cruise along the Potomac river to promote the theme of "Friendship and Camaraderie" among its members. "We decided to have a ‘Unity in Diversity’ as the theme for day two. In India people live in harmony despite the diverse cultural backgrounds and our members are representatives of the same diversity. Hence to celebrate the same sentiment we will have cultural programs which will bring the best of all the states," says Dr Shah.

Ba and Dadaji

Day three of the convention is devoted to public private partnership events that will have leading personalities and White House Representatives speak.

"We have also invited the President but for security reasons we wouldn’t know until last few days if he will grace the occasion. We will take 550 doctors to the US capitol to have a dialogue and reception with the Senators and Congressmen," he says. These are just some of the firsts, which have and will take place in the history of AAPI.

Brothers, Sisters , Sister-inlaws and Brother-inlaws

During the year, Dr.Shah personally visited a list of pharmaceutical companies and initiated a dialogue to explore ways in which doctors, institutions and pharma companies could work together for the betterment of the community at large.

Life will continue to remain increasingly active for Dr.Vinod Shah even after the completion of his tenure. When asked how he plans to remain involved in the initiatives undertaken as AAPI president, he says, "The incoming President Dr.Ajit Singhvi and I have worked closely together. I had also organized a global health care summit in New Delhi where people from as far s Dubai, UK, Australia, New Zealand, Canada and the US had participated and the entire program was drafted by Dr.Singhvi. I will now be working with him on following the same line of thought process of increasing participation of young doctors. We are likely to add 2000 new members this year and plan to have another 1000 in the next year. We want to have a unified body by bringing the young doctors under the same umbrella."

Philip J. Bean Center

Mumbai office

Chartable Activity in Medical College

Earthquake Relief Work

View more Photos in PhotoGallery

The passage of the Health Care Reform Bill has given a boost to the health care sector and Dr.Shah believes most should be made out of the Accountable Care Organization provision where a group of physicians either come together as individual practice association or a large multispeciality group and find a relationship with a large hospital for a unique area. "It is a very strong provision for people to work together," he says. Secondly Dr.Shah wants more work to happen in the area of Malpractice Reform. "Currently the laws are set by individual states but not centrally. In USA litigation is common. That is one of the nightmares that all physicians face in a country where it is very easy to sue. The second problem is escalating costs – the cost of doing business is going up – and that includes malpractice insurance, health insurance, the benefits we give to our staff, salary and wages. So you have escalating cost and declining reimbursement, which is a double jeopardy. Also, the average doctor comes out with $130,000 – $150,000 debt that they have to pay off. So a lot of these factors can lead to people losing the passion that is so necessary to practice medicine.

Surgery in Rural Village
Surgery in Rural Village

I honestly do not think that people go into medicine just for money. With the rigor of training, the amount of money that goes into education and practicing, there is a greater passion that is there. Due to the current system in the U.S., more and more physicians are retiring and telling their children not to go into medicine. This needs to be addressed effectively. Because if you take the incentive away of being a doctor, in the end it’s the people who are in need of care that ultimately suffer."

However, Dr.Shah believes that the US has the best health care system in the world. "Being doctors of Indian origin we have a very critical role to play between the two governments of India and America. Currently both the countries have best relationship in the last 30 years. I was fortunate to be at the First State Dinner, which significantly was in honor of Prime Minister Manmohan Singh and even President Obama is likely to visit India later in the year. It will further strengthen the ties. We as doctors are in a position to play goodwill ambassadors with our dedicated services and relationships, which we build with average Americans as well as the legislators. We need to cultivate relations beyond medicine."

And that’s the principle Dr.Vinod Shah  and his wife Dr.Ila have lived by all along. This Maryland-based doctor couple has several firsts to their credit. At a time when no one was willing to move to the rural American county of St.Mary’s they decided to start a medical practice there. Despite being just 50 miles south of Washington DC the community was in acute shortage of medical specialists with not even a pediatrician to name. So the Shahs decided to work at St.Mary’s Hospital, where Richard Martin, head of the hospital at that time, described them as "answer to his prayers."

Feeling at home in Southern Maryland, Shahs along with brother Dr.Umed K Shah, a gastroenterologist initiated a group practice in 1974. Members from their extended family apart from friends joined in years to come and today the two generations of Shahs serve several generations of Southern Maryland families that account for a majority of the county’s 1,10,000 residents.

Of course the going wasn’t easy. The Shahs faced a lot of prejudice from the community initially and local doctors were hesitant to join them. With dedicated medical care and efficient management they could win over both. In mid-90s they consolidated much of their practice in a 60,000 square feet facility and named it Philip J Bean Medical Centre after a country doctor who practiced in the county for 66 years. "During those days there was a lot of discussion about gatekeeper concept where a primary care physician would direct a patient to specialist who would further decide what diagnostic care the patient needed. We thought it would be a good idea for us to develop a center of excellence instead where all kinds of specialties and facilities would be available under one-roof," says Dr.Vinod Shah. The concept proved successful and at present 90 doctors from 21 specialties work under the umbrella of Shah Associates across 14 locations.

In order to provide comprehensive clinic services the Shahs also set up a BPO in Mumbai where all the billing and recordkeeping is done electronically overnight. "President Obama wants to encourage use of electronic patient record by 2011 but we did it six years ago. Even though we are in a smaller area, we implemented electronic health records. When people were not even considering it, we invested a lot of money in order to have a connection to each office and electronic access to each patient’s record even from home. We are a very forward-thinking group and focus on identifying what’s going to make a real difference."

The Shahs are keen on focusing on disease management protocol where the doctors take advance care of patients. "In a traditional system you approach a doctor if you fall sick but in advance care doctors will focus on preventive health care," says Dr.Shah.

Born in Ranpur near Surendranagar and raised in Mumbai, Dr.Vinod Shah, a cardiologist, met Dr. Ila, a pediatrician at Seth GS Medical College in Mumbai. The couple came to US in 1967 to pursue further studies. When he came down, his immediate plan was to return to his home country after all of five years. But upon completing prestigious fellowships in internal medicine and cardiology at Georgetown University Hospital in Washington, D.C., Dr. Shah had a choice: either return to India or use the resources he had gathered over the years since his arrival to do something truly revolutionary in the U.S. Dr. Shah chose the latter.

Dr.Shah has been a member of AAPI from the inception. "When Dr. Kiran Patel was president, he had asked me to chair a legislative conference and it was one of the best legislative conferences put together by the group. We had 51 congressmen and senators and among our speakers were Senator

Biden, Bobby Jindal and Congressman Steny Hoyer. The conference really showed the ability for us to excite people and invite them to come and be a part of what we were organizing. There was a crowd of about 250 people, and the idea was for us to really show our involvement in the health care dialogue moving forward. Because of that effort we got a $500,000 grant from the U.S. government to study diabetes amongst Indians, which was yet another landmark."

So, what’s the best part about being a doctor, we ask before he signs off, "The best part is I think I’ve made a difference in the lives of many, many people. It’s the most rewarding field. When you care for people and you come through for them, and they tell you "You know doc, you saved my life," it’s an indescribable feeling. That is what is motivating us to be hardworking doctors. I am very fortunate with the grace of God that I’ve never faced litigation in my 30+ years of practice. That is the nightmare, if you do honest and hard work and someone questions your integrity. But the joy of medicine is so much more that everything else is not important."

Dr Shah lives in Mechanicsville, Maryland with wife Dr.Ila. His son, Dr.Amish is a cardiologist, daughter-in-law Arpana is a dermatologist. They have two children, Samir and Neelam. Dr.Shah’s daughter Meena is a cardiologist fellow at Georgetown and son-in-law Nimesh will be gastroenterologist fellow at Georgetown. All his brothers, brothers-in-law and sisters-inlaw are doctors and live in Southern Maryland. Their group now has 102 physicians and network of additional 350 doctors.

Ribbon Cutting for the Patrick Jarboe Center

Medical Center Named After Dr. "Pat" Jarboe

Lexingon Park, MD - 7/18/2011

By Dick Myers

Courtesy of the Baynet.com

Dr. Vinod Shah of Shah Associates
Dr. Vinod Shah of Shah Associates

He has been a family doctor for thousands of St. Mary’s County families for more than 50 years. Dr. J. Patrick “Pat” Jarboe’s contributions to the community were recognized on Saturday with the dedication of a new medical center named in his honor.

The J. Patrick Jarboe Medical Center relocates the Breton Medical Center from San Souci Plaza to the new building on Buck Hewitt Road in California behind the CVS Pharmacy. The center will include family practice and other specialties of the Shah Associates, MD, LLC, which includes more than 100 physicians in 14 locations around Southern Maryland.
At the ribbon cutting ceremony Saturday, Rep. Steny Hoyer (D: 5th) called Dr. Jarboe “an extraordinary human being. We are all in your debt.” Hoyer also praised Dr. Vinod Shah, a long-time personal friend. Hoyer said, “The Lord, I am sure, sent us the Shah family.” He noted they were of a different color and a different culture than the typical St. Mary’s County family, but they quickly earned the respect of the community. “Dr. Jarboe and Dr. Shah came from different schools and different places of birth but with the same commitment to the community,” he said.
Dr. Jarboe, in remarks read by his daughter, said that he and his partner Dr. John Fenwick chose to align themselves with Shah Associates because the Shah family shared with them similar values.
Dr. Vinod Shah noted that times were different when Dr. Jarboe opened his family practice in Great Mills in 1960. Many of the diagnostic tools available today were not available then. It was just “one man in a small community providing health care.” He said it was an honor and a privilege for his family that Dr. Jarboe agreed to have the building named after him.
The Shah Associates practice was founded in St. Mary’s County 37 years ago. Dr. Shah noted the changes in health care from the time he was practicing 40 years ago in the emergency room of a small hospital in Glen Burnie. He said there were many challenges ahead for health care. “We need for all of us to come together for better health care in the community.”
“I have always received enormous support from my family, friends and community,” Dr. Shah said and singled out St. Mary’s Hospital, MedStar and their CEO Christine Wray. Dr. Shah’s wife Dr. Ila Shah sat with him at the ceremony along with two grandchildren. His brother, Dr. Umed Shah also spoke, and praised Hoyer, who he called “the community’s leader.”
Also speaking at the ceremony was Dr. Michael Szkotnicki, who founded of Breton Medical Center in 1992. They joined Shah Associates in 2000. “It’s been an interesting mix of two cultures,” he said of that union.
Among Dr. Jarboe’s many accomplishments include appointment and then election to the Board of St. Mary’s County Commissioners, a founding member of Health Share, and volunteer medical work in Guatemala with his friend, Dr. Martin Barley, a local dentist.

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