A doctors’ office with strong ties in Snohomish this month is joining Western Washington Medical Group, one of the largest in Snohomish County.
Snohomish Family Medicine is the fifth family practice group Western has added, bringing its number of family practice providers to 29. In total, 90 providers work with the medical group.
Both parties say coming together is a win-win. Western, based in Everett, was founded as a clinic of specialists and wants to add more general practitioners to offer comprehensive care. Snohomish can take advantage of a larger organization’s administrative, capital and technical resources.
“We are excited about this opportunity we feel will allow us to leverage ourselves in the new world we’re coming into and provide good quality care,” said Dr. Ival Salyer, director of Snohomish Family Medicine.
This partnership is an example of one effect of national health care reform: the demise of small, independent medical practices. Congress’s plan to fix how Medicare reimburses doctors includes so many complexities that it’s increasingly difficult for a doctor to practice solo — or even in a small group.
“One of the things I hear from providers is how stressful the changes administratively are in medicine,” said Jerry Tillinger, chief executive officer of Western Washington Medical Group. “It’s the death from a thousand cuts.”
Doctors spend far more time clicking boxes on the computer or filling out forms than ever before, he said.
While many of the changes and documentation the federal government or private insurers ask for make sense in isolation, together they become overwhelming for a small, independent practice that can’t afford a large administrative staff or sophisticated technical systems.
Dr. Salyer started work at Snohomish in 1978. He’s a soft-spoken physician with a deep faith and a passion for helping his local patients and disadvantaged people elsewhere.
He spends more time documenting care than ever before and worries it’s taking his focus away from what matters.
“It’s a new skill maintaining that good listening and not getting so involved with the computer we lose track of why the patient is there,” he said.
One of the advantages for his medical practice is the use of Western’s multi-million dollar electronic medical records system. Patients may not notice, but the family doctors and nurses at Snohomish now have seamless communication with specialists their patients work with at Western.
Another is Snohomish’s patients will have increased access to urgent and after-hours care. They’ll have more locations with Saturday and evening hours, and one location that is open 365 days a year.
Patients probably won’t notice too many other changes. Snohomish Family Medicine doctors will still see patients at the same office at 629 Avenue D in Snohomish.
Even the sign outside probably won’t change much. That’s because Western values provider autonomy, Tillinger said.
“We don’t put great stock in a homogenized brand name,” he said.
Western keeps a lower profile than other large medical groups in the county. You won’t see their doctors on billboards or on the side of buses.
The marketing budget is thin at Western and that’s the way they like it, Tillinger said.
Western already had a long, close relationship with Snohomish, referring many of its patients there.
Dr. Leeon Aller, known for his humanitarian work in Guatemala and Ethiopia, established Snohomish Family Medicine in 1953.
Since then, the small practice has become a community fixture.
The five doctors and two nurse practitioners that work there today carry on Aller’s legacy. Each year, one provider takes a sabbatical and travels at his or her own expense to a disadvantaged part of the world to provide healthcare and train doctors.
“This is a model where we can support a unique group like Snohomish Family Medicine,” said Dr. David Russian, president of Western Washington Medical Group and a pulmonary sleep specialist. “They are the best doctors in Snohomish, no question about that.”
Western Washington Medical Group is physician-run, meaning the doctors, not corporate managers, make all the business decisions for the group based on what they feel is best for patients.
A group of doctors formed the group in 1993 when the Clinton administration was looking into changes in health care that would make small groups of doctors ineffective in the health care market.
Its doctors are on staff at Providence Regional Everett Medical Center. Western is participating in the Providence Boeing accountable care organization — a network of providers who are paid a premium to deal with all of a patient’s needs.
Western plans to continue to grow. They would like to add 10 to 30 more providers in the next two years.
And they’re still weighing what is the best size. They know they don’t want to grow as large as the Everett Clinic, for instance, which has 357 physicians and 139 nurse practitioners and physician assistants.
“We want to be the right size to effectively compete in the market but still keep it personalized,” Russian said.
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