The Evolution of APMG
In the late 1970s and early 1980s, SPPH was an active, thriving hospital functioning at capacity of close to 300 beds. Because of the busy hospital based practice and the additional activity related to the start up of Bio-Diagnostics Laboratories (BDL) in 1980, two additional pathologists: Drs. Eric Glassy and Jerree Stroh joined SPPMG in 1981. In addition, pathologists in those times, derived the majority of their income from “Percentage Contracts” under which pathologists were paid a percentage of gross billings or later, of net collections. These financial arrangements certainly motivated pathologists to expand the hospital based revenue, but also had the unfortunate effect of allowing pathologists to ignore the actual value of their anatomic pathology services, since most of their income was derived from clinical lab charges. In the 1980s, percentage contracts disappeared. In addition, other dramatic events resulted in changes in payment to pathologists. These included Medicare’s cessation of clinical professional component billing payment, Diagnosis Related Groups (DRGs), Medicare’s change from charge based payment to a fixed fee schedule payment based in the Hsiao Resource Based Relative Value Scale (RBRVS), separation of global fees for anatomic pathology into professional and technical components, MediCal Czar and limited hospital contracting, Blue Cross Prudent Buyer PPO discounted fees, CLIA 1988, Fifth year pathology residency requirements, etc. The list is endless. None of these developments were financially advantageous to pathologists, thus survival and growth depended on creativity, innovativeness, hard work, and a bit of luck.
In this milieu, SPPMG was presented with the opportunity to expand its hospital based practice by assuming the contracts of two local pathologists: Dr. Jack Silverthorne at Los Altos Hospital and Dr. Jim Redwine at Bay Harbor Hospital. As a result of these opportunities, we decided that the “San Pedro” in “San Pedro Pathology Medical Group” was too limiting, so the name of our partnership was changed to a more generic, “Pathology Consultants Medical Group” or PCMG. Assuming the pathology contract at a hospital with the cooperation or invitation of the previous Medical Director was an excellent method of expansion. We soon, however, began to recognize that there were other growth possibilities available and when we had a chance, we began to respond to formal RFPs for pathology services. Primarily because of Dr. Glassy’s creative genius and energy, formal RFP presentations became one of APMG’s greatest assets with notable successes at Saddleback, Little Company of Mary, and Portland Adventist.
An interesting observation is that as time progressed, our organization of multiple pathologists and diverse locations came to be viewed as a positive factor, rather than a negative one. In the early years of PCMG, many hospitals wanted their own individual pathologist or pathology group and were resistant to that group providing services to other facilities. Now, the benefits of an organization with pathologists that have varied expertise is well recognized and serves as an asset for APMG.
The growth of PCMG/APMG, both in the increased number of pathologists and geographic expansion to multiple sites, increased the management challenges. Increasing the scope of the organization added complexity and required more sophisticated processes as the group changed from one with a few members in one location who communicated almost daily, to a group with multiple practice locations in which members went months or years without seeing or contacting other members. Development of more sophisticated management and decision making processes arose from the necessity of managing this increased complexity. These included formal partnership agreements with structured decision making procedures allowing decision making without the inimical delays of universal consensus; hiring of full time non-pathologist Administrator and Administrative Assistant; election of Board members and Group President; formal Board meetings; Strategic Planning Retreats; regular financial reporting via professional finance department; retention of outside legal counsel; and establishment of standing committees such as Recruitment and Compensation.
APMG continues to expand and thrive. Leadership responsibilities are now more evenly distributed. Yearly retreats (Advances) bring our members together to set priorities and build consensus. Task forces report on ACOs, technology, marketing, molecular testing, and succession planning. We truly believe we are the future of pathology.
APMG TodayFor over 25 years, Affiliated Pathologists Medical Group (APMG) has focused on providing leading pathologists, medical directors and pathology consultants to community hospitals, labs and their medical staff.
APMG seeks women and men who are not only proficient in their professions, but who are enlivened with a spirit of customer service and emboldened to create a better physician/patient experience with enhanced outcomes.
Members of APMG recognize the importance of providing the best patient care possible. We are enthusiastically engaged in providing quality and unparalleled physician services in an atmosphere of service to others.
The dream to pursue excellence, achieve the APMG vision, and help determine the future of healthcare is a testament to the great physicians of Affiliated Pathologists Medical Group.
To succeed, we will need to look at all our operations. Although each hospital or medical facility is quite distinct, working in silos does not advance the goals of APMG. We need to break down barriers and emphasize open communication and cross-pollination of ideas. Information Systems will help in that regard. We have implemented a central database for sharing and collaborating.
Problems require discipline to solve and permanently fix. All stakeholders need a voice. Process Improvement—in all its many forms— is a discipline that must be embraced by APMG.
As we develop a strong infrastructure, we must be sure that our plans meet the strict compliance requirements of healthcare regulatory organizations. Pay-for-performance will become the norm.
Finally, we need to vigorously pursue quality assurance in all its forms because clients demand it and our patients deserve it.
Goals for Affiliated Pathologists Medical Group
- Be the preeminent private practice pathology group in the United States.
- Be distinguished for our physicians who are excellent in their specialty and sub-specialty.
- Substantially grow our affiliations and strengthen our clinical outreach relationships further partnering with our hospitals, referral physicians and labs.
- Increase diversified revenue streams to facilitate revenue growth opportunities.
- Develop and market specific organ expertise where others seek out APMG for expert opinion consultation.
- Improve billing and collection practices so that we are paid for the legitimate and appropriate services that we perform.