Taking Care to a New Level

Emergent Medical Associates

If you have seen the Michael Moore documentary ‘Sicko’, you may have a negative opinion of the state of healthcare in the US. The representation is not flattering; it paints a picture of a system that is cold, uncaring, greedy and inefficient. However, this representation is not entirely accurate. The system has its inherent issues of course, but there are also key organizations working to actively change the story.

Emergent Medical Associates (EMA) is quite simply the antithesis of what was portrayed by Mr. Moore. This is an organization that is able to provide quality healthcare in a fashion consistent with what patients would and should expect. Business in Focus spoke with a very proud CEO, James Edwards, about the model of healthcare that EMA is pioneering.

EMA was started by Dr. Irv Edwards (James’ uncle) back in 1991. He came out of one of UCLA’s first residency programs in the seventies and went on to become an emergency room (ER) physician and work in the community. He decided that there was a better way to deliver healthcare and secured a contract with Mission Community Hospital in Panorama City, California. This contract, which launched EMA, is still in place to this day. The group was founded with Dr. Val Warhaft and the team worked together on building the company. Val left for personal reasons a few years later, so Irv took on another partner, Dr. Mark Bell, with Val later returning as Chief Risk Officer.

The company continued to grow from the late nineties through the 2000s without needing a business development group. “The reason for that was because Irv and Mark coined what they called an ‘Emergency Department of Excellence’ model. They learned that through the experience of managing inner city urban emergency departments, where the only way to build a sustainable practice and increasing care access was to be the efficient department that never closed to diversion. Providing quality care was the low watermark; doing better meant an integrated and collaborative approach that ensured patients were seen timely.”

The core tenet of this model is to become experts in patient flow. Dr. Mark Bell says, “Efficient care is a friend of quality care.” The goal of the model is to create access to care in the communities that it serves and to be the emergency department that never closes. As a direct result of this, the communities built up a lot of confidence in the emergency rooms because the wait times were markedly diminished. EMA’s compassionate physicians also make the patient feel like more than just a number.

Dr. Irv Edwards still sees this as a family business, even though it recently passed the $80 million revenue mark. He looks at physicians as part of the family and believes wholeheartedly that if the physicians are taken care of, then the rest would follow. “If we are always acting in the best interests of our providers, they will always act in the best interest of their patients and the communities they serve.”

Hospitals under the EMA model run more smoothly and the financial return has allowed some struggling institutions to remain open, prosper and maintain access to care for the community. This is due to what EMA calls an ‘ecosystem approach’. It recognizes that the emergency room is a part of the hospital that can act as an engine of change throughout the facility. “For the ER to run well, admitting, nursing, lab, radiology and departments like environmental services also need to run well. The ER is the one department in the hospital that is dependent on almost every other hospital department. Our PI team leadership is critical to care coordination and better patient flow.”

Among EMA’s hallmarks are the cross-functional performance improvement teams it leads at each facility. All of the departments, including very senior level administrators, work together to try to solve the problems that exist within the hospitals they serve. Under EMA’s model the ER is an engine of change and all of EMA’s partners have experienced improvements in clinical, operational and financial performance as a result of their presence. This translates into making a more profitable hospital and one that can therefore expand its services to the community.

The model has also taken critical access hospitals that were on the brink of closing and turned them completely around. “Not only do we take very well run hospitals and increase and enhance their performance, but we also take hospitals that might not have been managed as well and help keep their doors open, increasing access to care and making them a keystone of the community.”

The emergency room is the gateway to the hospital and the EMA team sees it like a restaurant business with beds in place of tables. The goal is to always provide the highest quality care possible, but it’s also to keep those tables or beds available for patients when they arrive. The only way to do that is by providing high quality and efficient care. This is done in part when doctors do not let a patient wait in a bed or waiting room, but instead treat that patient from the moment they get into a room or even at triage. EMA measures the performance of each part of its operations with objective metrics and these “Door to Doctor” times are but one metric evaluated. EMA’s Dashboard and Analytics Reporting Toolkit (DART) breaks down the ER into its core metrics and then surfaces the right data to the right team member at the right time to drive actionable insights and determine where the corrections need to be made prior to a minor problem becoming a larger issue.

“Our physicians and directors know those metrics and they are monitored closely at the home office. This is something that we have innovated; it has been part of our practice DNA since the beginning. Now it seems like everyone has followed suit, but we were at the forefront of pioneering these efforts. People are catching on which, for us, is great. We want the industry to step up the level of the game.”

EMA is expanding while maintaining the same standard of service. Jamey’s team has worked closely with Irv, Mark and the rest of clinical leadership to institutionalize all of their insights and methods into a process within the business. This strategy has been fine-tuned for the last eight to ten years with the company honing processes, putting the right infrastructure support in place and investing in IT platforms to monitor the data metrics. Many ER groups have grown to EMA’s size and collapsed, whereas EMA is doing the opposite.

“We are continually reinforcing our foundation to serve as a platform for future growth. We have no direct growth target; we are just looking to be opportunistic and smart. I think right now, what we are looking to do is to improve the overall quality of our portfolio, partner with health systems and provide great future careers for providers.”

Currently, EMA is entirely based in Southern California but is looking to expand into other states including Arizona, Nevada and Texas. A core part of its model involves “clustering”, meaning that density is needed in a given geographic area to make it successful. This density enables the organization to have scale in a geography, including a greater ability to recruit quality health care providers and leverage with the payers. EMA is looking to expand through system partnerships, requests for proposal or through mergers and acquisitions.

“Our business plan is constantly evolving. We are in a highly regulated market. As a result, the landscape is always developing. Reimbursement is always changing, which is a challenge for us as providers. Therefore, we have had to innovate in order to become even more efficient so that we can continue to offer providers wonderful careers – which we achieved.” EMA has been very successful in taking the ER’s given physical plans and channelling more patients through while maintaining quality service.

Demographics are changing and presenting challenges to the model. Aging populations and healthcare reform (more people seeking and having access to care) mean the ERs are getting busier. It’s not just the needs of aging baby boomers that create further challenges, however. The patient population is becoming more diverse nationwide. Universally across the country non-English-speaking persons are becoming a larger percentage of patients seen and EMA has made some strategic investments in tools to address that exact need. Language Access Network provides an on-demand remote video interpreting tool. The health care provider will carry it to the bedside, hit a button on the screen and, within thirty to ninety seconds, be connected to an interpreter.

“It can be intimidating enough to be a patient in the US when English is your first language. Imagine being a patient in a U.S. hospital when it is not. This tool allows patients and providers to communicate in their native language, allowing them to communicate freely. This communication is fundamental to every patient provider encounter and empowers the physician to make better and well-educated choices about their care.”

EMA is very proud of its accomplishments over the last twenty years and has striven to maintain that family feel to the business while being in the vanguard of healthcare reform.

The company has been recognized on the Inc. 5000 for the past four years as one of the fastest growing in the health industry. Modern Healthcare magazine, the leader in the health care media industry, has also recognized EMA as being one of the ‘Healthcare’s Hottest’ companies two years in a row.

“We felt that was a great recognition from a national organization for a regional group such as ours. It truly recognized all the hard work from all our physicians on the front line of medicine; our quality and innovation; and for what we are doing as a company to lead our industry.” Take note, Michael Moore. It may be time for a follow up documentary.

For more information about Emergent Medical Associates, please visit http://www.ema.us/

August 17, 2017, 3:41 AM EDT

A Model that Addresses Infrastructure Demand

The Labourers’ International Union of North America (LiUNA) is a National Union representing over 500 000 members – over 110 000 in Canada with an International Office in Hamilton, Ontario. It has Local Unions across the country and is the most common union of construction, healthcare, waste management, and show service workers in this country. In fact, LiUNA, established in 1903, is Canada’s largest Building Trades Union.