Practices building two new facilities to offer more coordinated treatment

Two groups are building medical facilities in Southwest Austin that will aim to serve as one-stop-shops for patients.

Premier Family Physicians plans to open its Southwest Medical Village off William Cannon Drive in early January, and Hughes Capital Management Inc. will open Phase 1 of Waterleaf Medical Center at Davis Lane in early 2014.

The projects are part of a shift in the health care industry toward doctors more actively coordinating patients' care.

Today, five primary care doctors may compete for the same primary care patient. Soon, five networks of doctors will compete to deliver all of a patient's medical care.

This is known as horizontal integration, and it sometimes takes place under one roof, said Dr. Mark Hernandez, chief medical officer for the Community Care Collaborative, Travis County's integrated health care delivery system.

"One of the challenges of primary care is that if I see a patient and determine he has asthma, I can tell him to see a lung specialist. ... I may even make that call and make an appointment for the patient, but then I lose control," he said. "How much easier is it if I refer my patient to a lung specialist, and the specialist is next door? I might even [walk the patient over] to the specialist. There is no [lapse] in care at that point."

Southwest Medical Village

When completed, the 80,000-square-foot Southwest Medical Village will house Premier Family Physicians staff and 20 specialty practices totaling 60 to 70 doctors. There will also be retail space for optometry and a pharmacy.

Premier chose to build on Vega Avenue because the location was in the middle of its existing coverage area, and because the 18-acre space was one of the last big tracts available in Southwest Austin, Steinle said.

The Southwest Austin market has grown so much and there is such a need for medical office space that some of Premier's specialists have wanted to open offices locally but could not find a place to practice, he said.

All of the space in the village has been informally reserved; Premier is now ironing out the lease agreements with the specialists, he said.

"The big advantage [of the village] is the concentration of all of [our patients'] care," Steinle said. "It truly allows them to go to one place to get their lab [work] done, go to a pharmacy to fill prescriptions, address their primary care and most every angle of specialty care."

Dr. Kevin Spencer, Premier's president, said having most of the practice's referral network on-site will allow doctors to coordinate each step of their patients' care.

Premier hopes to have the National Committee for Quality Assurance declare the village a Patient-Centered Medical Home.

Medical homes are "a model of care that emphasizes care coordination and communication" to transform primary care into 'what patients want it to be,'" according to the NCQA.

Waterleaf Medical Center

When completed, Waterleaf Medical Center at Davis Lane will comprise six buildings with more than 100,000 square feet of combined space at the intersection of Davis and MoPac.

HCM President Trac Bledsoe called Southwest Austin an under-supplied medical area.

"Historically, if you look at Austin, [the expectation] was, 'Wherever you were at, come to Central Austin for care,'" he said. "Frankly, we've grown as a city where traffic is a big challenge. An hour to get to and from an appointment is not practical."

All of the space in the first building is committed, and Waterleaf Medical Center East, at 5000 Davis Lane, will open in early 2014, Bledsoe said.

The firm is signing leases on the second building, and Waterleaf Medical Center West, at 5301 Davis Lane, will open later that year.

Bledsoe said the medical hub will serve patients south of the river, including those from Kyle and Dripping Springs.

He said the MoPac intersections at William Cannon Drive and Slaughter Lane have become nexuses of retail activity.

"We believe the intersection of Davis Lane and MoPac will be a strong health care location," he said.

The bigger picture

To understand the shift taking place in the health care industry, it is important to understand two different ways of approaching care.

In the current fee-for-service model, doctors compete for patients and earn revenue based on their care. Some of that revenue is reimbursements from Medicare and Medicaid.

"The Centers for Medicare and Medicaid Services, which are the single largest purchasers of health care, said, 'We are not going to pump any more money into the system,'" Hernandez continued. "'We have set the size of the pie. You need to divide the pie [differently] and will not get more just because you offer more services.'"

Collaborative care is more efficient and reduces costs through electronic record-keeping and fewer administrators, Steinle said.

"Medicaid is changing. Health outcomes are the thing, not services [rendered]," Hernandez said. "As these changes filter down, you are going to see the commercial health care providers piggy-backing off of that."

Another example of collaborative care is the planned Southeast Health & Wellness Center.

Central Health, the county's health care district, has hired a contractor to build the center at the former Veterans Administration Austin Outpatient Clinic site on Montopolis Drive.

The facility will include primary and specialty care, mental health clinics and meeting space in its first phase, slated for completion in October 2014. Phase 2, which will include radiology, a laboratory and a pharmacy, will be complete in October 2015.

Medicaid reform was in the spotlight in Central Texas in 2012 when voters approved Proposition 1. The ballot measure is best known for supporting the creation of a new medical school, but it also raised local property taxes to take advantage of a Medicaid waiver to change how health care was delivered locally.

The goal is to move away from emergency room care and toward more preventative, outpatient and community clinic care, according to Central Health.

Hernandez called the rise of urgent care centers a niche market that is attempting to deliver emergency room care at a lower cost.

"As we move to a more integrated system, those urgent cares will get pressed into joining certain networks to get access to patients that fall inside of a certain system," he said. "Most patients will end up in a large delivery network and get their care through that delivery network."