A group of local investors tired of being forced to drive to Salt Lake City and Las Vegas for access to medical and surgical specialists have engaged Maria Todd to research a new physician specialty clinic project to meet the needs of patients from St George, Ivins, Washington, Santa Clara, and other nearby communities in Southern Utah as well as from Mesquite, Nevada and Beaver Dam and Littlefield, Arizona. Currently, these residents have to drive as far as Provo and Salt Lake City to the north or to Las Vegas, 112 miles to the south to access care. Appointment scarcity is also an issue with many specialists booking 2-3 months in advance. The new clinic project would likely be staffed by independent full- and part-time physician specialists willing to come to see patients in the Snow Canyon area in an innovative space-sharing business model with centralized management and operations.
“In Utah, corporations can provide medical services as long as the corporation does not interfere with the physician’s independent medical judgment” says Maria Todd, a veteran consultant with more than 35 years of experience in healthcare business administration. Todd is a new resident living in Entrada at Snow Canyon, a top ranked retirement community known for its year-round golf, desert climate and 300 plus days of sunshine.
With its private gated golf community of fine custom homes surrounding the Johnny Miller Signature Design 18-hole golf course, the community boasts the number one rated year-round golf course in Utah, an award winning clubhouse, luxury spa, quality sports and fitness center, and the five-star Inn at Entrada. The active Entrada community attracts both the young adult and adults who are young at heart, among them, many affluent working and retired executives with its resort quality amenities and rich social life. The drawback? Not enough doctors and not one concierge medical practice for those who want that level of service and had it prior to moving to Southern Utah.
Orthopedics, Joint Replacement, Neurology, Rheumatology, Psychiatry, and many other specialties are critically underserved. Meanwhile, “the area continues to attract new residents at an amazing rate of a little over 3% a year,” says Todd. The state of Utah as a whole is believed to be growing its population at a rate about double the national average, mostly due to “natural growth” that comes with having more births than deaths. But it also sees growth due to its attraction to retirees and a fast-growing economy that encourages move-ins. Of the St. George area’s 2016 overall increase, 3,285 new residents were attributed to new residents who moved in from elsewhere – many from colder climates and others from Southern Califorina. The same attraction factors that attract new residents to this area should attract new physicians and surgeons, but it hasn’t…or at least, it hasn’t kept pace.”
“A lot of doctors in St George are employed by Intermountain Healthcare, a not-for-profit healthcare system and the largest healthcare provider in the Intermountain West, but for whatever reason, strategic, employment offers, or something else, the medical community isn’t keeping pace. I’ll find out why eventually as part of my research.”
The award-winning local hospital, Dixie Regional does a great job and has a fiercely loyal following, attracting patients from Mesquite to the south and all throughout the Southern Utah/Northern Arizona region. Led by a very capable and affable administrator and executive team, Dixie Regional boasts a strong and supportive foundation, and is doing all that they can to grow the healthcare delivery system and services in southern Utah, most notably with its new comprehensive cancer center is the future of medicine.
The new cancer center features a “medical home” for research and a place for patients to receive care, filled with science and technology that is advancing the care of cancer close to home. The new site, currently under construction will be equipped with radiation oncology, medical oncology, and all of the components of treatment and Stanford University, Precision Medicine, and the Translational Science Center. It will tap into Intermountain’s huge biorepository of over 4-million tissue samples to advance research and treatment. Virtually any specimen that’s been collected since the mid-70’s has been stored and saved, and what’s really unusual is Intermountain knows the health histories associated with those samples. They’ll be able to look at the DNA of the tissue samples to identify possible genetic traits known as biomarkers that can lead the doctors and researchers there to provide more precise treatments. But first, people need to be able to get an appointment with a primary care physician when they notice symptoms so that they can access early intervention. “Right now we have the moon shot, but the launch pad (primary care and many critical specialties) can’t handle the traffic to get there,” says Todd.
“We’re at the saturation point and patient care is beginning to suffer because of it.”
At the same time, Todd has been listening to stories from friends, family and neighbors about physician access issues, long waits for appointments — sometimes several months, and some horrific physician insolence most likely arising from the frustration of feeling overwhelmed with too many patients and too little time. Donors to the Foundation report being sent letters saying “you have 30 days to go find yourself another doctor” and wondering who will care for them. Todd has heard stories from seniors being overprescribed opioids and steroids to mask pain and discomfort without vigilant management. Other alarming signs and symptoms like doctors standing in the exam room with a hand on the door and feet facing the exit while talking to patients seated on the exam table, or crowded waiting rooms with standing room only and doctors running habitually late for scheduled appointments by more than an hour are indicative of a stressed medical community. “We’re at the saturation point and patient care is beginning to suffer because of it” she says.
For active seniors, opioids and steroids may be a temporary fix in the short term, but opioids have so many nasty side effects. Doctors prescribe corticosteroids and glucocorticoids for a variety of acute, immediate conditions such as asthma, arthritis, lupus or skin problems, to reduce activity of the immune system and therefore help reduce inflammation. But that’s not all they do. They can reduce your ability to fight infections, cause weight gain, increase fluid retention and raise blood pressure, cause hardening of the arteries, raise blood sugar levels, cause mood changes that could mimic early signs of dementia, cause insomnia, contribute to stomach ulcers, suppress adrenal function and your ability to deal with physical stress, reduce bone mass and increase your risk of osteoporosis and fractures, worsen glaucoma and worsen or cause cataracts.
“I recently attended a Meetup for newcomers to St George. A nice man seated next to me told me he and his wife relocated to St George because of the warmth from a colder part of Utah. He has Multiple Sclerosis, and there’s no specialist here to care for him. I’ve seen people with visible symptoms of rheumatoid arthritis in their hands and asked who they use for rheumatology. They tell me they have to drive 3-5 hours for their appointments. When my husband need a certain diagnostic test, I had to call on contacts from medical tourism community in Las Vegas to get him an appointment without a 4 month wait. Every person we ask about establishing with a primary care physician says “I use Dr So and So, but he’s not taking new patients right now. With the rate of new residents moving into Entrada, I can safely assume we aren’t the only ones hearing these stories. My neighbors are active. They play golf, tennis, pickleball, and do their best to stay fit and active. After working so hard during their working lives, they are frustrated by the fact that they can afford the medical care they need, they have insurance, but care isn’t accessible without planning a road trip and driving for hours to get there.”
Accelerating the Expansion of Healthcare Access through Innovation
“We need a better solution for a population with these and other conditions, and the best solution is an increase in the number of specialists and surgeons who have time to consult, explain, monitor and pivot to an alternative treatment plan if something’s not working. That’s not possible with the way things are here in Southern Utah, Todd explains.” But these days, many doctors – especially those who just completed their residencies or fellowships, are heading for hospital employment instead of private practice because the administration and office rental is centralized and taken care of for them. Todd believes that some would be attracted to Southern Utah if there was an alternative.
That alternative might be a part-time expansion office where doctors from other areas see patients in St George and need only bring their lab coat and their stethoscope. Everything else is there for them: a fully outfitted medical suite, a trained team of assistants and nurses, adequate help to schedule tests and referrals, insurance contracting and billing, electronic medical records accessible from anywhere, an attractive, upscale waiting room, marketing and advertising to get the word out, and full service diagnostic testing nearby. The lawyers will work out the business model for who pays what and how and how revenues and overheads are dealt with. The regulatory compliance aspect is something that, while complex, is not that daunting to Todd, given her past work experience.
Urgent Care Fails to Pick Up the Slack
Currently, St George has little in the way of walk-in urgent care. It doesn’t exist on weekends or late evenings or early mornings. That forces people to use the Emergency Department when that level of care is both costly and excessive.
“And when you read the social feedback on the closest urgent care location to Entrada, Ivins and Santa Clara, the comments aren’t all that wonderful. People deserve better — better access and better manners than what’s been posted”, says Todd. While Todd takes the posts with a grain of salt because people who are unhappy tend to post comments more than people who are pleased with the service, there’s a theme to those comments and they are consistent across several different ratings platforms.
Todd, soon to be 61, draws from her past work experience as a medical practice and surgery center administrator and as a surgical nurse. Her healthcare business development goes back as far as the early 1980s and she’s advised doctors, hospitals and healthcare investors and venture capitalists on healthcare business strategies for their projects in 116 countries. The fact that she and her husband now reside in St George makes this project personally relevant, rather than simply one of many other consulting engagements.
Currently in the ideation stage, she will use the rapid sprint method of ideation and research that she currently uses to design concierge medical practices for physicians around the country. Google Ventures uses a similar design sprint process to help entrepreneurs and startups answer critical business questions through design, prototyping, and testing ideas with customers.
The first step is feasibility. In additional to a feasibility assessment, Todd will review things like the Interstate Medical Licensure Compact, enacted in 2015, as a means to attract physicians licensed in multiple states. To attract physicians interested in part time practice, she’ll also analyze the best way to get physicians to the area from a distance too far to drive. The St George Airport has a beautiful FBO for physicians who are private pilots who may want to fly to St George for a day or two, play some golf, see some patients, and fly back and manage via telehealth in the interim between visits to St George. In that case, the project may require overnight accommodations to be arranged similar to the way commercial pilots use “crash pads” around the country to stay overnight at locations they visit frequently. One alternative would be to outfit a house purchased or leased by the corporation for that purpose for those who need it, similar to a short term lodging arrangement available only to the doctors and their travel companion. Uber and Lyft are already present making transfers from the FBO to the clinic and accommodation easy.
She’ll also investigate state of the art telehealth and how receptive senior patients might be to using telehealth to contact their doctor between visits. She’ll also need to identify appropriately equipped, “Class A”, triple-net leased medical office space, which is scarce in the Ivins, Santa Clara and the upmarket Snow Canyon communities. The facility to house the clinic services may need to be developed. How much space is required is related to scale. Depending on the number of physicians attracted to the model, the building must have the space available to expand to more exam rooms and staff support areas without delay. Design requirements are very specific for medical use. Not every building that currently exists will be suitable.
Physicians and investors, media and medical equipment suppliers interested in learning more about participation in this new venture should contact Todd at 800.727.4160.