Molpus: So if you're getting paid on reducing overall growth costs, where do you put the effort? Is it in chronic care? Is it in diabetes?
Jeffries: We're going to go for the low-hanging fruit, okay? They're going to produce a list that's going to show us—however you want to view it, the top 200, bottom 200—in terms of cost expended to an individual patient. We're going to begin to look at those and try to make obvious savings where we can on ER visits, etc. We found one patient who had 42 ER visits in one year to eight different ERs and spent $81,000. I mean, that's pretty low-hanging fruit when you get right down to it. Now not all of them will be that straightforward, but then we're going to look at the chronic conditions of diabetes and hypertension. Those are all things that are very doable and we could easily see a 4% savings against the trend just doing those things.
Molpus: Tim, you made the move to integrate the hospital and clinic years ago. How has that evolved as you face the new challenges like medical home?
Rice: One of the first things we realized as we got into it was how little we knew about the clinic business. When we integrated, we had specific staff and compensation models that we felt would be the one that we should utilize. And as we got into it even with the initial medical director, we realized that a lot of them wouldn't work. So over time it just continues to evolve, and it really has got to be fluid. You develop a model that you feel that works both operationally, fits the practice in the organization and what's changing in the market. We do use RVUs. We have some on salary. We have developed a set of bonuses over time. We're now working on a shared [bonus] regarding a medical home, but even if you come to terms on a specific relationship, you don't catch everything. So if something does come up during the year, you still do what's right and you make those modifications.