Merger of Stanford Health Care and ValleyCare Begins with the Start of a New Hospitalist Program

During a time of mergers and acquisitions in all manner of businesses, it should not surprise anyone to learn that Stanford Health Care has joined forces with a nearby community hospital. What might surprise, however, is the warmth of the merger and the excitement on both sides as the first new clinical program rolled out on August 1, introducing hospitalists from the Department of Medicine to the physicians, staff, and community served by ValleyCare, now known as Stanford Health Care - ValleyCare.

Stanford Health Care – ValleyCare’s hospital of approximately 200 beds is located in Pleasanton, about an hour east of Palo Alto. According to John Yee, MD, an internist specializing in pulmonary and critical care medicine, the ValleyCare Physician Affiliate Group has had the responsibility for covering unassigned inpatients from the Emergency Department for years. During a year-long transition prior to the merger, “other health systems around us tried to grab whatever market share they could grab,” he says. “We began to lose physicians, and our hiring process was frozen, so the remaining physicians not only had to cover the outpatients but also the unassigned inpatients of the physicians who left, in addition to their own outpatients and inpatients.”

Yee took aggressive steps. “As CMO, I rallied the troops, pressing even older doctors who have been in practice for 20 or 30 years to help cover the ED. We basically had an all-able-body alert in our group.” When the merger was completed in late May, as its first clinical program Stanford offered to introduce fulltime hospitalists. “It was a God-sent opportunity,” says Yee.

Neera Ahuja, MD (clinical associate professor, General Medical Disciplines, and director, Stanford Hospitalist Program) has overall responsibility for the new program. She sees it as a win-win for both doctors and patients: “Now physicians can focus on spending time with their clinic patients and not worry about rushing to the wards early in the morning or at the end of their day to take care of sick inpatients. The patients, the nurses, and the ED physicians will now have a physician available to be at the bedside as needed throughout the day.

“Because this program falls under the Stanford Hospital Hospitalist Program, and I head that one, I asked one of our talented hospitalists, David Svec, MD, MBA (clinical instructor, General Medical Disciplines), to help lead the program at ValleyCare. I can’t credit him enough,” she says; “he’s done an amazing job.”

Svec has already found his business education to be helpful at Stanford Health Care - ValleyCare. He is a believer in workflow processes, high value care (the best quality care at the lowest cost), checklists, and growing correctly. “We intend to provide 24/7 coverage,” he says. “Right now we are growing to that point, but it will take some time to ensure that we grow appropriately with both the academic and research missions of Stanford. I hope within 12 to 18 months we will be able to take care of a sizable majority if not all patients in the inpatient setting. That’s our goal.”

“On a day-to-day basis, we will have one hospitalist at ValleyCare all the time. We will most likely have several different teams eventually: a daytime team, a swing shift, and a nocturnist. We may also want to introduce a surgical co-management team, depending on the surgical volumes and if that is desired.”

He continues: “Two hospitalists are currently onsite fulltime: Minjoung Go, MD (clinical instructor, General Medical Disciplines) and Alex Chu, MD (clinical instructor, General Medical Disciplines). Both of them went through Stanford residency, finished on June 30, and took their Boards.”

One of the attractions for Go and Chu was being involved in a program that was starting from the ground up. Svec says, “Even during their Board preparation they helped out by creating templates and smoothing the workflow for the hospitalist team.”

For Svec, education follows right after patient care on his list of achievable goals. “One of the things about ValleyCare that excites me is the potential for continuing the educational mission of Stanford, having medical students, advanced residents, and physician assistant students train here.”

After only a few weeks praises were being sung on all sides. But this successful rolling out of the hospitalists could not have occurred without additional help from Brittney Kendall, Manager of Strategic Initiatives at Stanford Health Care - ValleyCare. Kendall’s role critically involves, as she says, “building out programs that add value from the perspective of our patients and driving communications among various disciplines in support of this vision.”

Her role has been significant, according to Svec: “Brittney has been extremely helpful with data that we needed in order to properly plan and properly structure the hospitalist team. She’s been able to find us the resources (a hospitalist workroom) and supplies (for example, a pocket ultrasound machine to enhance our physical diagnoses). She has helped us through the credentialing process, helped us understand what the current status is like, and helped us plan for the future.”

Overall, the hospitalists feel totally welcomed. Svec describes it: “I have to stress how supportive everyone here has been. I can only imagine how difficult it is for them to have brand new faces as well as a new concept of care. Yet from Scott Gregerson (Stanford Health Care - ValleyCare President) on down—nurses, pharmacists, patients, physicians—everyone is willing to help, provide insights, support the team.”

Given the auspicious introduction of the ValleyCare-Stanford hospitalist endeavor, it is not too early to ask how the team will define success. On their behalf, Svec responds: “When we are able to provide educational opportunities and research opportunities as well as excellent patient care in this uniquely different environment.”