Physician-Owned Doctors Hospital in Texas Attributes Success to Community Focus

With 503 beds, Doctors Hospital at Renaissance, in Edinburg, Texas, is one of the nation's largest physician-owned hospitals. Adjacent to McAllen in South Texas, it also is located in one of the nation's poorest regions. Despite this challenge, it was recently named one of Thomson Reuters' 100 Top Hospitals for the third year in a row. Its rapid growth and ability to meet quality and satisfaction standards in an area with significant economic and health challenges can provide a roadmap for other similarly challenged hospitals.

More than a decade of growth
A group of eight physicians formed Doctors Hospital as an ASC in 1997. Since then it has grown exponentially, receiving its hospital license in 2003 with 30 inpatient beds. Today, in addition to its 500-plus beds, it has grown to include some 400 physician-owners and an additional 50 investors from the local business community, says Susan Turley, the hospital's CFO.

One of the keys to its success, she says, is its investment of profits back into services needed by the community. "We took a look at the patient needs in the community and we developed the hospital around those patient needs," Ms. Turley says. "Over time as we grew, we would reinvest the profits year after year into what we needed here in McAllen."

That investment has paid off in state-of-the-art services available to the patients who visit the hospital. "Founded, built and operated by South Texans for South Texans, DHR works to ensure that medical marvels from around the world are available and attainable for everyone in our community," said Marissa Castaneda, the hospital's chief operating officer, in a news release announcing the Thomson Reuters top hospitals designation.

Booming economy, underserved patients
The border town where Doctors Hospital is located is a paradox of economic growth, with a thriving business community fed by Mexican maquiladoras countered by an impoverished and underserved patient base, 80 percent of whom are covered by Medicare or Medicaid. The hospital does not have many major commercial insurers in its market, Ms. Turley says.

Based on data posted in Dec. 2009 to CMS's Hospital Compare website, 73 percent of the hospital's patients said they would definitely recommend it to others, while another 22 percent said they would probably recommend it. The hospital was given a high overall rating by 71 percent of surveyed patients. As for care measures, Doctors Hospital at Renaissance scored above the national average on four of five applicable heart attack measures, four of four heart failure measures, five of six pneumonia measures and six of eight surgical-care improvement measures, according to the Hospital Compare data.

Doctors Hospital, which is about 80-percent physician-owned, has also been at the center of the heated political debate over physician ownership of hospitals. The new healthcare reform law makes new physician-owned hospitals ineligible for Medicare and Medicaid payments and also curtails the expansion opportunities of existing physician-owned hospitals. The leaders of Doctors Hospital at Renaissance say it is unclear how healthcare reform will affect their prospects for growth until regulations are released that explain the details of the law further. However, Ms. Turley says she is hopeful the hospital will meet requirements for expansions because of its underserved community. In any event, the hospital would need to get CMS approval before expanding its number of beds further, she says.

Attention to staffing and costs bring success
Ms. Turley declined to provide specific financial information for Doctors Hospital at Renaissance because it is a privately held partnership, but she says one of the keys to its success is an emphasis on strong staffing levels. "We have one of the highest nurse-to-patient ratios probably in the state of Texas," she says. The ratio is 1:5 on medical floors with the number of patients dropping as acuity levels rise.

The hospital also considers itself an efficient business model. "We have a very lean senior management structure," Ms. Turley says. "There is little to no bureaucracy in terms of middle layers and processes to go through." Because of the physician ownership structure and local involvement, decisions can be made quickly, she says.

The hospital's physician-owners are also very in tune with the cost structures for physician preference items, which helps when it comes to negotiating prices with vendors, she adds. "Because we're physician-owned, our doctors and staff have very good relationships," she says. "They talk to one another; they communicate better in terms of driving down costs and ensuring patients are in the acute-care facility for the amount of time they should be."

Keeping it local
When it comes to lessons other hospitals can learn from successes achieved at Doctors Hospital at Renaissance, Ms. Turley emphasizes a community-oriented patient focus. "You have to understand what your business is from the patient's perspective and devote the resources to ensure that their experience at the hospital is high quality," she says. "From a patient satisfaction standpoint, little things do matter."

For the predominantly Hispanic patients that come to Doctors Hospital at Renaissance, that means always having bilingual staff and caregivers on hand. The hospital has also made a point of engaging with the community and partnering with organizations to help bring educational and preventive resources to the McAllen area. The hospital helped create two associations to bring diabetes and obesity prevention education to the community, and it has affiliated with academic medical institutions to bring specialty physician services to the hospital, in addition to technologies such as robotic surgery.

"We believe that if you really focus on the community and the needs of that community, that you'll be successful in your business," Ms. Turley says.

Learn more about Doctors Hospital at Renaissance.