On July 12th, a widely known, highly accomplished emergency physician from one of the country’s finest academic institutions tweeted the announcement that Dr. Jesse Pines had joined US Acute Care Solutions:
wow, I missed that @DrJessePines is moving to @USACSolutions
Congrats to Jesse and huge gain for USACS.
interesting data point in shifting sands of HC… academia vs. private markethttps://t.co/1SERPdKxL3
— Jeremiah Schuur, MD (@JSchuurMD) July 12, 2018
Shifting sands indeed. The last half-decade of consolidation in healthcare has left few corners of the industry untouched, and that includes emergency medicine groups.
As insurers and health systems consolidated, US Acute Solutions has grown in to the largest physician-owned emergency medicine group in the country. This size and model present an opportunity for academically-minded physicians like Pines.
“A number of things sparked my interest in leaving academia,” said Pines in a recent interview. “The central one is the ability to have a much bigger footprint for actually testing innovative ways to deliver emergency care.”
Practicing Science-Based Medicine
Pines has collaborated for years on research with USACS physicians, including National Director of Clinical Education Dr. Jestin Carlson and Dr. Arvind Venkat, who currently serves as Vice Chair for Research and Faculty Academic Affairs in the Department of Emergency Medicine at Allegheny Health Network.
The three were co-authors on a study, released early in 2018, that examined whether various indicators, including individual Press Ganey scores, were predictors of whether emergency physicians would later be named in malpractice cases. The paper’s biggest conclusion was that Press Ganey scores depend far more on the institution where the physician works than the individual physicians. If your institution as a whole is doing well, chances are the physicians working there are scoring well. Take the same exact physician and put them in a different institution, and the scores will likely shift to reflect the environment. Pines also has and is collaborating with Carlson on several other projects that touch on studying medical malpractice in emergency medicine, as well as Medicaid expansion.
What Pines appreciated is that USACS actually changed the way it does things as a result of the Press Ganey study. According to USACS Chief Medical Officer Dr. Amer Aldeen: “We continue to focus on the individual, but we’ve stepped up our focus on involving the entire team and team dynamics rather than purely individual improvement.”
It makes sense from a patient perspective. After all, the patient has a whole team at their disposal, and their experience at the hospital will reflect whether that team is working well overall. “Previously our training was more individual-based, but we’ve shifted to make it clear it’s the entire team that matters,” Aldeen said.
This willingness to embrace change in the face of new data made a big impact on Pines. “I realized this is a company that really takes data seriously as well as innovation and is willing to really invest in good science and delivery system changes,” he said.
From Academia to “Priva-demic”
Pines was already considering a move when the study came along. He had been in academics for his entire career, publishing more than 280 peer-reviewed academic papers amid route to becoming one of the country’s premier health services researchers in emergency medicine.
Pines holds a BA and a Masters of Science in Clinical Epidemiology from University of Pennsylvania, and an MBA from Georgetown University. He did his residency in emergency medicine at University of Virginia Health Sciences Center and completed a research fellowship, also at Penn. He served as faculty at Penn’s School of Medicine for five and a half years before moving to George Washington University in 2010.
While in D.C., along with serving in leadership positions at GW, Pines became a Senior Advisor to the Center for Medicare and Medicaid Services Innovation Center and consulted with both the World Bank and the National Quality Forum on patient safety and emergency care.
“Very smart people in very high places ask him for advice. He’s also extremely hard working, and also extremely humble,” Aldeen said. “The humility I think really speaks to the heart of being an emergency physician. He knows enough that he knows what he doesn’t know.”
“When someone of his caliber indicates some kind of interest in making a move, we take that very, very seriously,” Aldeen added.
Pines said he raised the possibility of potentially making a move with Venkat nearly a year ago. Then, early in 2018, he began having discussions with Aldeen and others at USACS, including Dr. Dominic Bagnoli, CEO at the time. Bagnoli is now Chairman of the Board.
In the Spring, Pines met with USACS leadership to discuss his ideas for innovation within emergency medicine, new approaches to acute unscheduled care, and creating systems of incentives for departments to deliver better value-based care. Specifically, he discussed ways of making acute unscheduled care better for patients, bringing access to emergency physicians closer to the point of injury or illness, and extending the ED visit beyond the four walls of the ED to improve transitions in care.
In July, USACS announced that Pines would officially join the group as its National Director of Clinical Innovation.
“The opportunity came along to think about how I could innovate on a bigger level,” Pines said. “And not just writing about innovation, but actually doing the innovation with a large company that had a lot of physicians and a lot of hospitals, that has a great reputation, a great footprint, as well as people that I’ve known for a long time who really want to invest in innovation.”
Pines also said USACS’ blend of academic sites and community hospitals was a key differentiator for him. USACS currently manages and staffs eight emergency medicine residency sites throughout the country. “They are one of the only groups that is a hybrid between private and academic.”
Aldeen dubbed this model “Priva-demic,” in that the group’s physician leaders have a strong background steeped in academia. “We’re a private group with an academic flair,” he said.
A Growing Trend
It’s not just Pines who has joined USACS. The opportunity to innovate in emergency medicine at this scale is drawing other renowned educators and academics. USACS recently announced that Dr. Amado Alejandro Baez, an internationally-recognized researcher and physician leader, is joining the group as Medical Director at Florida Hospital Tampa. Meanwhile, in June, Dr. Michael Beeson joined USACS as Program Director at Summa Health in Akron, and last year USACS announced Dr. David Seaberg would become Chair of the Department of Emergency Medicine at Summa.
Aldeen said that the community of emergency medicine is taking notice, at times with some combination of incredulity and wonder. “We are seeing a trend, and I think we’re seeing it because we have the physician ownership model,” Aldeen said. “We respond to data, and we respond in a way that helps patient care.”
Pines agreed. “The people who really understand systems are those who implement systems and live in the real world,” he said. “I think academicians, myself included up until this point, to some degree have not been in the real world when it comes to really changing care delivery in an impactful way. That was one of the things that attracted me to USACS.”