Mid-Atlantic Hospitalist Group Expands With Like-Minded Firm, Expects 2018 to See Additional Growth Opportunities

In 2017, large healthcare mergers dominated the headlines, but as 2018 begins, a smaller player in the hospitalist space made its first acquisition, for the same reasons as its bigger relatives.

Adfinitas Health is the largest private hospitalist group in the Mid-Atlantic region, operating in Maryland and Virginia, as well as Michigan. Earlier this week it announced it moved into the Pennsylvania market by acquiring the majority of Advanced Inpatient Medicine (AIM). Terms were not disclosed.

Based in northeastern Pennsylvania, AIM is a regional private hospitalist group that serves 4 hospitals and several long-term acute care and skilled nursing facilities. The company and its nearly 40 employees will become part of Adfinitas Health, which currently partners with 14 hospitals and more than 40 post-acute facilities. Together the combined company will have just under 500 employees. The founder of AIM, Louis O’Boyle, DO, retains minority ownership and will remain with the company.

The 2 companies are very similar, making the deal attractive, Idara Nickelson, the vice president for business development at Adfinitas, said in an interview with The American Journal of Managed Care.^®

“It’s the first acquisition in the history of the company,” said Nickelson. “We’ve been looking to grow pretty aggressively in the mid-Atlantic region.” She said that “both companies share a strategic alignment” in how they approach care.

Both companies use an integrated staffing model with nurse practitioners (NPs) and physician assistants (PAs) working at the top of their license as advanced practice providers (APPs) in care teams with physicians.

Adfinitas takes the APP model farther by requiring employees to take 6 to 12 months of additional training and education with the company, including both critical care and leadership and professional development. Nickelson said they built upon the curriculum designed by the Society for Hospital Medicine.

Training includes soft skills such as leadership management, peer collaboration, performance management, and effectiveness.

Nickelson said they have high expectations around collaboration and want to get away from the “lone wolf” mentality sometimes common in healthcare.

“We come at it from a real team approach,” she said.

The formal training program is only for new hire NPs and PAs. However, when they are assigned to a site and begin their on-site training with clinical instructors, current doctors and APPs may also attend, she said.

A study published in JAMA Internal Medicine in December 2017 found that patients treated by physicians in their first year as hospitalists have worse 30-day and hospital mortality when compared with more experienced hospitalists. The study found early-career hospitalists may benefit from increased support and reduced caseload.

Nickelson agreed with the study, stating that is “why there is not necessarily a hard stop to the training program at 6 months. We have some APPs that have remained in training for as long as 18 months because we felt that they needed additional supervised, formal training with a clinical Instructor. Also, our physicians, medical directors, and lead APPs maintain close supervision of our new hires even after training to provide support, ongoing clinical education, and mentorship—it’s a continuous learning process, with strong monitoring and feedback loops. Our programs are successful because an entire ecosystem that supports the success of our clinical teams, especially our APPs. The training program is just one component.”

Integrated staffing models can improve quality metrics while creating cost savings, Nickelson said. It works particularly well in areas where there may be a physician shortage, for example, or spikes in salaries, with “no decline in quality,” she said.

For example, a recent 18-month study conducted by Adfinitas (which changed its name last year from Physicians Inpatient Care Specialists) found that including a higher ratio of PAs on a care team with doctors saved health care costs without affecting quality.

From a workplace standpoint, Nickelson said their staffing model can have a positive effect on issues like physician engagement and preventing burnout by segregating the patient mix according to high/low function and severity and not just by volume.

For millennial physicians looking for an improved work/life balance, there are more predicable schedules, salaries and benefits, as well as different career paths, such as medical director, clinical director or director of observations.

Nickelson said, 2018 will undoubtedly bring challenges and opportunities, and that means other possibilities for acquisitions. As hospital chains continue to merge, they may find it challenging to focus on both quality metrics and managing staff, so there may be opportunities in markets that were previously closed to the idea of outsourcing, she said.