Choosing employees carefully and treating them well fosters staff loyalty and longevity unalterable by the strongest of storms, says radiation oncologist Bernard Lewinsky, M.D., owner of Western Tumor Medical Group in Los Angeles.
He knows of what he speaks. When his daughter, Monica, was caught up in the political tempest of President Clinton's impeachment, his employees remained steadfast.
Despite a media invasion of Lewinsky's three cancer centers, so did his patients. "Amazingly, I never had a single patient who left my practice because of it," says Lewinsky, who finds solace outside the office in landscape photography. "My practice and my photography were my salvation."
Lewinsky's two vocations will meld when his pictures, long shown in galleries, grace the walls of his reconstructed WTMG center in West Hills, slated to open in late 2001. "The idea is to relax patients by letting their minds wander into the landscapes. By being relaxed and serene, the anxiety of getting the treatment is dissipated."
The 10,000 square-foot replacement facility will boast state-of-the-art information technology, high dose rate equipment, CT scan and two treatment vaults housing computer-controlled linear accelerators. But with a $5 million price tag, the enormity of the venture gives him pause.
"The total package is a tremendous investment, which becomes a real fear because of the reimbursement issue," he says. "It's a tremendous risk, with the government constantly cutting back on reimbursement and all of the insurance companies using the government as their standard."
That risk likely will grow, as Lewinsky's business plan calls for similar upgrades of his other centers in Sherman Oaks and Valencia.
Much has changed since Lewinsky, 57, joined the two physicians who owned 5-year-old WTMG in 1977, and thereafter paid $90,000 to become a full partner. The partners each sold Lewinsky their interest in the business when they retired in 1984 and 1998.
"The way I started, and the way I'm ending, it's a different world. Nowadays, everything is wrapped up in contracts. It's very complex. In communicating in the infrastructure of the medical world today, you can't just open up your door and hang out a shingle."
When he signed on at WTMG's original for-profit clinic in Sherman Oaks, it was one of the few freestanding radiation centers in the area, and private insurance ruled the day. That initial center was eventually augmented with facilities in Northridge, West Hills and Valencia.
During his 23-year tenure at WTMG, Lewinsky has seen private insurance lose significant ground to managed care. "Los Angeles and the (San Fernando) Valley have been the mecca of HMOs, and we got hit much earlier than anyone else in the nation. The impact on us was tremendous."
Managed care claimed his Northridge cancer center in 1995, Lewinsky says, when Northridge Hospital awarded its oncology contract to another practice.
Nevertheless, Lewinsky accepts all insurance and provides treatment to the indigent of Los Angeles County. "There are many physicians who will not take county insurance, who won't do HMOs. But in order to provide the care to as many people as possible, you have to accommodate them with whatever insurance coverage they carry."
A downfall of the practice is managed care companies that leave the market or go bankrupt. One large IPA, Family Health Care Medical Group, filed for bankruptcy in October. It covered 10% of WTMG patients and had more than $35,000 in outstanding payments on the books, Lewinsky says.
Still, he strives to offer quality care for his 750 patients, despite such setbacks and slumping reimbursement. With oncology patients expecting cutting-edge treatment on one hand-and his commitment to properly compensate his 17-member staff and maintain cash flow on the other-achieving balance is a challenge. "That's a really tough thing to do."
Purchasing equipment capable of delivering superior treatment is appropriate and justifiable, he says. Yet adding new apparatus just because patients demand "the latest" may increase market share and possibly reduce side effects but does not necessarily enhance cures.
"You don't need a Rolls Royce to get to downtown L.A. You can get there in a Chevy. But everybody expects to get there in a Rolls Royce." The decision to replace equipment, he says, is most often a business one.
Doctors today are increasingly required to make such business judgments, he says. "As physicians, we're not trained in business. We're trained to take care of patients. Sort of by force, we have become involved in the business management. I think back in 1969, 1970, we never even dreamt about what financial and business acumen would be required to run a practice."
Lewinsky's apparent acumen and attendant success were revealed in news reports during the impeachment crisis. "When my income and financial status were broadcast--and often incorrectly--it was an embarrassment for me to know that my colleagues and patients were exposed to that information, and therefore I prefer not to discuss this matter."
Citing overhead running 75%, he says continuing reimbursement reductions have triggered economizing. "The cash flow for us has remained relatively steady, and to compensate for increasing costs, we have had to be very cost efficient."
With an eye on retiring in about 10 years, Lewinsky's long-term goal is developing WTMG into a business in which young radiation oncologists will be willing to invest.
The West Hills center features a comprehensive prostate cancer treatment program, considered a regional forerunner in radioactive implants, Lewinsky says. Shifting demographics due to the aging baby-boomer population are expected to increase the need for such treatment in coming years.
In Sherman Oaks, animals are treated three afternoons a week by Rodney Ayle, D.V.M., the only board certified radiation oncologist veterinarian in Los Angeles. That unusual endeavor was launched in response to repeated requests from pet owners, Lewinsky says. One of the first patients was a San Bernardino Zoo snow leopard, stricken with jaw cancer last year.
"Amazingly, when we first started talking about this, we thought that this is something the patients would abhor. But it's been just the opposite. They love
Lewinsky also continues to enlarge his staff and is putting out feelers for a radiation oncologist to join the two already on board.
While major decisions such as recruitment still fall to him, Lewinsky says, he is sleeping better these days. He recently hired a former hospital administrator to oversee various aspects of business for WTMG, including contract negotiation.
"He has taken over the micromanagement of the practice. It has opened up the opportunity to just concentrate on the patients."
Still, caring for oncology patients remains inherently stressful. That's why he places a premium on benefits, which include not only health insurance, 401(k) and multiple weeks of vacation, but a generous Christmas bonus and four rest and relaxation days each year.
"We have a very stressful job. People burn out. And so you have to be prepared to meet the needs of the staff and pay them well," Lewinsky says. "The proof of the pudding is that the vast majority of my employees have been with me for many, many years," he adds.
Dennis Hulet, healthcare management consultant with Milliman & Robertson in Seattle, says specialized medical clinics such as cancer centers frequently see a particular patient group and therefore tend to offer the most efficient and highest-quality care. But the emotional drain of seeing very sick and dying patients results in high staff turnover.
Jan Collier vividly recalls her years as a radiation technician in Lewinsky's "compassionate" employ before she ventured professionally into the world of art the two still share. She is a Mill Valley, Calif.-based commercial artists' representative; examples of his photography are on display in her home.
"Although it was the most stressful job I've ever, ever had, Bernie created an emotionally supportive environment for patients and staff alike--by being accessible, regarding everyone as whole people and adjusting to the capricious business of medicine with grace," Collier says. "All of that, along with perks that helped us maintain our equilibrium, enabled staff members to thrive despite the stress. And we formed bonds that persist to this day."
Linda Boone Hunt is a Prescott, Ariz.-based investigative reporter and feature writer.