Late-night snack inspires medical group’s plan for a 24-hour office

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“There’s a Dunkin’ Donuts down the street from me. It’s 24 hours. So I would be leaving the hospital, going home, and it’s like 11 p.m., and no problem, I can get a doughnut. But if a patient has chest pain at 11 p.m., there is nowhere in the country they can see their primary doctor. I found that kind of ridiculous.” — Dr. Zeyad Baker, one…“There’s a Dunkin’ Donuts down the street from me. It’s 24 hours. So I would be leaving the hospital, going home, and it’s like 11 p.m., and no problem, I can get a doughnut. But if a patient has chest pain at 11 p.m., there is nowhere in the country they can see their primary doctor. I found that kind of ridiculous.” — Dr. Zeyad Baker, one of three principals of Riverside Medical Group

Doughnuts and doctors don’t necessarily go together, but they are serving as the genesis for Riverside Medical Group to explore a new medical business model: A doctor’s office that is open 24 hours.

“If they can figure out how to get doughnuts to you at 11 p.m., and coffee, how can you not take care of someone that needed you most?” asked Dr. Zeyad Baker, one of three principals of Riverside Medical Group, which plans to move to an always-open model later this month in its Secaucus location, if successful, expand the program to other locations.

He admits the plan is ambitious. But he says a combination of sufficient funding, solid relationships and a full team of residents will help his group pull it out.

And improve the overall health care experience in the process.

 “I’m not arrogant enough to think that the doctor, anymore, matters in the health care experience,” Baker said. “You are lucky if 10 percent of your visit is with me.

“We are improving; it’s not like we are 100 percent. We see about 2,000 patients a day. It’s not like I don’t get complaints. “

In the past three years — half the lifespan of the medical group — Riverside has grown from serving 90,000 patients to at least 160,000, as well as growing from 15 sites to more than 65.

Baker estimates a growth in revenue of about 35 to 40 percent per year, almost double the lowest average growth for physician groups, in the past three years.

“I can tell you that we are among the most cost-efficient models in the region — despite sitting in the heart of the most expensive inpatient region in the country,” he said.

John Tedeschi, a well-known longtime physician in the state and CEO of Continuum Health Alliance, said the average rate of growth is anywhere between 15 to 30 percent, depending on the size of the group.

Riverside’s humble beginnings are rooted in Jersey City, where it began as a pediatric practice started by Baker’s father 37 years ago.

The three sons — Zeyad, Iyad and Omar — say they are carrying on their father’s legacy by expanding it into the robust group it is today.

Currently affiliated with Hackensack University Medical Group, Baker said Riverside has “outgrown” its market after three years and is looking to expand out of the region — specifically into New York City and Philadelphia, where discussions are already underway.

For the past five to seven years, hospitals have been buying out or leasing space to doctors with the goal of controlling the population’s health through physicians, and increasing their urgent care partnerships. Hackensack, for instance, is expanding its current partnership with CityMD, a New York City-based urgent care center, throughout the North Jersey region.

Baker said his model follows the physician-first strategy, giving the physicians and specialists the upper hand.

“Urgent cares are a very short, insufficient answer to a long question,” he said. “Even though they are successful, we don’t think you have to choose between access and quality.

“What I used to hear my first year is that patients would rather get sick than navigate the health care system.”

In order to staff the expanding practices, Riverside has developed strict guidelines for partner specialists to follow, as well as pooled from former residents.

At least 50 percent of recent hires are ex-residents, Baker said, adding he has the largest non-hospital residency programs in the state.

Students from Columbia University in New York City, St. George University in the Cayman Islands, and Rutgers University are at Riverside.

Iyad Baker, Riverside’s chief medical officer, and director of the Family Practice Residency Program at Palisades Medical Center, said the residency program benefits both students and staff.

“Whereas most physicians are not keen on teaching and maintaining an academic culture once they’ve gone into private practice, we actually insist on it at Riverside,” Baker said. “We firmly believe that by requiring that our providers teach students and residents in our offices, they are never too far from academia, and this serves to keep them always abreast of the most current medical advances. This, in our view, can only translate into better care for our patients.”

Partnering with specialists is a little harder, because Baker wants to make sure the specialists work with him to meet his goals of serving the patient as quickly and efficiently as possible.

Riverside has an in-house call center with staff who will find a specialist, book the appointment and work on the insurance calls for the patients — all within 48 hours. If they can’t comply, Baker refuses to work with them again.

Having that level of access was the goal Zeyad Baker said he started off with.

That is when the more than three-decades-old pediatric practice added adult medicine to all its locations six years ago.

Then followed the same-day appointment guarantee, coordination with specialists and late hours; and the subsequent growth in volume has helped leverage solid insurance.

Riverside is also testing two telemedicine programs, Honolulu-based MedX and New York-based pingmd.

“It’s about convenient care,” Baker said. “Most doctors are stuck and saying, ‘Well I’m the doctor, this is my schedule and you have to fit into it.

“Well, sorry, that’s gone. Patients are demanding and they want more, and it’s not unreasonable.”

Though one of the current buzzwords in the industry is “patient-centric” care, Baker believes it is being used loosely across the health care spectrum.

“Does the hospital guarantee that I’m going to see my specialist that day every time? Absolutely not. Then how are you patient-centric?” Baker said, as an example. “No matter what you do, we will only accept the insurance payment and not anything else. That’s not patient-centric.”

Which is where the idea to have Riverside handle the coordination of care came from.

And like many family-owned practices, the ultimate goal of care stays on. One recent example Baker shared was an Indian family in Jersey City, which just welcomed its second child. The grandmother flew in from India to lend a helping hand, but does not have health insurance.

“She doesn’t have health insurance, no problem, I gave her the flu shot for free. The flu shot costs me like $8. I understand the economics, but the economics here is I built a loyalty with that family. That’s the best ROI in the world,” Baker said.

The change in attitude toward care has driven growth “more than I’d ever imagined,” he said. And that has resulted in an increase in revenue.

But the growth of patients also comes, in part, as a gift from being located in northern New Jersey.

“Word of mouth is No. 1, by far. The density of where we live, word of mouth is critical,” Baker said. “It’s driving the growth.”