Chief puts focus on quality of care

Debra A. Geihsler , chief executive of Harvard Vanguard Medical Associates and an affiliated organization of medical groups called Atrius Health, grew up on a farm in rural Nebraska. She attended a one-room schoolhouse and learned to drive a pickup truck at age 10. Recruited from a Chicago healthcare network last year, Geihsler, 53, spoke with Globe reporter Christopher Rowland about her new job running one of the largest physician groups in New England serving 600,000 patients.

Q From a competitive standpoint in the Boston healthcare market, why is being big important?

A I don't look at physicians as competitive. We're just focusing on quality. We have 700 physicians, 60 percent of them primary care doctors.

Now that we have one electronic medical record, we want to become proactive about managing patient care. We need to become as efficient as a dentist. None of us would think about skipping a dental appointment.

Q But doesn't your large size help you get better insurance contracts?

A I hope that payers believe that because of our size and because of our mix of services, we can manage the resources better and be a good partner with them. I'm very much an optimist, and I like to believe in the goodness of people.

Q But you have a certain amount of market leverage, too -- you can't deny it.

A We do. But I hope they choose us because of our quality.

Q Are patients more sophisticated in what they ask for?

A They are asking a lot of questions, but there are a lot more options, too. It's more complex. The primary care provider needs to be a good navigator. If we leave it up to the patients, it's not a good thing.

Q Where are you headed in terms of having your own MRI units, radiation oncology centers, and surgical outpatient centers?

A We have a cancer center on the South Shore that is opening May 1 -- a joint venture with Commonwealth Oncology -- and we have an MRI in Braintree that opened a year and a half ago. We don't have a surgery center. There are legal hoops to go through -- right now in Massachusetts they can only do single-specialty surgery centers. There is still that fear sometimes in the community about the physicians having too much control or power.

Q The hospitals don't want the competition?

A Part of my career was on in the hospital side. To me the best of all worlds would be if we all got along and saw the whole continuum of care and said, "How can we best collaborate?" But that's my over-optimistic viewpoint.

Q As you get bigger, how are your relationships changing with hospitals. Where are you referring to?

A We have patients that go to Brigham and Women's Hospital, but we have patients who go to all hospitals.

We're also looking more at what kind of services are we providing in our offices in the community. It would be great to have kind of one-stop shopping for our patients. Our focus is to keep patients out of the hospital. If we're doing our job as best we can, patients should have to go to the hospital very minimally.

Q Do you feel like managed care will come back into the market?

A There will be some refinement of some managed care type of product that will come along. We need to be rewarded for keeping people healthy, and not just rewarded for addressing the sick.

Q What were some experiences growing up in Nebraska that help you now?

A Because I grew up poor with no benefits, I respect doctors for the work they do. I never saw a dentist until I was 18, and I never saw a doctor.

I stepped on a nail every year of my life, and my mother would pull it out and just wrap it up with Epsom salts and say that was your only pair of shoes, so forget it.

One time my dad fell on a piece of sheet metal and it went all the way through his arm. She pulled it out, wrapped it up with a dish towel, and said get back on the tractor. Pretty soon, we saw the tractor weaving all over, and he had passed out. No one had any health insurance, so it was pretty tough.