Over the past 10 years and between 10 Charlotte-area offices, close to a half million patients have come through Carolina Digestive Health Associates, P.A. seeking screening, diagnosis or treatment for digestive conditions and illnesses. Thirteen doctors—gastroenterologists all—and eight physician extenders make up the medical staff which provides these services. The group caters to an adult population over sixteen years old.
“The easiest way to think of what we deal with is everything within the intestinal track from the mouth to the rectum, including the esophagus, stomach, small intestine and colon,” says Dr. Glen Portwood, MD and chairman of the board for the practice. “In addition to that, are some of the solid organs such as the liver and pancreas which produce enzymes and participate in the digestive process.”
Both Portwood and Preston P. Purdum III, MD, a co-partner in the practice and the former chairman, enjoy the investigative nature of the field. “Often, patients who have seen a lot of other doctors come in for consultation. We’re trying to figure out what is the complexity of this patient; what is their diagnosis; what will establish health or symptom control to give them the highest quality of life,” shares Portwood.
“I love the Sherlock Holmes side of medicine instead of, say, surgery,” says Purdum, who has been with the practice since its beginning in 2001.
The roots of the practice
Carolina Digestive Health Associates started with a merger of two practices, explains Purdum. He was with the downtown group of Charlotte Clinic for Gastro-Intestinal and Liver Diseases which joined forces with University Gastroenterology. The merger made sense because of the cross-coverage geographically of practice areas. Also, after managed care started taking root, it became a good idea to be larger in numbers for negotiation purposes, particularly with regard to insurances, according to Purdum.
The newly merged practice moved into offices on Billingsley Road, which continues to serve as the main office and serves the downtown area. Now the practice has offices all across the Charlotte region including Concord/Kannapolis, Davidson/Lake Norman, Harrisburg/Cabarrus, Matthews, Monroe/Union County, Mount Holly/Gaston County, Pineville, University/NE Charlotte, and Waxhaw/Western Union County.
The practice maintains five endoscopy centers outfitted with the necessary equipment to do both screening of pre-cancerous conditions and, in many cases, treatment of findings. Doctors there administer anesthesia and perform endoscopies and colonoscopies. Some procedures such as those involved in bile duct and x-ray work require a hospital setting. “Depending on the patient’s diagnosis or health condition, we may need the extra support a hospital provides to manage risk,” explains Portwood.
Carolina Digestive Health Associates is well represented both geographically and in areas of sub-specialty among the hospitals within the Carolina HealthCare System and the Presbyterian Healthcare System. Medical practice privileges are granted individually by each of the hospitals.
A long list of private insurances are accepted by the practice plus Medicaid and Medicare. “We want to serve the patient and the referring populations in our region,” says Portwood.
Physicians, not patients, move across offices. “We have a very deliberate plan for the best utilization of our staff members and physicians,” says Purdum. “While it doesn’t make sense to have all of us serve all over the entire area, our physicians will often be involved in two or more offices.”
Purdum, himself, works in the Billingsley office and travels across the Catawba River to a practice in Mt. Holly in Gaston County, taking extensive sub-specialty expertise (hepatology). Portwood works in the University and Huntersville offices. His sub-specialty is biliary (bile duct) work.
Stressing relationships and availability, Portwood points out that their system of physician rotation benefits patients with ongoing gastrointestinal issues. “You are there in their geographic area frequently enough so that you are responsive to any need that they have.”
Important to the practice is its independent status. “When you are independent you have more flexibility to run the practice the way you feel is best,” says Portwood. “You have more control over personnel and contracts, more control in setting and implementing standards, wishes and thresholds for your practice.”
Portwood goes on to explain that a huge difference between a private practice and a hospital setting is how physicians interact with patients. “Part of what makes me very passionate about what I do is the idea that you see patients in different contexts of their lives and at different points in their illness,” shares Portwood. “If you are in a hospital-based practice, you’re going to see them at a focused point in time and that’s it.”
Individual physicians of the group follow their patients who land in the hospital, taking care of their acute needs and then seeing them again when they’re back out. “Our patients appreciate this,” says Purdum.
Being independent creates a need to be represented at both major hospitals. “A lot of our referral base comes from these two networks,” states Purdum. “If you become aligned with one, you will alienate a good percentage of your patient base right off the bat.” Naturally, hospital systems want to use physicians who are affiliated with them.
Potential changes in how contracts are made can pose significant challenges and threats to such independence. Aligning with hospital systems and growing a practice in significant numbers are defenses against the possibility that insurance companies won’t enter into contracts with small and medium-sized practices.
“Insurance companies are always trying to negotiate different fees such as those that relate to facilities, and combining fees leaving participants with the task of dividing those fees,” says Portwood. Insurance companies renew contracts, or not, every two years. “You must maintain a smartly managed organization.”
A few years ago, hospital systems were buying up many independent practices but that pressure has waned, according to Purdum. “If you’re providing the best care you can and the best in Charlotte, you’ll be okay,” says Portwood.
Responding to the community
Purdum and Portwood cautiously await upcoming health care reform. Topics that concern the practice include the inability to contract across state lines, a need for honest tort reform and a payer mix that allows for patients who receive care for free or through assistance programs as well as Medicaid and Medicare. Portwood explains that in a hospital setting, between 15 and 50 percent of patients are not in a coverage plan, depending on the month and the hospital. True self-pay amounts to between two and five percent.
“You can’t run a successful practice like this if the problem of uninsured patients increases without a meaningful plan to address this national problem,” says Portwood. Both are concerned with malpractice laws and wonder why they are so variable across state lines. “In a more hostile environment, you would be compelled to do more testing,” says Portwood and procedures may take place at an earlier point when monitoring the situation would suffice. “The care gets changed based upon what could happen,” laments Portwood.
One of the strengths of the practice is involvement in active research, according to Portwood. Not only does that keep physicians engaged in the advancement of the field, but it may also give patients some opportunities that otherwise would not exist.
Of the 13 physicians, 11 are partners. A board of directors of five serves to get more people, ideas and expertise involved to guide decision-making to be more responsive and to streamline the process.
Each of the 10 centers has a personality of its own which is the combined personality of the personnel there. Portwood’s style is that of preferring to share ideas throughout the day.
Purdum is married with a son and a daughter who pursue soccer and horseback riding. He also contributes to the community through his support of Brookstone School, a religious-based private school for underprivileged children. Portwood is very involved with Care Ring, formerly known as Community Health Services, which provides access to medical and dental care to the uninsured and underinsured. Portwood serves on their board of directors. Together with his wife, he participates in multiple programs in the social sciences which look at difficult social problems.
The practice overall supports area food banks and also organizations and foundations related to gastroenterology such as those for Crohn’s disease and colitis. It chooses to be very active in physician community outreach programs for indigent care. “We try to empower patients to access health care insurance and make healthy lifestyle choices. We try to get them connected with physicians that they can stay with,” says Portwood.
Settling into the field
Originally from Macon, Ga., Portwood began his medical education at the Medical College of Georgia, followed by a residency in internal medicine at the University of Virginia Hospitals. He completed a fellowship in gastroenterology at Duke University Medical Center in Durham, N.C. After leaving Duke, Portwood went to Charleston, S.C., to join a new digestive disease center at the Medical University of South Carolina and became an assistant professor there.
Then, his wife’s work summoned the family to Kansas City, Mo., where for nine years Portwood served as a partner in a private gastroenterology practice. Five years ago, his wife’s work compelled the family to move again—this time to Charlotte—where Portwood met Purdum and the other partners of Carolina Digestive Health Associates. Portwood has served on the board of directors of Carolina Digestive Health Associates. Off-duty, Portwood enjoys supporting his two sons in lacrosse and traveling with the teams as well as good food and wine.
Purdum grew up in Richmond, Va., and stayed to attend the Medical College of Virginia. His residency in internal medicine followed at Thomas Jefferson University Hospital in Philadelphia. “I got a bug for GI because I kept running into people who loved what they were doing,” says Purdum, who went back to the Medical College of Virginia and pursued several fellowships before becoming an assistant professor. He was recruited to the former Charlotte Clinic for Gastro-Intestinal and Liver Disease by a former student, Dr. Stephen Deal who is also now a partner in Carolina Digestive Health Associates.
“I am a transplant hepatology oncologist and when I learned that they were starting a liver transplant program and needed a medical director, I never looked back,” says Purdum.
Indeed, the group is forging ahead as it prepares to bring another physician to the downtown area specifically to build expertise in pancreatic and biliary work. “We’re hopeful we can attract the right person with the right skill set within a year,” says Purdum.
With sights to the future, the group stays abreast of growth and demographic changes in the area such as that around Lake Norman, Denver and along the South Carolina border. “We’re looking to see if there is a need for us to be there,” says Portwood.
The practice is in the final stages of getting on board with Allscripts, an electronic medical records system which will provide a significant upgrade to the data storage system being replaced. In-house IT personnel manage utilization of the system.
“When I first came, I saw patient number 27,000; today I saw patient number 431,000. Thankfully we were ahead of the curve on paperless medical records; the paper side of the practice would have eaten us up,” says Purdum.
Carolina Digestive Health Associates offers a steadfast commitment to always improving as a practice and utilizing benchmarks and performance measurements as part of their professional development.
“In everything we do, it’s still about the patient,” says Portwood.
Most patient business comes from physician referrals but word of mouth is still effective, according to Purdum. “Being the person that you say you are still works,” shares Purdum. “Getting a referral to a patient’s family member, friend or neighbor reflects the compassion and care that you give.”