1. Starting & Sustaining Your Medical Practice for Hispanic Populations Rene A. Sepulveda, MD, FACS Urology San Antonio

2. About San Antonio 9 th largest U.S city Bexar Co. seat Population: ~1.6 M 58% Hispanic Ethnic Areas: –Westside 90% –Southside 87% –Eastside 56% http://www.healthcollaborative.net/assessment06/social-environment/social1.php

3. Movers and Shakers Hispanics in SA very well represented –Mayor Julian Castro – national figure –60% of city council Hispanic –First Hispanic president of a Health Science Center; now UT Chancellor –Hispanic president of UT San Antonio –Numerous CEOs of various companies

4. About Urology San Antonio 110,100 visits in 2010 26 urologists, 1 NP, 1 radiation oncologist 9 clinics Northwest North Central Northeast Southeast Downtown-The original office started in the heart of SA Far West Boerne (1/wk) Alamo Hts (1/wk) Radiation Center

5. About Urology San Antonio President/CEO, 2 of board members Hispanic 1/3 of docs speak Spanish 3 women in the group, 2 of whom speak Spanish Public relations department with emphasis on Hispanic population

6. Accessibility and Integration Easy access to mass transit, walkable Provide services in house that keep our patients from traveling while maintaining the highest of quality When pts are unable to get to us, we provide transportation Integration = huge component of our success

7. Integrated Services Imaging Lab services Outpatient surgery center Pathology services Cancer center for chemo and advanced radiation therapy Revenue is used to promote and market to the community

8. Personnel Front office/ Nursing / Medical Assts / Billing personnel –Truly bilingual and bicultural –Preferably “home grown” – can understand local issues –Clinic director is Hispanic nurse –Practice administrator is Hispanic woman –Patient issue can be addressed in either language

9. Patient Education Registration forms, questionnaires, materials need to be in Spanish Some of our physician educational seminars are given in Spanish Cancer consultations when needed are referred preferentially to our Spanish speaking specialty surgeons and radiation therapist

10. Community Service Projects Screenings, Health Fairs –Need to be in their “backyards” –Venue is important Ex. San Fernando Cathedral -a trusted, user- friendly location

12. Community Involvement MAHPA founded in 1983, an outgrowth of the old NCHO effort MAHPA has provided over half million dollars in scholarship and countless hours of mentorship via Med Prep Cisneros’ American Sunrise “You must maintain the pipeline”

13. Political Support Historically, doctors were the worst Now more than ever we must support our local, statewide and national politicians and educate them as to the health concerns of our communities If the future is Accountable Care Organizations, then lets make sure that they are culturally appropriate as they evolve

14. Summary We feel that all these efforts will not only validate what you do but will underwrite your sustainability Sustainability = responding to the needs of the community at all levels