all streets lead to lexington

alejandro escovedo. photo by marina chavez.

alejandro escovedo. photo by marina chavez.

When last we heard from Alejandro Escovedo, the acclaimed Texas rocker and songsmith was booked into the now defunct Dame on the night of the worst winter storm of 2009. A sizable portion of the city lost power that evening. But not The Dame and definitely not Esscovedo, who ripped through tunes from his then-new Real Animal album with a swift, efficient immediacy that was indicative of his firebrand rock ‘n’ roll.

But it was still a muted return for an artist that has made Lexington a second home of sorts since the mid ‘90s.

Considering Escovedo has been cultivating a strong local fanbase through frequent performances – some proudly electric and rockish, others acoustic and almost chamber-like – one expected a healthier turnout. Given that national audiences had started flocking in more appreciative numbers to Escovedo’s music since the release of Real Animal, a similar growth spurt in local attendance was in order. Shoot, Escovedo even recorded Real Animal in Lexington. Didn’t that count for something?

Not when Old Man Winter was rocking out. The snow, sludge and blackouts that night kept the crowd turnout down to the faithful few. But here we are in the height of autumn with a return Lexington performance and an even newer Escovedo recording, Street Songs of Love. Like Real Animal, it was cut locally at the Saint Claire Recording Company. And like its predecessor, Street Songs of Love screams something to the rest of the world that Lexington has known for roughly 15 years – that Escovedo is one of the most keenly literate, emotionally direct and robustly rocking songwriters in or out of Lone Star country.

“It was such a blast to make this record and to write this record,” Escovedo said by phone recently from a tour stop in Miami. “Everything about Street Songs of Love has been really exciting. It’s a real fun one to play, too, which is not always the case with an album. I can tell you now that The Boxing Mirror was not a fun record to play live. I don’t think we’ve played any of those songs live for awhile now.”

The Boxing Mirror was released in 2006. Produced by one of his musical idols, John Cale, the album was inspired, in varying degrees, by the years Escovedo’s life and career were derailed while battling Hepatitis C. But upon regaining his health, revisiting the songs from his darker days in nightly performance settings offered few thrills.

“I think it was just about what those songs were reflecting. I was trying to get so far away from what they were speaking of. I just didn’t want to live there again. So I became very anxious to get to work on a new record. That’s where Real Animal came in. It changed the whole attitude and reflected more of what I was at the time – healthier, stronger and more creative.”

Real Animal also represented a dramatic shift in Escovedo’s songwriting. Specifically, he penned the entire album with West Coast Americana stylist Chuck Prophet.

“First of all, songwriting is such a personal thing in my opinion,” Escovedo said. “It has been for many, many albums now. And while I have co-written with other people, I’ve never written an entire album with anyone. But when Chuck and I started work on Real Animal, we realized that we had something special going on. You put the two of us together and we start telling stories and showing off for each other. Do that and you’re going to get some good songs.”

Prophet also co-wrote over half of Street Songs of Love. But the guest list is a little more crowded this time. Another of Escovedo’s musical heroes, Mott the Hoople’s Ian Hunter bolsters the vocals on Down in the Bowery (“Ian continues to impress me on a level that very few artists do”) while Bruce Springsteen sings with typical reverence on Faith (“He’s a real gracious guy to have done this”).

Of perhaps greater importance, though, is the fact Real Animal and Street Songs of Love were produced by Tony Visconti, who was behind the boards for the career defining early ‘70s albums of David Bowie and T. Rex, among many other projects.

“I think having been a fan, first of all, of his production and his expertise in making records helped create a relationship that is so intensely musical. But that relationship is also built in friendship and camaraderie. I think we can all hear the difference between the albums I’ve made in the past and the last two that I’ve done with Tony.”

But what literally brings Esvovedo’s Visconti-produced music home to local audiences is that fact that Real Animal and Street Songs of Love were both cut within the Lexington studio walls of Saint Claire.

“Just to be in Lexington with the four guys in my band (dubiously dubbed The Sensitive Boys), Tony and the guys at Saint Claire and then to come up with the record that we did says a lot about that combination of people. So as far as I’m concerned, we’ll probably come back there for the next one as well.”

Alejandro Escovedo and the Sensitive Boys perform at 7:30 tonight at the Kentucky Theatre. Tickets are $33.75. Call (859) 231-7924.

AREA DOCTORS’ GROUPS COMBINE HARVARD VANGUARD DEAL HOPES TO BOOST PROFITS, MEDICAL CARE

The Boston Globe (Boston, MA) April 21, 2004 | Liz Kowalczyk, Globe Staff Four doctors’ groups in Eastern Massachusetts have taken the unusual step of merging, saying their larger size will allow them to increase profits but also improve medical care for their nearly 600,000 patients.

The deal includes an odd twist: All the groups agreed to become nonprofits, which allows them to pump more of their revenue back into operations a competitive advantage rather than paying it toward taxes.

Harvard Vanguard Medical Associates with 500 doctors, one of the largest multispecialty physician practices in the state has been pursuing the merger for more than two years. The new group of doctors, which has organized under a parent organization called HealthOne Care System, includes about 700 physicians.

The doctors are following an example set by hospitals during the 1990s, when more than 1,000 US hospitals merged, generally to gain financial clout against powerful managed-care companies.

In recent years, doctors increasingly have complained about flat or falling salaries while squeezing in more patients to meet demand and keep pace with the cost of running their offices. Meanwhile, many doctors say they are unable to afford electronic medical records and other cutting-edge technology to improve patient care and safety.

According to the most recent figures from the Center for Studying Health System Change, a nonprofit research organization in Washington, doctors’ salaries fell 5 percent between 1995 and 1999, increasing just slightly in 2000, when taking into account inflation and cost of living. As a result, according to a study the center published last month, physicians are using a variety of strategies to increase their incomes, including offering patients bone densitometry tests, positron emission tomography, or PET, scans, and endoscopy tests in their offices; opening ambulatory surgery centers; and merging into larger groups.

The impact on patients is unclear. Critics say physicians’ business practices are contributing to the public’s rising use of unnecessary medical services and to growing costs. But other health specialists say larger doctor groups may operate more efficiently and are better at coordinating patient care. see here south shore medical center

Kenneth Paulus, Harvard Vanguard’s chief executive, said he was looking for a way to boost revenue for doctors and improve patient care at the same time. Doctors in Massachusetts, he said, are seeing “15 to 20 percent more patients than they did 10 years ago,” while they earn about the same, an average of $150,000 for an internist.

“When you consider inflation, that’s a significant hit on income,” he said. “Doctors also want to go back to spending more time with their patients. I hear physicians talking about it every day.” The doctors formed HealthOne partly “to help us survive these difficult economic times,” Paulus said.

The new group, formed in January, also includes Dedham Medical Associates, Southboro Medical Group, and South Shore Medical Center, which is also a doctors’ group. Concord Hillside Medical Associates and Lynnfield Medical Associates already joined Harvard Vanguard during the past two years.

The group is the largest independent doctors’ group in Massachusetts that is not aligned with a particular hospital network. It’s smaller than the physicians’ group associated with Partners HealthCare System, the parent organization of Massachusetts General and Brigham and Women’s hospitals, which has about 1,100 primary care doctors, 2,000 community cardiologists, gastroenterologists, and other specialists, and 2,000 specialists at the two teaching hospitals, many of whom do research part time and treat patients part time. But HealthOne is now significantly bigger than Lahey Clinic, a group practice with about 450 doctors.

Paulus said HealthOne will have more buying power to implement electronic patient medical records, as well as the resources to open an outpatient surgery center, and two additional imaging centers. Harvard Vanguard opened an imaging and endoscopy center last year at its Kenmore Square location, and already has electronic medical records. Imaging and endoscopy centers bring in extra revenue for doctors, and Paulus said that by owning their own, the doctors can keep better track of their patients’ results. go to web site south shore medical center

“Right now, we’re referring out to for-profit imaging centers. Patients go all over the place,” he said. “There’s very little integration of information and data. We think we can significantly improve patient care and safety.” Dr. Michael Lee, a pediatrician with Dedham Medical Associates, said it would have cost his group $1 million a year for seven years to implement electronic medical records, electronic prescribing, e- mail communication with patients, and other Internet-based medical information systems. “We were eager to go forward with this, but we could never make that leap,” he said.

Harvard Vanguard already was a nonprofit group, but the other physicians’ groups converted to nonprofit status as part of the affiliation. This allows them to keep more nontaxable money in reserves, which they then can invest in new services and systems.

The doctors also will be able to negotiate fees jointly with health insurers.

In the study published last month, researchers at the Center for Studying Health System Change said they are concerned that doctors’ groups that offer profitable ancillary services will be more likely to refer patients for unnecessary tests because they stand to profit from them.

“The main issue the public worries about is the conflict of interest that could lead to overuse of services,” said Paul Ginsburg, president of the organization. “But I worry about this more with a small group of 10 physicians than I do with a large organization where the financial benefit to each individual doctor is more diffuse. This new organization could be good for patients; large groups do much better at integrating care for their patients.” But hospital executives worry that this new physicians’ group, as well as other doctors’ groups providing ancillary services, will lure away a growing portion of hospitals’ best-paying business. Physicians are not required to treat the uninsured, and tend to attract patients with private insurance and simpler problems to their MRI and endoscopy centers. This has the potential to leave hospitals with the more complex cases, and more poor patients.

“Hospitals have to care for anyone who walks though the door,” said David Ball of the Massachusetts Hospital Association. “The proliferation of these providers makes it more difficult to do that, and puts more pressure on hospitals.” Liz Kowalczyk can be reached at kowalczyk@globe.com.

Liz Kowalczyk, Globe Staff



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