Wednesday, November 18, 2009

As Hospitals Gain Cardiologist Employees, Private Cardiologists Are Shunned

An interesting story has developed in Missouri where a private group of cardiologists was asked to no longer see their patients at the local hospital. It seems the hospital hired it's own group of cardiologist-employees. Things grew so contentious according to the video accompanying the report, when the cardiologists asked for an OR lite, they were told to use a flashlight (the hospital disputes the claim).

As the cardiologist shift to adjust for the economic realities that confront them, they have much more to lose from their patient relationships as its the patients that are inevitably affected the most when these shifts occur.



Anonymous said...

do you think any cardiology groups can survive without affiliation with a hospital? or is only a matter of time until they sell out?

DrWes said...

Anony 01:00 PM-

Interesting question.

I think it depends on two things: (1) the current health care reform efforts underway to create "accountable care organizations" and "medical homes" and linking payments to that model and (2) the market conditions of the community in which the cardiology practice has established itself.

If the cardiology group is the so-called "only game in town," their chance of survival (at least in the short term) is good, since they can negotiate effectively with hospitals to meet their needs. On the other hand, if the market contains many cardiology players, then the risks are greater for the independent groups.

Recall that there are many fewer hospitals than cardiologists. If the model going forward requires institutional affiliations for payments (a la the "bundled" payment concept), then cardiologists will have to affiliate to get paid. If the hospital already has cardiologists, or hires others at lower cost to support their needs, the existing private doctors may find they have to move their patients or travel further distances to maintain their practices at another inpatient facility (as it appears to be in the above referenced instance).

Keith said...

This is the problem, however, in driving this model of payment.

It is essentially placing control in some of the stodgious parts of the health care system; namely hospitals, which have been some of the major drivers of cost over the past several years. Whether these brilliant CEO's at these institutions can now effectively function in a non-fee for service world where the objective is no longer to sell more widgets is what we will need to see.

The hospital (in the traditional sense of a place where more complicated surgery is performed and patients are monitored and treated overnight) has been a dying business for some time. It is not clear that we should entrust hospitals as the epicenter of care when most of this care can be performed outside of the hospital setting. Hospitals have known this for some time and have expanded their services into outpatient services in a dramatic way. Certainly the EMR no longer requires all of the medical team to reside in one location as in the past. So what this idea of accountable care organizations may do is consolidate the power and influence of the hospital industry and will likely regionalize these big providers so that little if any competition exists! And then how will costs be controlled?

Better that multi-specialty medical groups act independently of the hospital structure and be allowed to partner and split these shared payments so that groups can move their patients to the hospitals that provide the best service to their patients. This would allow some flexibility and competition to the system and diminish the importance of the hospital, which is ultimately where the cost savings will be acheived. Just look at what choices do you have in your area of practice if you are not content with the service (total dominance of one provider on the North Shore of Chicago) and the fact that required accountable care organizations will spell the death knell for whatever little competition exists. Not a pretty senario in my mind.

Anonymous said...

A similar scenario is being played out in a major LA hospital. It is not yet complete, but they are trying to force out the private practice cardiologists.

Anonymous said...

Sorry. This comment is not about this article. It is about Rep. David Camp's most recent statement about the latest breast health study. Please blog regarding this. No fair begging off because you aren't a "breast man". This is the very same guy you felt was talking sense a couple of weeks ago. What say you today?

Anonymous said...

David Camp quote (from Gail Collins column in NYT). In case you missed it....

I mean, let the rationing begin. This is what happens when bureaucrats make your health care decisions,” said Representative David Camp, the ranking Republican on the House Ways and Means Committee

DrWes said...

Anony 10:05 and 11:05pm-

I'm not sure I could say it better than Dr. Rich did, so I'll refer you there, rather than detract from this thread.

Orac said...

Sorry, but Dr. Rich has no clue what he's talking about on this the issue of the USPSTF recommendations, no clue at all, no clue at all.