Heartfelt with Dr Melissa Walton-ShirleyView all posts »
Will everyone be anointed with the oil of hospital acquisition? God help us.Sep 16, 2012 15:14 EDT
Not all hospital systems, CEOs, or governing boards are created equally. Their nuances are best compared with long-recognized institutions of learning, ranging from well-respected stalwarts of the Ivy League to schools that fall short in rating and barely achieve adequate benchmarks. Included in the mix are those that by any measureable standard find themselves rated woefully inadequate. The same goes for healthcare-delivery systems that navigate the hospital acquisition of human flesh. At best one could describe them as "unevenly performing" all across the US.
Lisa Nainggolan's piece "Hospital employment of cardiologists triples, ACC survey finds" outlines how rapidly private-practice cardiology is losing its foothold on the pie chart, with 24% of practices now hospital owned, "up from just 8% in 2007." For some, it is a welcome relief from balancing entities such as EMR costs with the ever-ballooning price tag of employee health insurance and the "practice-busting" plunges we are experiencing in reimbursement. Subtract the hassles of managing the day-to-day challenges of private practice and add the built-in buffers against the personal cost of malpractice insurance, and acquisition becomes no more resistible than taking a golf swing on a cloudless Saturday afternoon.
The ideal acquisition would allow cardiologists to reside in offices and labs of their choice, continue to treat the same patients, keep the same work schedules or improve them, approve who works in their offices, and decide when and how much vacation and CME activities serve all parties best. The only noticeable changes in a utopian acquisition would be an acceptable preservation or improvement in personal revenue, a decrease in the hassles of dealing with private-practice management, and an unheard of cost savings directly translated to patients. For the appropriately paranoid draftees into this movement, the greatest concern is what happens when the honeymoon following this lavish wedding is over. Only then does one understand if they were joined in a holy or an unholy union.
A few of my friends who were acquired early on are very happy with their new big brother. As a matter of fact, they look at me as if I had three heads when I inquire about their relationship with their employer. No doubt, the body-snatcher–like pods placed in their rooms have been comfortable, effective, and far more lucrative than anything private practice offered them in the past five years. It's worked for all happy parties with good salaries, stable futures, and grateful employees. Their call schedules are better because their parent companies purchased more physicians to share or obliterate weekend duties. They have shinier toys in better, newer equipment. By all accounts, my friends look the same, sound the ,same and seem oblivious to any change other than the ones for "good." But it isn't that way for everyone.
Some of my hard-working but previously happy-go-lucky and newly anointed friends now seem worried. Like Lovey Howell who queried Thurston III on the widely popular Gilligan's Island TV series, I sometimes ask rhetorically, "What's that on your brow, Thurston?" It's not the old sweat of hard work to which my colleagues have long been accustomed. It's a new kind of sweat . . . as in sweating bullets over whether they are going to hit their benchmarks to retain their salaries. My anxious friends are now calling me for more referrals and more practice support. They take any transfer I give them and they often talk of what they are going to do next and how their life is going to change when they come up for contract renewal. One told me he lost his retirement in the deal. One relative related the complaint that the doctor opens the door each morning to a different nurse or secretary. Others complain their EMRs are reconfigured or totally different. They are scrambling for better deals with other institutions so they can turn the hourglass upside down again to a more advantageous half-full position.
Then there are communities who have suffered when acquisition came to towns urgently. In knee-jerk responses to bail physicians from the clutches of the IRS or bankruptcy, the deals were mismanaged. Private-sector colleagues who could remain independent were left to navigate the practice costs meant to be distributed evenly between them and their former colleagues. Cardiology "new blood" brought to town as competition turned out to be "tainted blood" in some instances and caused marked disruption in patient-physician relationships and even physician-physician relationships. Noncardiologist physicians in the communities were also acquired, including their office staff, and suddenly continuity of patient care was passé. Independent cardiologists opened office doors to find their patients who were anticipating decisions on timing of defibrillators, caths, or medical therapy had undergone testing at other facilities. Those tests were interpreted by cardiologists who were in no way connected to their care, their referrals to unfamiliar testing venues now incentivized by hidden contractual microformulas. They were evaluated far away from the familiar eye of their long-time cardiologists. The reimbursement for those tests that previously subsidized the health insurance and salaries of their employees and office staff were forever lost.
CEOs who never had their finger on the pulse of their communities continued in their thirst for acquisition like Ms Pacman. One can literally hear the romping rhythmic sound approaching, as another acquisition is imminent. Monopolies never meant to be planted in gardens so small grew like bull thistles, literally overtaking all the good things that small community medicine had to offer. They are now barely recognizable small towns with the crabgrasslike metastasis of big corporations choking out other smaller businesses. They establish in-hospital pharmacies, home-care product suppliers, outpatient labs, and dry cleaning and laundry services. leaving formerly well-established businesses to languish. Even business suppliers and car dealerships that have nothing to do with the practice of medicine are left wanting for business because the mafialike mentality took their business out of town.
After the acquisition deals are done, some physicians merely continue the great work they are doing with little difference except the name at the top of their pay stub. Others morph from human flesh into a Rubik's cube of relative value units (RVUs), the formula through which all future salaries and bonuses are calculated. The three-year honeymoon period immediately after initial acquisition easily resembles a leisurely evening bike ride on the beach. One starts with the wind at their back, feet up, surfing the coastline, pushed by some miraculous hand, until it's time to turn homeward to renegotiate. During contract renewal, their comfortable practice landscape becomes hardly recognizable. A sandstorm of wind, rain, and lightning envelope them as promised salaries, perks, and benefits are no longer the recognizable golden carrots once dangled.
It is no surprise then that the ongoing purchases of cardiology practices, brick and mortar have and will have a wide-ranging impact on medicine and communities. We can only hope that what is coming will be directed by caring competent individuals with the well-being of patients, cardiologists, and their communities as their prime objective. Will the oil of hospital acquisition eventually anoint us all? If all of us are to succumb, God help us, and God help the United States of America and the practice of cardiology as we know it.