Prognosis in physician buyouts unclear
Pediatrician Tom Lacy was happy owning his practice but feels more flexible since selling to Nemours Children's Hospital, freeing him of business duties to focus more on care and providing him the hospital's ample resources.
“For my patients, it's the same experience as it was before we associated with Nemours,” said Lacy, of Orange County, Fla.
Internist Neha Doshi of Winter Park, Fla., says she felt squeezed by her employer, Florida Hospital, and felt her care was suffering from the load. Now on her own, she feels like she can provide personal care.
“I love it, love it, love it, love it,” Doshi said.
The doctors' stories illustrate a critical debate: Some say hospitals that are buying physician practices are improving care and reducing costs; others argue the trend is driving up prices and hurting physician-patient relationships.
Lacy says his TLC Pediatric & Adolescent Medicine practice sets its own office hours and schedules patients. He and his partners make the health care decisions. And Lacy refers patients to any specialist or hospital he thinks is best.
But referring patients to Nemours' employed specialists or Nemours Children's Hospital has advantages for Lacy and the hospital. It keeps patients' money flowing to the hospital and coordinates patients' records and care, he said.
“We can see all the specialists' notes and the emergency department notes, the hospital notes, the urgent-care notes of our urgent-care facilities, and likewise they can see our office's notes as well,” Lacy said.
Critics worry that consolidation of health care into the hands of hospitals can limit patients' choices and drive up costs by increasing hospitals' control over pricing.
“The real purpose of acquiring practices is to basically attempt to make sure those patients stay in your system,” said Tommy Thomas, co-founder of the Winter Park-based Association of Independent Doctors.
But proponents argue the trend creates a “continuation of care” system, reduces inadvertent testing and hospitalizations and may be the surest way to stabilize health-care costs.
Nationally, an AMA survey found the number of doctors who owned their own practices had fallen to about 53 percent by 2012, down from about 61 percent in 2008.
The hospitals say they are open to acquiring more practices or hiring more doctors directly but deny any immediate major expansion plans. The big expansions may already have happened.
“We have a hybrid model. We have a blend of employed and private-practice physicians,” said David Banks, executive vice president and chief strategy officer with Florida Hospital, which is among hospitals purchasing practices. “One of the things we've wanted to do is maintain a robust private-practice community.”
For Doshi, working for a hospital didn't work.
Her boss at Florida Hospital Medical Group fired her in November 2012, after four years. Doshi said the medical group kept ramping up workload expectations until she no longer felt like she was providing quality care.
“If you see 10 patients a day, they want you to see 15. If you see 15, they want you to see 20. If you see 20, they want you to see 25,” she said. “I felt like I wasn't a good doctor anymore.”
Florida Hospital did not directly respond to her complaint but noted she retains staff privileges at the hospital.
“We had a little bit of a family disagreement,” said Sy Saliba, Florida Hospital's vice president for marketing, who called her “an excellent doctor.”
But it's not easy for a doctor to set up a profitable practice without seeing many patients a day, especially since insurance companies essentially dictate low payment rates for them, while hospitals have leverage to negotiate.
So Doshi set up a concierge practice, charging patients an initial $1,500 a year for access, plus the usual insurance co-payments per visit.
With fewer patients — about five to 10 a day — she's spending far more time with them, more directly coordinating specialists' referrals and even making house calls.
Her clientele is about 75 percent elderly or others who expect to spend that much on health care each year, though many are middle class, she said.
Still, she's saddened that she must limit her clientele and her services, if many of her previous patients might not be able to afford her services.
“I feel for the rest of my clients. But I get to be a better doctor. And yeah, I get to be a better mother, a better wife, a better housekeeper. I get a better lifestyle,” she said.