Hospital CEO says days are numbered for independent doctors

As a group of suburban doctors prepared for a discussion tonight on the possibility of becoming hospital employees, the head of Arlington Heights-based Northwest Community Hospital said Wednesday the future of health care depends on doctors and hospitals joining forces as one company and the days of each operating independently are over.

NCH Chief Executive Officer Bruce Crowther said employment of doctors directly by the hospital provides an all-inclusive delivery of health care, with incentives to grow internally and more resources to ultimately help patients. The payment system will ultimately drive out the one- or two-doctor practices, he said.

"Their days are numbered, especially over the next five years," Crowthers said of solo practitioners.

Crowther's comments came as suburban doctors mull the choice of remaining independent or becoming directly employed by NCH's Affinity practice after it fully merges with the hospital later this year. More than 250 suburban doctors have been invited to a meeting tonight to discuss the impact on their practices and livelihoods in a changing health care industry. Itasca-based Integrated Healthcare Associates LLC, a co-op of eight physicians in various practices, will host a town-hall meeting at 6 p.m. at the Rolling Meadows Park District Central Building, 3000 W. Central Road.

While many suburban hospitals already directly employ doctors to have more control over health care delivery, some centers are just starting. Northwest Community Hospital said last month it intended to merge with Riverwoods-based Affinity Healthcare LLC and for the first time employ its 41 physicians and clinicians. Integrated Healthcare's doctors, like other doctor groups, are currently affiliated or "on staff" with NCH.

"We need to open up the discussion so physicians know they have options," said Integrated Healthcare Executive Director Jonathan May. "Once a hospital begins to purchase a medical practice, it creates some good and some not-so-good situations."

May wondered: Would employed doctors provide referrals to nonemployed doctors? And how would employed doctors' privileges be affected at other suburban hospitals?

"For those who want to maintain their independence, there are concerns," May said.

May said the cons include selling a practice and losing independence, following a new set of policies and procedures, changing salaries impacted by reimbursements and expenses, and growing pressure to produce more billable hours or more revenue. He said the pros include working a set number of hours for a known salary, allowing the hospital to do all the marketing, and accessing more resources and equipment.

Crowther noted that hospitals have the resources and economics of scale to provide what doctors need to treat patients. Employed doctors also can refer patients to any other doctor, not necessarily to those part of the same work force, he said.

"But what will happen is, these doctors are incentived together to make it successful," Crowther said. "If they don't have the best doctors in the group, then they'll get them."

Crowther couldn't say if all doctors will be employed by the hospital in the future, or if some will remain just affiliates.

The exact number of Illinois hospitals that employ doctors, instead of having them on staff, has yet to be tracked by medical associations. But it has been a growing trend in recent years and is expected to continue under health care reform, said Illinois Hospital Association spokesman Danny Chun.

Hospitals want to more closely align and integrate physicians and the push to transform the delivery of health care with things like bundling of payments, so-called accountable care organizations, and medical homes, Chun said. Accountable care organizations are associations of hospitals, physicians and all others under one corporation that takes one payment for services from insurance companies and divides it in-house.

"There is the generational factor with newer and younger physicians working fewer hours than their older predecessors, and female physicians, who account for an increasing number of younger physicians, are working fewer hours to accommodate their work-life choices," Chun said. "Also, many younger physicians entering the field have to deal with the challenges of large educational loans to pay off ... and large medical liability insurance costs."

Illinois ranks among the top three states with the highest medical liability insurance premiums in the country in many specialties such as ob/gyn and internal medicine. Hospitals sometimes help pay off the school loans of doctors they employ and many will cover or pay for their employed physicians' medical liability insurance premiums, Chun said.

"So it's a win-win situation for both the hospital and the employed physician," Chun said. "And as the nature and field of health care continues to change and evolve, which will only speed up with health care reform, it is more challenging for many physicians to practice as independent physicians."