Health care switch shouldn't hurt a bit

Gabrielle Donatelli of Schaumburg works for an independent doctor in Arlington Heights, but found it convenient to go to both her family doctor and podiatrist at Affinity Healthcare LLC, a large medical practice in the suburbs.

But that changed after Northwest Community Hospital acquired Affinity and now directly employs its physicians and staff. The podiatrist, wanting to continue his affiliations with other suburban hospitals, opted out of the group. That switch put Donatelli's treatment of an ankle problem on hold for a few weeks until the podiatrist relocated.

Affinity doctors and Northwest Community said that should be one of the few effects Donatelli and other patients will see from the merger, part of a growing trend of doctors being employed directly by a hospital rather than working independently with staff privileges at various hospitals.

Earlier this month, Northwest Community absorbed Riverwoods-based Affinity's 200 employees, including 42 physicians and clinicians. Patients will see the same Affinity doctors in the same offices in Arlington Heights and Buffalo Grove, they were told in a letter about the acquisition. All of the same insurance plans will be accepted. And Northwest Community CEO Bruce Crowther said patients can continued to be referred to specialists at other hospitals a key point, said other hospital systems and doctors who are not part of the merger.

"The one core principle that must remain paramount, regardless of setting, is the autonomy of clinical decision-making that allows patient needs to come first," Illinois State Medical Society President Steven M. Malkin said through a spokesman.

Crowther said the group is now developing new policies, including those for patient referrals in and outside the network.

The doctors benefit by referring patients within the Northwest Community network, "but they're not required to stay within the system," Crowther said.

Crowther said he does expect Affinity patients to see more coordination of care and fewer duplicate tests as a result of the hospital acquisition.

Behind the scenes, the merger will have the biggest effect on doctors, who will now get paid by the hospital and have broader use of hospital resources and marketing, experts said.

The exact number of Illinois hospitals like Northwest Community that directly employ doctors, instead of having them affiliated, has not been tracked by major medical associations.

Still, 61 percent of patient-care physicians nationwide are self-employed and have a full- or part-ownership interest in their practice, while 39 percent are employed. Hospitals currently employ 16 percent of physicians who work with patients (instead of only teaching), while physician offices employ 14 percent, according to a 2007-2008 American Medical Association study, the most recent available.

Some experts believe directly employed doctors provide more coordinated care for patients, which could lead to cost savings down the road. But how much patients would save wasn't clear, as many of these hospitals, especially community hospitals like Northwest, are still adapting to this growing trend. Other hospital groups nationwide, including Oak Brook-based Advocate Healthcare system, have been directly employing physicians for years.

Advocate started employing doctors when it was formed 15 years ago and now has about 750 on the payroll. The employment offered a regular income and job stability for doctors and streamlined the health-care system for patients, said James Dan, a doctor and president of Advocate Medical Group, a subsidiary of Advocate Healthcare.

"Our goal is to do the best thing for the patient," Dan said.

Dan said Advocate doctors mostly refer patients to specialists within the Advocate system, but aren't required to do so.

"We always refer within the Advocate system as long as the talent is here and the insurance allows it," Dan said. "I cannot tell a doctor not to refer a patient elsewhere."

At Northwest, the acquisition of the doctors group could mean lower costs for patients down the road and a reduction in duplicative testing or files, said Bruce Crowther.

In coming months, Northwest plans to connect Affinity to its technology network. This will make patient medical records available systemwide and provide a simpler method to schedule tests and appointments, said Crowther.

If an Affinity patient shows up in the emergency room, all his records and test results would be readily available, which could avoid running a test again, Crowther said.

"Fewer duplicative tests means better, consistent care through a broad system," Crowther said.

Crowther expects Northwest to "rapidly" hire more doctors to expand the staff and increase the number of available specialists.

Nationwide, physicians become employed by a hospital for difference reasons, including the consolidation of hospitals and health insurers and difficulties dealing with increasing regulatory requirements, among other reasons, said AMA spokesman Robert Mills.

Some doctor groups have said the cons of direct employment by a hospital include selling a practice and losing independence, following a new set of policies, and growing pressure to produce billable hours or more revenue. Others have 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.

Hospitals want to more closely integrate physicians so they can bundle payments together for the doctor and hospital, or create Accountable Care Organizations, which means hospitals and physicians are under one corporation that takes one payment from insurance companies and divides it in-house, Illinois Hospital Association spokesman Danny Chun said.

For the doctor, direct employment with a hospital could mean a lot of changes, including following new hospital policies, requirements for bonuses and possibly working nights and weekends, said Jonathan May, executive director of Itasca-based Integrated Healthcare Association, a group of independent doctors.

"But it should be transparent to the patient," May said.

<p class="factboxheadblack">What it means for patients</p>

<p class="News">Northwest Community Hospital recently acquired Affinity Healthcare, a large medical practice. That makes the doctors and staff direct employees of the hospital, part of a growing healthcare trend. Here's how it will affect patients, according to Northwest Community:</p>

<p class="News">• Specialists. Doctors will refer patients to specialists at Northwest Community when possible, but also can refer to outside doctors. </p>

<p class="News">• Insurance. The same insurance plans will be accepted. </p>

<p class="News">• Coordinated care. More coordination by doctors within the Northwest Community system. </p>

<p class="News">• ER access to patient records. Fewer duplicated medical tests.</p>