Friction Heats Up Between Salem Hospital and Independent Physicians

August 3, 2011 -- Tensions are running deep in the Salem community, with independent physicians convinced Salem Hospital wants to create a monopoly by hiring providers and restricting the ability of independent physicians to care for their patients in the hospital.  

“Those of us in private practice are getting squeezed out,” said Dr. James Parosa, one of the founders of Salem Pulmonary Associates. “They (the hospital) want to own medicine in Salem.”

Parosa had been the medical director of the Non-Invasive Vascular Lab at Salem Hospital until he was “kicked out” recently. Now he believes the hospital is weeding out doctors who aren’t hospital employees. “A vascular lab is a good money maker,” he said. “They wouldn’t be interested if it didn’t pay.”

Salem Hospital insists it has no intention of creating a monopoly by only having employed physicians, said Julie Howard, spokesperson. Its parent organization, Salem Health, employs 63 providers, while 434 providers are on its medical staff.

“Compared to other hospitals in Portland and the mid-Willamette Valley, this is a relatively small percentage of employed physicians,” Howard explained.  If physicians are having concerns, she said, “Salem Hospital administrators want to hear provider feedback.”          

The notion of Salem Hospital creating a monopoly is not a new one.  In 2007, Salem Women’s Clinic sued the hospital after it removed the clinic’s access to backup physicians, alleging it was using monopoly power to shut down their clinic.  Although the clinic reached a settlement with the hospital, believing it was the best alternative at the time, its physicians no longer deliver babies, but do provide gynecological care and other women’s health related services.

Monopoly or not, healthcare has become a complex issue in many communities, including Salem.  Between healthcare reform, government and insurance modeling, and the rising costs, anxiety over what comes next is growing.

Meanwhile, Salem Hospital’s hospitalist program has created growing concerns. Hospitalists are doctors who only care for patients while they’re in the hospital instead of an internist having to juggle his practice.  A relatively new specialty, such programs are emerging in hospitals across the country. In theory, the patient is the ultimate beneficiary of this relationship.

But not all physicians agree that a hospitalist program is the best alternative, among them, Dr. Earl Van Volkinburg who believes continuity is just as important. He prefers taking care of his own patients when they’re hospitalized.

At the same time, Van Volkinburg realizes he might need to rely on a hospitalist for back-up coverage.

That doesn’t pose a problem, Howard said. “Any community physician can contract with hospitalists at Salem Hospital to care for their patients, either as call coverage or on a regular basis,” she said. “A number of medical groups already contract with hospitalists at Salem Hospital.” 

That’s not what Van Volkinburg experienced when he tried working out an agreement to cover his calls on an “as needed basis.” The hospital told him “no,” that the hospitalist program wasn’t taking on any more practices. “If I hadn’t been sitting down, I would have fallen down,” he said. “You guys (the hospital) aren’t very inviting here.”

Eventually Van Volkinburg managed to reach an agreement with Salem Clinic to cover his hospital related calls as needed.  But, outside of that clinic, no other internists in Salem see patients in the hospital.

“Salem Hospital is supposed to be the core of medical care in the community,” he said.  “The hospital has created a situation where the majority of general internists and family doctors have become dependent on the hospital staff to take care of hospitalized patients. The relationship between many of the doctors in the community and Salem Hospital administration is not a healthy, collegial one. It is one of tension and mistrust which gets in the way of good care for our patients.”

Howard denied that Salem Hospital refuses to allow independent physicians to use hospitalists as back up or for their patient admits. “That’s not the case,” she maintained.

Dean Andretta, chief financial officer for the Mid-Valley Health Authority, confirmed Van Volkinburg’s experience. “At the time, he was told there was no capacity for him to utilize the hospitalist program,” he said. “Later, we heard that the hospital had the capacity but they (independent physicians) would have to pay for it (using the hospitalist program).”

Another question arises about whether it’s appropriate for Salem Hospital to charge independent physicians to pay for hospitalists who care for their patients. According to Howard, there’s a charge.

“Charges are negotiated based on the specific needs of the physician or medical group for hospitalist coverage,” she said.

Salem Hospital, which is non-profit, sees this as a pure cost-driven business decision.  “Some of the hospitalists who practice at Salem Hospital are employed by Salem Health, and others are separate medical groups.” Howard said. “In the case of hospitalists employed by Salem Health, any charge for using the hospitalists covers the cost of employing them to care for hospital patients.”

Andretta noted that none of doctors the MVP Health Authority represents are actually charged for this program.

However, according to Sheryll Hoar, another Salem Hospital spokesperson, this decision aligns with federal law. “Not-for-profit hospitals like Salem Hospital are prohibited under federal law, including anti-kickback statute, rules and regulations, from providing services such as hospitalist coverage to members of their medical staff for free — unless the providers are employed by the hospital.”

Samaritan Health Services, which runs non-profit hospitals in the mid-Willamette Valley and central Oregon Coast, doesn’t charge independent physicians to use its hospitalist program or allow independent physicians to use their hospitalist program only as needed.

Samaritan created its hospitalist program for the benefit of patients, not physicians, said Marti Cersovski, marketing and public relations director. “It’s not a benefit to patient care to have a service available only when it’s most convenient for a physician group.”

It comes down to the issue of predictability, she added. “Hospitalist staffing needs to provide the best care possible to any patient. Offering services that are variably utilized by a primary care physician or a group doesn’t provide any level of predictability and doesn’t offer proper hospitalist staffing, which can have an effect on the quality of patient care delivered.”