Feud­ing over physi­cians

WakeMed seeks records on UNC Health Care’s ar­range­ments with docs

Modern Healthcare - - The Week In Healthcare - Vince Gal­loro

In the com­pe­ti­tion over physi­cians in North Carolina’s Re­search Triangle re­gion, one com­peti­tor has de­cided that if you can’t beat ’em, ask ’em how they’re do­ing it. Raleigh-based WakeMed Health & Hos­pi­tals took the un­usual step last week of fil­ing a pub­lic records request with pub­licly owned UNC Health Care Sys­tem, based in Chapel Hill, seek­ing com­mu­ni­ca­tions be­tween var­i­ous UNC Health Care units and WakeMed’s physi­cian staff.

The request also seeks au­dited fi­nan­cial state­ments and In­ter­nal Rev­enue Ser­vice Form 990s for UNC Health Care, its 658-bed Rex Health­care hos­pi­tal in Raleigh and two physi­cian-re­lated units, Rex Physi­cians and the re­cently formed Triangle Physi­cian Net­work.

Not-for-profit WakeMed also re­quested doc­u­men­ta­tion of ex­pen­di­tures of pub­lic funds by these en­ti­ties, ac­cord­ing to WakeMed’s news re­lease on the request.

The Triangle Physi­cians Net­work was un­veiled in Oc­to­ber as a tax-ex­empt, wholly owned sub­sidiary of UNC Health Care. Physi­cian groups and in­de­pen­dent physi­cians can link to UNC’s elec­tronic health record, prac­tice op­er­a­tional sup­port and the UNC fac­ulty prac­tice’s spe­cial­ists and sub­spe­cial­ists through the net­work, ac­cord­ing to a news re­lease.

At its launch, the net­work had 15 prac­tices and 60 physi­cians, ac­cord­ing to the re­lease, but sub­se­quent com­ments by UNC of­fi­cials in­di­cate that it had grown to 130 physi­cians by mid-Novem­ber.

The in­creas­ing com­pe­ti­tion be­tween WakeMed, UNC and Duke Uni­ver­sity Health Sys­tem, Durham, N.C., over physi­cian ar­range­ments has been most vis­i­ble re­cently in car­di­ol­ogy. WakeMed com­pleted the ac­qui­si­tion of Raleigh Car­di­ol­ogy As­so­ci­ates, an eight-physi­cian group that al­ready was prac­tic­ing at WakeMed fa­cil­i­ties, on Oct. 1.

Less than two weeks later, UNC an­nounced that it had reached an af­fil­i­a­tion with Wake Heart & Vas­cu­lar As­so­ci­ates, a 23-physi­cian group that had prac­ticed mostly at WakeMed. The af­fil­i­a­tion will be­gin in Jan­uary, but it will not pre­clude Wake Heart physi­cians from prac­tic­ing at WakeMed. Terms were not dis­closed in ei­ther deal.

Bill Atkin­son, pres­i­dent and CEO of WakeMed, said in an in­ter­view that UNC has made a “sig­nif­i­cant in­crease” in its physi­cian re­cruit­ment in profitable ser­vice ar­eas such as car­di­ol­ogy, or­tho­pe­dics and surgery while be­ing a state-owned en­tity.

Mean­while, Atkin­son said, WakeMed shoul­ders 80% of the char­ity-care bur­den in Wake County.

“ We’ve been watch­ing state money fos­ter what we be­lieve is an un­level play­ing field,” Atkin­son said. “ It’s not about in­creas­ing ser­vices but mov­ing ser­vices from one to the other. When it’s be­ing sup­ported with tax­payer money, that’s a prob­lem.”

Atkin­son noted that WakeMed and UNC’s med­i­cal school have had a 30-year, mu­tu­ally ben­e­fi­cial res­i­dency re­la­tion­ship, but UNC Health Care’s more ag­gres­sive, com­pet­i­tive stance is mud­dy­ing the wa­ters—leav­ing the ques­tion of whether UNC is a teach­ing and re­fer­ral cen­ter or an out­right com­peti­tor, he said.

And UNC’s ag­gres­sive be­hav­ior hasn’t been aimed solely at WakeMed, Atkin­son claimed.

UNC has tar­geted physi­cians af­fil­i­ated with the Duke sys­tem and also in ar­eas far­ther from UNC’s Chapel Hill head­quar­ters, he said. A Duke spokesman de­clined to com­ment for this story.

One goal of the records request, Atkin­son added, is to bet­ter de­fine the sta­tus of Rex Health­care, which UNC pur­chased about a decade ago. “ Some days it’s pub­lic, some days it’s pri­vate,” Atkin­son said. “ It’s al­ways claimed what­ever sta­tus was con­ve­nient at the time.”

UNC Health Care de­clined to make its CEO, Bill Roper, avail­able for an in­ter­view. In re­sponse to WakeMed’s records request, UNC re­leased ex­cerpts of a speech that Roper gave to the Wake County Med­i­cal So­ci­ety on Nov. 18. Roper cited the need for physi­cians and hos­pi­tals to co­or­di­nate care to lower costs and boost qual­ity. Aca­demic med­i­cal cen­ters, Roper said, are a good place to start be­cause they al­ready have that in­te­gra­tion be­tween physi­cians and hos­pi­tals.

UNC is flex­i­ble in its ap­proach to physi­cian ar­range­ments, us­ing em­ploy­ment, joint ven­tures and aca­demic af­fil­i­a­tions as ap­pro­pri­ate, Roper added.

Roper: Physi­cians and hos­pi­tals need to co­or­di­nate care to lower costs and boost qual­ity.

Atkin­son: “We’ve been watch­ing state money fos­ter what we be­lieve is an un­level play­ing field.”

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