Feuding over physicians
WakeMed seeks records on UNC Health Care’s arrangements with docs
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.”