“Everyone realizes they have to be big to play in the game. What we’re looking for is different ways to become big without necessarily becoming employed’’ by a hospital, Chung said.
It is not the first time that hospitals have acquired physician practices. In the 1990s, the move toward managed care prompted a similar surge, but that effort resulted in huge financial losses for hospitals, and they subsequently divested themselves. This time around, economic and political pressures are such that hospital executives say they have no choice.
Hospitals with primary-care doctors on their team have the resources to “figure out which patients are at risk, which ones need to be monitored more closely depending on their fragility,” said Bob Kocher, lead author of a New England Journal of Medicine report in March about hospital hiring of physicians.
By contrast, individual doctors, who lack those resources, “almost never do this today,” said Kocher, director of the McKinsey Center on U.S. Health Reform.
Locally, Inova Health’s plan to hire 200 primary-care doctors over five to eight years has brought them about 20 such physicians, virtually all of them recent graduates, according to Wayne Diewald, an executive vice president.
Many Northern Virginia doctors aren’t interested because of mistrust dating to the 1990s, when Inova bought practices but then shed them, doctors said.
Hopkins, the newest player, has the longest history with employed physicians. The Baltimore-based powerhouse is making Montgomery County and Northwest Washington “a major focus” for primary-care hires in the next two years,
said Steven Kravet, president of Hopkins’s community physician group.
Hopkins has hired 10 primary-care doctors since acquiring Suburban Hospital in 2009 and will open practices at Sibley and downtown Bethesda this summer, he said. Hopkins wants to hire another 10 doctors over the next year and a half, he said.
Doctors from one local practice, Foxhall Internists, declined to become Hopkins employees because they want to keep their independence, said Alexander Chester, Foxhall’s president. The practice, which does not accept insurance, schedules 30 minutes for established patient visits and an hour for physicals; a Hopkins representative told them they would have to see patients every 15 minutes for regular visits, Chester said.
Brown, the Hopkins physician, confirmed that she was allotted 15 minutes for established patient visits and 30 minutes for physicals. But if she is running over, she can ask for help from colleagues and keep working through her lunch or stay later.
Her performance is not based solely on patient volume. “It is about how many and how sick they are,” she said. Hopkins sets a monthly goal for Brown based on “relative value units” that take both factors into account.
Hopkins officials say part of her salary is also linked to quality metrics, such as patients receiving mammograms, colonoscopies and vaccines. She gets a bonus for meeting the goal. “I’m not finding it at all difficult to reach my goal,” she said.