Consumer Reports’ medical director, Orly Avitzur, found that her gastroenterologist of seven years recently had begun working at a new practice, one owned by a large medical center. When Avitzur contacted her about a colonoscopy, they discussed her pre-colonoscopy prep and diet and the scope the doctor would use, then scheduled an appointment at her new hospital.
What Avitzur’s doctor neglected to share with her was that because of the changes related to her new practice, she wouldn’t be performing the procedure herself.
Doctors throughout the country are leaving their practices in droves to become employees of hospital-owned practices and multi-specialty clinics. From July 2012 to July 2015, the number of hospital-employed physicians increased by 50 percent, and it’s estimated that only about 1 in 3 doctors remain in private practice. (This is largely because hospitals and health-care systems are buying up practices to attract more patients and because government and insurance regulations are becoming too labor-intensive for small practices.)
These changes in doctors’ employment status come with a host of new conditions that can affect your care. Three key examples:
When your doctor leaves a private practice for a hospital-owned one, you may find that he or she has new office staff and hours and new rules about cancellations, and that appointment lengths have changed.
Even if you’ve been seeing your doctor for years, you’ll probably need to fill out new registration forms at your first appointment. And because the new practice may use a different electronic medical records system and might not yet have access to your information, you should bring with you a list of your medications, supplements, surgeries and diagnoses. Your doctor might also get slowed down while learning that new system, so be patient.
Several factors might affect what you’re asked to pay. For example, when doctors join a hospital-owned practice, they’ll probably begin accepting some new insurance plans and will drop others. So ask the billing department whether the practice still participates in your plan; otherwise, you could be stuck with out-of-network bills.
Even if your doctor still accepts your insurance, your coinsurance (the percentage of the bill you pay out of pocket after insurance pays its portion) could go up. This is because your doctor may start charging his new employer’s prices for tests and other services. Check beforehand with the office billing staff.
The hospital that bought your doctor’s practice may designate his office an outpatient clinic and can legally charge you a facility fee if procedures or tests are performed there. Ask about facility fees ahead of time. (The 2015 Bipartisan Budget Act prevents health systems from billing those on Medicare for facility fees at practices acquired on or after Nov. 2, 2015, but systems can continue charging for those purchased beforehand.)
By joining a larger group of health-care providers, your physician is likely to provide you with access to a broader network of on-call and consulting doctors who can easily share information about your health. This can usually be beneficial.
But not always. Just before Avitzur’s pre-colonoscopy sedation was administered, it occurred to her to make sure her doctor — who had not yet approached her bedside in the outpatient procedure suite — would be performing the test.
She was stunned to discover that a doctor in training was scheduled to do the test and that her doctor would only be supervising. The doctor’s new medical center is a teaching facility, and trainees perform such tests as part of their education. (Avitzur requested that the doctor do the colonoscopy herself.)
Most patients’ bills of rights give you the right to know the names, positions and functions of all hospital staff involved in your care and to refuse their treatment, examination or observation. And doctors in training are mandated to inform patients of their respective roles.
But as in Avitzur’s case, these rules are sometimes overlooked. So if your doctor changes practice settings, it’s important to ask ahead of time whom you will be seeing in the office and who will perform any scheduled tests or surgery.
For further guidance, go to ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.