When nearly 100 doctors announced their surprise split from Atrium Health last year to form an independent practice, the exodus from the giant Charlotte hospital system was seen as an anomaly.
The doctors, who went on to form Tryon Medical Partners, were bucking a nationwide trend of health care consolidation.
But in mid-September, Tryon Medical announced its first expansion outside of Mecklenburg County. Seven doctors are leaving CaroMont Medical Group’s South Point Family Practice in Gaston County to join them.
Area hospitals insist they are not worried about any more doctors heading out the door for life in an independent practice. But Tryon Medical Partners CEO Dale Owen said he expects to see just that scenario.
”This is our goal, this is our mission,” he told the Observer. “And that’s to free physicians from hospital systems so they can take care of patients in the most efficient, cost efficient and value-based way possible.”
It makes sense that doctors would want to be independent, said Barak Richman, a Duke Law School professor specializing in health care policy.
“You don’t see a whole lot of physicians breaking away,” he said. “But at the same time, it’s not entirely surprising that they would want to.”
It can be frustrating for doctors to have to follow instructions from a “hospital mothership,” Richman said. Independent practices allow doctors to be more involved in decision-making.
But CaroMont said being part of a health care system allows doctors more freedom to focus on practicing medicine.
“There is great stability and support that comes from being part of a health system, especially one that has been in operation for nearly 75 years,” CaroMont said in a statement.
The health system said it doesn’t expect to see more doctors leave as a result of the Tryon Medical expansion.
“This,” Caromont stated, “is an isolated situation.”
‘Same boat... same vision’
Mike McCartney, one of the doctors leaving CaroMont, said patients had many complaints about the health system.
Lab tests were more expensive for patients when using hospital equipment and patients griped that it was hard to get phone access to doctors, McCartney said.
What’s more, he said, hospitals can be slow to make needed infrastructure changes.
“One of the things about being an independent model is being more nimble,” McCartney said. Physicians will be able to costs down more effectively in an independent practice, he said.
“In my eyes, there seems to be a better ability to control costs,” McCartney said. “We’re all in the same boat together, with the same vision.”
There are three ways hospitals like CaroMont, Atrium and Novant Health are able to make medical services more profitable, Richman said.
First, big hospital systems ensure less competition, Richman said. Hospitals can also charge facility fees for hospital property usage. And a broad network of physicians means hospitals can count on higher referral rates.
“It becomes a very lucrative combination for those involved, but it often becomes a costly combination for (patients),” he said.
Referral rates was one complaint mentioned in Tryon Medical Partners’ 2018 lawsuit against Atrium — accusing the system of monopolistic and anti-competitive behavior. That included ordering doctors in most cases to refer patients to Atrium-owned or managed facilities, according to the 2018 lawsuit.
“The whole area is better served from a cost and value standpoint on the patients’ behalf if there are more independent doctors, rather than controlled referral patterns,” Owen said.
Atrium said there is no policy guiding doctors to primarily refer to its facilities.
“Atrium Health physicians always focus on what is best for patients,” Atrium said. “…Atrium works hard to be the first and best choice for care, and we are proud that is so often the case.”
Health care professionals have moved toward value-based care in the last few years, meaning care that incentivizes keeping patients healthy and out of emergency care facilities.
It’s harder for hospitals to make that change from the old model of fee-for-service care, which rewarded doctors for performing as many tests and services as possible, Richman said.
“It requires a fundamental change in their business model,” he said.
Giving doctors a voice
The Observer asked area hospitals and health systems why doctors benefit from their networks.
In a statement, Caromont said it employs about 250 doctors and advanced care practitioners, and has about 200 more community providers who are part of its medical staff.
The seven doctors leaving CaroMont submitted their 90-day resignation notice on Aug. 23, and are suing to be able to make that move. Tryon Medical Partners has a temporary office location ready for those Gaston County doctors — and it just happens to be across the street from CaroMont Regional Medical Center.
The departing doctors make up a small percentage of the hospital workforce, and CaroMont stated it expects to add several more physicians to the South Point Family Practice office in the next few months.
“We place great emphasis on being clinically led, meaning physicians play a critical role in decision-making for the health system,” CaroMont said. “Doctors have a voice and can make a difference here, both for their patients and for the community.”
Being part of a health system allows doctors to focus more time on practicing medicine, CaroMont said, instead of the complicated business functions of running a medical practice.
Perks of the system
At Charlotte’s second largest hospital system, Winston-Salem-based Novant Health, physician turnover is low — there was about 6% physician turnover during 2017 and 2018, the hospital system said in a statement.
But a group of 40 doctors left Novant early this year — after Tryon Medical filed its suit against Atrium — to join Tennessee-based Holston Medical group.
Novant spokeswoman Megan Rivers said she is not aware of any other doctors in talks to leave the system.
Novant launched a physician network in 2016 to collaborate with independent physicians. It now includes about 600 members, with more than 350 in the greater Charlotte market, Novant said in a statement.
There are many perks for doctors joining hospital systems, Atrium Health said in a statement, including access to state-of the-art equipment, secure employment and benefits, and supporting infrastructure to handle the administration of the practice.
Atrium Health is Charlotte’s biggest hospital system, with more than 3,700 physicians.
Tryon Medical Partners had more than 110,000 patients as of Sept. 12, and Owen said he believes patients typically choose to follow their doctors.
But Atrium said more than half of the patients who had been seen by a physician who left the system had returned to Atrium for some form of care since the physician’s departure.
The system has a physician-led engagement group to address physician concerns, Atrium said.
“Throughout the organization, we always have, and always will continually look for ways to make sure all of our teammates are happy and engaged,” Atrium said.
Atrium didn’t say if the system expects more doctors to leave. But it said patients continue to choose Atrium Health for care — with over 31,750 patient interactions a day.
‘Loud and clear’
In Rock Hill, Piedmont Medical Center spokeswoman Daisy Burroughs said the hospital is not seeing the same local movement of doctors leaving health systems.
Hickory’s Catawba Valley Medical Center did not respond to requests for comment on concerns of doctors leaving hospital systems.
Hospitals might not hear the complaints from doctors, but Owen said he’s been getting calls from physicians across the region. “And all of it is about trying to get out of the hospital,” he said.
He’s not surprised hospitals aren’t aware of other physicians thinking of leaving.
“These doctors aren’t going to tell them,” Owen said. “These doctors are going to come to us. And we’re hearing it. We’re hearing it loud and clear.”