There is a good chance that your once-independent doctor is now employed by a hospital. Dr. Michael Reilly, a Fort Lauderdale, Fla., orthopedic surgeon, does not believe this is good for physicians, patients or society.
For years he watched Broward Health, a nonprofit Florida hospital system, hire community doctors, pay them millions and minutely track the revenue they generated from admissions, procedures and tests.
鈥淲e are making money off these guys,鈥 Broward Health鈥檚 CEO told Reilly, according to a federal whistleblower lawsuit filed against the system by Reilly and the U.S. Justice Department.
Last month Broward Health to settle allegations that it engaged in 鈥渋mproper financial relationships鈥 with doctors under laws prohibiting kickbacks in return for patient referrals.
Giving doctors incentives to generate medical revenue is widely deemed unethical because it tempts them to order unneeded treatment or send patients to lower-quality providers. Physicians with a financial interest in a medical facility than those who don鈥檛, studies show.
Lawmakers have repeatedly tried to ban or limit such behavior at least since the 1970s. What happened at Broward Health and numerous other hospitals suggests they haven鈥檛 succeeded. Now that hospitals everywhere have gone on their own physician acquisition sprees, Reilly worries the same thing will keep occurring.
鈥淲e have got to get hospitals out of the business of hiring doctors,鈥 he said in an interview. 鈥淚t鈥檚 potentially detrimental to the patient, and it鈥檚 terrible for health care.鈥
Hospitals, burdened with large, fixed costs and anxious to ensure patient referrals and revenue in a changing industry, are doing the opposite.
鈥淒oc binge buying rolls on鈥 was the , an industry magazine. A third of doctors now work directly for hospitals or for practices with at least partial hospital ownership, estimates the American Medical Association.
Broward Health is a taxpayer-supported system with five hospitals and a publicly appointed board.
More than a decade ago it launched an expansion drive that included hiring previously independent physicians and paying CEO Frank Nask and other executives large bonuses if the institution increased revenue and the bottom line.
It agreed to hire orthopedists and cardiologists for more than $1 million a year 鈥 far more than average for such specialties. It paid orthopedic surgeon Dr. Erol Yoldas, also baseball team, nearly $1.6 million in 2009.
Reilly rejected an employment deal with Broward Health after his lawyer told him it was illegal, he said. His whistleblower complaint, originally filed in 2010, was unsealed last month.
The system carefully tracked the return on its investment in the other doctors, recording the value of referrals and pressuring them to increase volume if they lagged, the lawsuit said.
Although Broward Health paid an enormous sum to settle allegations of wrongdoing, it did not admit those allegations, which is typical in such cases. CEO Nask retired last year. Nobody in the system has been charged with criminal wrongdoing.
Yoldas did not respond to requests for interviews. Nask did not respond to messages left at a number listed in his name.
Thanks to an uncoordinated system that pays for procedures instead of keeping people healthy, on unnecessary treatment, excessive administrative costs or fraud, calculates the authoritative Institute of Medicine.
Reilly responds carefully when asked whether doctors employed by Broward Health were ordering unneeded procedures. He鈥檚 concerned about possibly getting sued by a system with 鈥渄eep coffers,鈥 he said.
鈥淚 wasn鈥檛 allowed to review medical records,鈥 he said. But when he sometimes saw patients who had been recommended for surgery by those doctors, he added, 鈥淚 never agreed with the previous opinions.鈥
Reilly preferred working as an independent 鈥 on staff at hospitals but not employed by them. He didn鈥檛 feel compelled to generate revenue by ordering procedures, he said.
If Broward Health pushed a brand of artificial knee he felt was wrong for a patient, he could do the operation elsewhere. If he had concerns about the system鈥檚 radiology department 鈥 as some doctors did, according to the lawsuit 鈥 he could refer people to a different facility.
Fewer and fewer doctors have the same freedom, Reilly worries.
Some believe the AMA underestimates . Hospitals have been especially keen to hire primary-care doctors, the specialty that generated the highest referral profits for Broward Health, according to the lawsuit.
Not only does hospital employment 鈥渄ramatically鈥 boost chances that a doctor will refer to that hospital, but it also raises odds that patients will end up at a higher-cost, lower-quality facility, from Stanford University researchers. Like Broward Health CEO Nask, many hospital bosses get .
In the last two years the Justice Department has settled more than a dozen cases under the to doctors in return for patient referrals.
鈥淢y wish would be that the hospital-physician employee contract would go away,鈥 said Reilly, now retired and entitled to $12 million of the whistleblower settlement. 鈥淵ou could pick just about any hospital, and I will tell you there is a component where that contract is driven by referrals.鈥
He is skeptical that accountable care organizations 鈥 collaborative groups of doctors and hospitals that are supposed to focus on keeping patients healthy and not on maximizing revenue 鈥 will change the dynamic.
Hospital hiring of physicians 鈥渘ot only fosters an environment to motivate physician referrals, but also blunts physician innovation, discovery and ingenuity,鈥 he said.
What should patients do? Ask their doctor who he or she works for, Reilly added. If the doctor is employed by the hospital and recommends surgery or some other expensive treatment, he said, 鈥渞esearch the indications for the procedure鈥 and 鈥渃onsider a second opinion鈥 from an independent practitioner.