Forces Bringing Specialist to Twin Falls Part of National Trend
By Brian Smith, The Times-News, Twin Falls, Idaho | |
McClatchy-Tribune Information Services |
McEntire, a pain management specialist fresh off his residency and fellowship with the
Across the nation, younger physicians and specialists are increasingly being employed by growing hospital systems, which are creating under-one-roof, team-based approaches they say will improve health outcomes and lower costs.
But old-guard physicians, many who value the stature that comes with independence, don't view the trend through those rose-colored glasses.
Many reference St. Luke's recent attempt to purchase the 43-physician
Dr.
Physicians under the St. Luke's umbrella -- which he estimated now dominate the area's market -- will now be referring only to
Coordination of Care
St. Luke's offers a different view, one they say is exemplified by McEntire's role in their system and dictated by the Affordable Care Act.
That federal legislation seeks to incentivize wellness instead of rewarding sickness by shifting payment from a fee-for-service model, to paying based on health outcomes, said
A key part of achieving that is coordinating care, a pillar of which are electronic records that follow a patient through an episode of care, helping all doctors a patient sees get on the same page, she said.
But that idea isn't just attractive to hospitals.
"I like being part of a hospital system because I like the communication within a communal record system where you can send notes back and forth," McEntire said. "It is much better for the patient and it is much better for the doctors."
McEntire, who uses a wide range of treatments from injections to psychology to radiofrequency denervation, said he focuses on reducing high-dose, long-term opioid use, the national overutilization of which has been called an epidemic by some. St. Luke's system helps him achieve that by flagging patients already on opioids.
While few would disagree that integration of medical records is a good thing, Dille said St. Luke's explanation fails to mention existing integration efforts. Each time his staff sees a patient, Dille said a note is sent to the referring physicians allowing them to "be as involved in the patient's care as they want to be."
Pain management is a specialty that could grow in importance under health care reform, as hospital reimbursement from the
Reducing pain also removes barriers to exercise, and improves a patient's psychological outlook on their health, she said.
Employed vs. Independent
McEntire is also part of a wave of new employed doctors who aren't attracted to the idea of starting a free-standing practice, which requires considerable capital, research and oversight. He is trained to be a doctor, not a businessman, he said.
"And you are kind of gambling that you are going to get enough patients to pay the bills, he said. "With a system like this, where they hand it to you on a platter, it makes it that much more enticing."
In that way, the growth of hospital systems might be good, as they provide a stable base from which to extend needed specialty care in rural communities, said
"It wouldn't be an open heart surgeon, but someone like a pain specialist? Absolutely, because that pain specialist helps the whole system and keeps people out of the hospital," he said. "That's where the other part of rounding out their salary comes from. They are helping save money."
Wanted: Specialists
Specialists earn an average of two and often four times as much as primary care physicians,
Kytle said St. Luke's is actively seeking specialists, but often has a hard time getting them to an area flanked by two cities --
Since 2006, St. Luke's has recruited more than 88 physicians, 43 of whom are specialists, 27 are primary care doctors, and 18 are hospital-based positions like hospitalists, anesthesiologists and emergency medicine physicians.
"Most of the specialists recruited will support our core specialties, like cardiology, general surgery, urology, gastroenterology and psychiatry," said
Addressing Shortages
St. Luke's is seeing specialists retire and its patient pool grow through population increases, the aging population and increased access afforded by the ACA. That mirrors trends seen around the nation as many predict the current physician shortage will be rapidly exacerbated.
Nearly 20 percent of Americans already live in an area short of primary care doctors, reports the
The national benchmark is one physician for every 1,000 patients.
Added specialists can help with that, Kytle said. Pain management specialists, for example, can shift patient loads away from overloaded doctors who may not want to, or be trained to treat long-term pain. That, coupled with additional front-line care positions such as physicians assistants and nurse practitioners, can make a dent in the need, she said.
"You have to have a very appropriate, delicate mix of doctors and that means the right primary care physicians, the right types of specialists, and it also means the right types of extenders -- physician assistants and nurse practitioners," Bodnar said.
Independent Still Needed
Dille said that mix needs to include independent doctors.
"I talk to a lot of patients that are very happy that I'm not part of St. Luke's," he said.
He said he expects patients to jump around, as is common among those with chronic conditions, when a new provider comes to town.
"I'm all for that because I think they'll get better quality care at our facility and at a decreased cost to them," he said.
"We need a variety of physicians, whether they are sub-specialists, whether they are private, whether they are employed -- we need that whole system to be networked together so everyone is talking to each other," Santos said.
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