Primer on ED Contracts

Find it here, in an article titled “Turf war leads to ousting of ER docs“:

An ongoing power struggle between Haywood Regional Medical Center CEO David Rice and doctors in the emergency room came to a head last week when the hospital board, at Rice’s recommendation, voted to hand over ER operations to a corporate physician staffing company.

The hospital is terminating its contract with the local group of doctors despite 18 months remaining on their contract. The physician staffing company is slated to assume responsibility for the ER on Dec. 28, but as of Monday it did not have any doctors lined up.

Rice said the decision to replace the ER doctors is necessary for the long-term solvency of the hospital. Rice said the ER doctors have been generally uncooperative in implementing hospital initiatives, such as a new computer system and efforts to reduce patient wait time.

“I think the community will understand we had no other option than to do what we had to do,” Rice said.

Meanwhile Jaben said Rice has attempted to micromanage ER operations and interfered with doctors’ autonomy. The ER doctors objected and are now being ousted as a result, Jaben said.

The biggest sticking point?:

The primary deal-breaker in the contract would give Rice authority to remove an ER doctor. The contract did not spell out specific instances that would warrant such action, but instead left it open-ended and up to Rice’s discretion.

Read the entire article, it’s a series of days-long lectures on contracts and relationships in one article.

And it says nothing good about this set of hospital administrators, but they aren’t the only ones.  Our group was told, in no uncertain terms, that to be renewed we’d all have to amend our contracts to agree to a “No Due Process” dismissal policy.  It rankled then and does now.


Comments

  1. Charity_Doc says:

    UtOh…looks like somebody need AAEM to the rescue!!!!

    Allen,

    It’s the same load of crap B.S. everywhere. I’m sure you know that already. Same ol’ play book that every hospital CEO across the country use to oust an established private group so they can hire on a cheaper corporate group to cover the ED. Of course, these corporate groups are all self-insured, saving the hospitals from having to pay loads of money in liability insurance for the docs, whereas the small private groups cannot afford to be self-insured, because it typically cost an average size group well over $1 million, easy, a year for malpractice coverage.

    These hospital administrators all use the same ploy from Press-Ganey scores (core measures/bench mark my ass), to T-sheets or “computer system” for documentation instead of dictations, to utilization reviews…I’ve seen it all. Same ol’ sh*t everywhere in attempts to oust a small private group and hire a cheaper corporate group. Does anyone really think that these bastard hospital administrators care about board certification and quality of care? Think again. It’s all about $$$$$. In the end ED physicians are expendable because the law does not require board certification in Emergency Medicine to work in an ED. For that reason, you will rarely ever find any ED contracts longer than a year or 2. You will also find that these corporate groups make lofty promises that they cannot possibly keep, such as covering the ED of a UtOh…looks like somebody need AAEM to the rescue!!!!

    Allen,

    It’s the same load of crap B.S. everywhere. I’m sure you know that already. Same ol’ play book that every hospital CEO across the country use to oust an established private group so they can hire on a cheaper corporate group to cover the ED. Of course, these corporate groups are all self-insured, saving the hospitals from having to pay loads of money in liability insurance for the docs, whereas the small private groups cannot afford to be self-insured, because it typically cost an average size group well over $1 million, easy, a year for malpractice coverage.

    These hospital administrators all use the same ploy from Press-Ganey scores (core measures/bench mark my ass), to T-sheets or “computer system” for documentation instead of dictations, to utilization reviews…I’ve seen it all. Same ol’ sh*t everywhere in attempts to oust a small private group and hire a cheaper corporate group. Does anyone really think that these bastard hospital administrators care about board certification and quality of care? Think again. It’s all about $$$$$. In the end ED physicians are expendable because the law does not require board certification in Emergency Medicine to work in an ED. For that reason, you will rarely ever find any ED contracts longer than a year or 2. You will also find that these corporate groups make lofty promises that they cannot possibly keep, such as covering the ED of a <20% reimbursement rate county hospital without any subsidy, promising board certification in all of their MD’s, willingness to take on the cost of documentations by employing T-sheets, templates, etc…so the hospital does not have to spend money on dictation services, 24 hrs. triple physician coverage, do their own billing, etc…They’re essential lying out of their a$$ and will promise anything and the moon in order to win the contract.

    My group was successful in renegotiating our contract for 2 years just 6 months ago by getting the medical staff behind us. It speaks volumes when every member of the medical staff signed a petition requesting that the hospital retain our group. It was an overwhelming vote of confidence in our favor. However, I anticipate a much harder fight 2 years from now as our PG scores continues to suck wind.

  2. Well, as crummy as it is, and it IS crummy, nurses have lived under the thumbs of CEOs, COOs and CNOs all along.

    Until professional practice groups are the almost universal modality for nurses and physicians to use in contracting with hospitals, nursing homes and the like, this weapon of slice, dice and replace will be used by corporations to keep us lackeys in our places – subservient, goose-stepping and saluting.

    Any traction to the notion of uniting RNs and MDs to grow self-governing professional practice groups instead of traditional employee/employer relationships?

  3. Well, yes, and no.

    The problem with ED staffing is that, frankly, it’s a business, and it’s a pretty specialized business. Hospitals have absolutely no interest in getting their ED staffed themselves, they just want to deal with one person, make a business deal, and then hopefully forget about it.

    What that means in reality is that the big contract management groups have a leg up when an ED contract comes open, and just threatening to bring them to the table can get a small (single hospital) group to cave to the demand of the day.

    AAEM has several statements about contracts and their vision of the ‘ideal’ ED contract. I think as the balance of power swings more to the administrators and away for the providers, the Union word will get a lot more play.

  4. Grunt speaks the truth.

    I’ve worked in large academic centers, and small community hospitals. The larger facilities have an “it’s just business” attitude, it’s entirely impersonal, and they could care less about who staffs their ED. The smaller ones have much more of a “small town” feel, where every doc on staff is on a first-name basis with the others.

    In the latter scenario, I’ve seen the medical staff circle the wagons and force the administration to back down, costing the hospital hundreds of thousands of dollars in the process. At a smaller facility, Tom the ER doc’s kids play with Dave the surgeon’s kid’s, and Tom the ER doc goes to church with Sally the FP. There is actually a “medical community” and they protect their own.

    There is a critical mass (in size terms) where a facility simply grows too large (and the medical staff too dispersed) to form the community that used to protect physicians. At that point, it’s every man (or group) for himself, and physicians are divided-and-conquered by the suits and bean-counters.

  5. Trench doc says:

    This is nothing new for this facility and for the area in general; Western NC is a dangerous place to practice EM.

  6. In Texas, employees are presumed to be “at will.” At-will employees may be terminated for any reason, so long as it’s not illegal. In most states, employees that work under an employment contract can only be terminated for reasons specified in the contract. However, in Texas, the mere fact that an employment contract is in writing is not sufficient to overcome the presumption that the employment is at-will. To overcome this presumption, an employment contract must directly limit, in a meaningful and special way, the employer’s right to terminate the employee without cause. In other words, the employer has to unequivocally indicate that it will not terminate the employee except under specific circumstances.

    http://research.lawyers.com/Texas/Employment-Law-in-Texas.html

  7. I should clarify. We’re all Independent Contractors, so our contracts could easily be cancelled.

    What we had to sign was that standard Due Process rights under the medical staff bylaws didn’t apply to us. So, the surgeon butts heads with the ED doc; guess who’s thinking, in the back of their mind, “push comes to shove even if I’m right who’s easier to get rid of”? It ain’t the surgeon.

    And that made us in the ED the Second Class Citizens of the medical staff.

  8. Mike Bronson says:

    This is the basic problem with doing a residency that only allows you to work in a hospital – the hospitals own you for life.

  9. True enough. However, there are ranges in the practice environment, and I know of a couple of groups that manage to remain (relatively) autonomous but still keep the hospital happy.