How West Idaho Orthopedics and Sports Medicine’s independence allows them to practice medicine without constraints, and to the benefit of the patient.
From Small to Big
In recent years, due to changes and struggles within the American healthcare system, many physicians are joining large, hospital-owned medical groups. These corporate medical giants have hospitals, physicians of all varieties, surgeons, surgery rooms, therapists and more, to provide every aspect of healthcare to a large number of patients. The problem with this model, says West Idaho Orthopedics’ Dr. Michael Daines, is that it isn’t patient oriented. Physicians within these hospital groups have little incentive to create an excellent patient experience, and also have limitations in what they can do, when they can do it, which professionals they can recommend, even which drugs they can prescribe. Dr. Daines speaks from experience having spent several years as an employed hospital system physician. For example, suppose a patient with a knee problem sees a primary care physician who is part of a large medical group. The physician discovers that the patient needs knee replacement surgery. The doctor can only recommend surgeons and facilities that are a part of the same medical group. This can mean the patient is put on a waiting list for a needed surgery, sometimes months long. It also means that a patient has limited options in terms of pre-surgery testing, surgical centers and rehabilitation. Some facilities have equipment and capabilities that improve the quality of surgery for certain orthopedic issues, but patients who enter the corporate healthcare system often don’t have the option to pick the facility that best suits their condition. [box] How a Patient Benefits from an Independent Provider
- You can choose a surgical facility closer to home.
- You don’t have to pay facility fees, which are sometimes more than the cost of care itself.
- You can choose care that fits your condition and budget.
- You can get needed care sooner.
- You can know your surgeon.
A Wall St. Journal article recently commented that physicians working for hospitals are worse at continuity of care, worse at passing patient information off to other doctors and less likely to make time to see patients or take calls. Incentives for better care are stronger for independent doctors. Orthopedic surgeons in large-system medical groups often have months of surgeries lined up for patients they don’t even know. The system feeds them patients, and they simply do the number of surgeries each week that their employer requires. In contrast, it is common practice for independent physicians to create space in their schedules for unexpected patients, extending clinic and surgery hours, despite having full schedules already. “It really comes down to the delivery of patient care,” says Dr. John Q. Smith. “We work to educate our patients so they can make smart choices. We work with their availability to schedule after hours appointments and even surgeries. We treat each patient individually and tailor a treatment plan to achieve their goals, unlike hospital doctors who stick to a traditional 9-5 work week.” In addition, with an independent practice, you are directly involved with the surgeon early on. “Our surgeons are involved from start to finish,” says Dr. Charles Schneider, who has been with the practice in Caldwell and Meridian for 37 years. “Being available to the patient helps pre-surgery and getting to know that patient helps tremendously with post-surgical care.” The bottom line is that independent physicians have more flexibility and are more likely to cater to the needs of the patient. This isn’t to say that corporate physicians aren’t great doctors, adds Dr. Robert Hansen, but they simply have little incentive to go above and beyond for their patients. This is why WIOSM’s patients who call with questions will speak directly to one of the surgeons in the group. In this way the doctors keep close tabs on their patients. This would be largely impossible for a physician employed at a large hospital.
Dr. Michael Shevlin recalls this recent experience: “A few months ago I saw a patient in the office with an ankle fracture that needed to be fixed surgically. We tried to schedule the procedure at one facility. They were unfortunately unable to get that surgery scheduled within the next few days and the patient would have had to wait over the weekend to have it done (it was only Wednesday at this point). My schedulers were then able to get this surgery scheduled at another facility the next day. “
WIOSM also works with the patients’ insurance, ensuring we are treating patients in network, containing costs every step of the way, so there are no surprises. “I relish the autonomy to practice how best fits the needs of my patient and not the organization for which I work,” says Dr. Jonathon Wolf, who will join the practice in September. “The ability to be flexible, and the ability to pass along cost savings to the patient are huge advantages.”
Another way the patient is put first is the access to their doctor after hours. Most hospital system physicians work a strict schedule and do not take calls after hours. “My phone is always on for my patients,” says Dr. Nicola. “Often times following surgery, the patient is uneasy those first couple nights and I am always available to talk with them. This is not the case with a hospital system physician”
Privacy is another advantage offered by independent practitioners. Most hospital medical groups use electronic medical records that are accessible by any doctor, PA, or nurse in the system. Personal information - all information - is widely available. This means any doctor or nurse, at any time, can access any of your personal medical information, whether it is relevant to the specific case they are working on or not. Independent doctors do not openly share electronic records. WIOSM’s approach fits well with the changing patient attitudes of today, says Dr. Shevlin. “Patients today are much more engaged in their own healthcare. They are better educated. They understand that they have a choice.”
Dr. Nicola adds: “In this changing healthcare arena, we are aware patients are paying increased cost for care, from insurance premiums to out-of-pocket expenses to the rising cost of care itself. For us it's all about the quality of care. Our patients come first. Our surgical outcomes are second to none.”
[box] In addition to the main clinics in Meridian and Caldwell, West Idaho Orthopedics has satellite offices in Emmett and Fruitland. Being independent allows the WIOSM surgeons to offer quality, affordable care close to home. Find a Location Near You[/box]
The freedom of independence raises physician productivity and quality of care, and also allows for more controlled costs, according to Dr. Daines. Certain MRI machines cost more than others, and the same goes for different equipment at various facilities around Boise and the Treasure Valley. WIOSM surgeons are able to choose which equipment to use and create a personalized patient plan. On top of this, they don’t charge their patients a facility fee (sometimes thousands of dollars), which a hospital will tack on, and which insurance sometimes doesn’t cover. Hospitals must be equipped to provide critical services for a wide variety of medical conditions, of any severity, which is what a community needs and wants. However, having the facilities, professionals and licensing to operate at this capacity costs a lot of money. To balance these costs, a hospital tacks on what are called facility fees to the bills for procedures. For example, a woman in Florida took her young daughter to an urgent care center owned by a hospital. The center billed $233 for care from the doctor, and a $275 facility fee. This means that the patient is responsible for not only the doctor’s care, but also must pay the hospital for the facility fee.
“Costs can more than double with these fees, and patients, along with their insurance companies, foot the bill,” says Dr. Nicola. “For the patient, depending on your insurance plan the fee may not be covered and you will be 100% responsible for the bill.”
Medicare covers most of these facility fee charges, which helps those patients age 65 and older. But for many younger people with high-deductible private insurance plans, these visits can be quite expensive. While independent practices do not charge facility fees, these fees can occur when a surgery is scheduled at specific hospitals. The question is this: should the patient feel comfortable paying to offset hospital operational and overhead costs? Independent practices say no.