Five doctors at a physician-owned hospital in Idaho have had their medical privileges revoked at an older, larger rival hospital, allegedly for competing "in a way that can't be reconciled with what's best for the community."
The dispute is between the 19-year-old, 342-bed Eastern Idaho Regional Medical Center, a for-profit hospital owned by HCA, and the upstart 13-month-old, 20-bed Mountain View Hospital, owned by 33 local physicians. Both facilities are in Idaho Falls.
"When you boil it all down, it's just absolutely blatant economic credentialing," said Mountain View CEO Dennis Tolman.
A Jan. 30 letter to the community from the EIRMC board of directors, posted on the hospital's Web site, said: "We just made a hard decision. We determined that five physicians are no longer eligible to hold privileges at EIRMC, because they chose to compete in a way that broke our privileging rules, and in a way that can't be reconciled with what's best for the community."
For the complete text of the letter, see www.eirmc.org.
EIRMC spokeswoman Amy Stevens said the policy that included the privileging rules was put in place 16 months ago. Privileges would hinge on whether a physician disclosed that they had a financial conflict of interest with the hospital or refused to disclose any financial conflicts; whether they had significantly changed their patient volume at the hospital; and whether there had been a harmful change in payer mix of their patients.
The analysis initially was performed on blinded data from all 187 physicians with EIRMC privileges, Stevens said. Five physicians were marked for exclusion, after which their data was reidentified.
The board on Jan. 29 voted to strip the five of their privileges effective March 1, Stevens said. The five physicians were informed of the decision the next day, she said. A hearing was not held before the decision, she said, but the five can request a meeting with the board to discuss their position.
Both Stevens and Tolman declined to identify the physicians, but a report in the Post-Register, the local newspaper, identified them as orthopedic surgeons Phil McCowin, M.D., and Gregory Biddulpha, M.D.; OB/GYN Barbara Nelson, M.D.; and plastic surgeons Tim Thurman, M.D., and Kirk Moore, M.D.
McCowin is the chief of staff at Mountain View. He was the president-elect of the medical staff at EIRMC when Mountain View opened but was not allowed to assume that position by the EIRMC board.
Moore is not an investor, sources said.
The multisurgery facility opened Dec. 2, 2002, and recently requested and received certification from CMS that it was an acute-care general hospital, not a specialty hospital.
Eighty-seven physicians have staff privileges at Mountain View, including the physician owners, according to a hospital representative. The owners include a family practitioner, a radiologist and several anesthesiologists, as well as surgeons.
Tolman said physicians have not been allowed to peruse the data on which the decisions were based and "they would not accept any of our data about patient mix."
Tolman said Mountain View physicians give their patients a choice of facilities, but "they (EIRMC officials) do not recognize patient choice as a factor in any of this." The rift will hurt the five physicians financially, as well as patients in the community, he said.
For example, the three-physician OB/GYN group in which Nelson is a partner performed 227 deliveries at EIRMC and 771 at Mountain View, Tolman said. Nelson and her partners routinely cover each other's hospitalized patients.
"Given this cancellation of privileges, that puts a real kink in the patient/physician relationship," Tolman says. The five physicians are looking at their legal options, Tolman said.
Stevens says 10 of the 11 members of the hospital board are local residents and that their decision cannot be interpreted as corporate policy of HCA, which owns or operates 191 hospitals.
"Every community is going to look around and see what that facility is facing and do what they have to do to protect their community service," Stevens said.
Tolman says he finds irony in the local situation, nonetheless, given the roots of HCA.
"Tom Frist started a physician-owned hospital in Nashville in 1966," Tolman said, referring to the doctor who founded the HCA chain. "The very same approach to medicine is being followed here, and now it's they who are pointing a finger and saying it's bad medicine."