The dramatic reorganization plans of Roanoke, Va.-based Carilion Clinic are meeting some equally dramatic opposition from independent physicians in the clinic’s service area.
The recently formed Coalition for Responsible Healthcare, which represents roughly 200 Roanoke-area physicians, aired concerns with the seven-hospital system’s restructuring plans during a public hearing last November and met mid-December with Carilion executives seeking assurances that independent doctors won’t be squeezed out of the market.
In June 2006, Carilion Health System announced plans to convert from a health system to a physician-led clinic; expand its Roanoke campus; hire specialists and subspecialists; and launch a research partnership with nearby Virginia Polytechnic Institute and State University (August 2006, p. 10). Carilion expanded its efforts with a Jan. 3 announcement to open a medical school with Virginia Tech by 2010. The five-year medical school would be Virginia's fifth and cost an estimated $30 million to $50 million to launch.
Geoffrey Harter, M.D., with Roanoke Ear, Nose and Throat Clinic and the coalition’s president, says the coalition fears Carilion’s plans to employ doctors will financially cripple private practice groups in southwest Virginia, alienate patients from longtime providers and give the clinic a monopoly hold on Roanoke’s healthcare market. Carilion’s 1990 merger of two not-for-profit Roanoke hospitals was the first such healthcare deal ever challenged by the Justice Department. The system succeeded after a two-year court battle.
The coalition also challenged the clinic’s plans to spend $100 million on its conversion, he says, which is money that might be better spent on upgrading Carilion’s hospitals.
The coalition turned up the heat in December, launching a petition drive to rally opposition. The petition can be viewed at responsiblehealthcare.org.
"Independent doctors play an important role in the healthcare of this community," says coalition physician Jesse Davidson. Doctors are seeking a written guarantee from Carilion’s executives the clinic wont recruit and hire specialists to compete with existing private practices, Davidson says.
Mark Werner, M.D., Carilion’s chief medical officer and executive vice president, says he welcomes discussion with the doctors.
"I don’t have any heartburn over there being a coalition," Werner says. "We’re delighted that physicians want more information. We’re delighted that they want to engage in thoughtful conversation" about improving the quality and efficiency of medical care. "It’s not yet as good as it can get," he adds.
The clinic held six two-hour community forums that attracted an estimated 90 people each, a Carilion spokesman says.
Harter says independent physicians—whose practices and patients will be affected by Carilion’s conversion—were not consulted as health system executives drafted their plans.
Carilion officials have vowed to keep the clinic’s medical staff open and are considering how to collaborate with private practices, Werner says. The clinic won’t "encroach on the responsibilities, accountability and authority" of Carilion’s medical staff, but officials will stress that those responsibilities include quality improvement efforts such as evidence-based medicine.