“That presents a disruption in the basic flow of medical care,” said Dr. Keith Chamberlain, vice chair of legislative and practice affairs division of the California Society of Anesthesiologists.
The group wants Tenet's hospitals to negotiate with the doctors directly. “There are ways to do it and ways not to do it,” he said.
There are about 33 contracts that stand to be affected by the change, said Dr. Marc Futernick, president-elect of the California chapter of the American College of Emergency Physicians. The larger contracts might cover 30 to 40 physicians.
“I think the plan has serious consequences for patient care and doesn't engage the medical staff,” he said. In addition, as consolidation continues across the state, a precedent could be set for other groups that are seeking to realize similar cost savings. Tenet is the first chain to attempt such a move.
Savings for the publicly-traded company, estimated to be about $15 million, would come not only through negotiating lower rates with physicians but by sharing profits between lucrative and less lucrative specialties, Futernick said. For instance, the profits from higher-margin emergency room care, instead of being returned to the local physician practices, could help pay for hospitalists.
The Coalition for Quality Hospital Care—whose members include the California chapters of the American College of Emergency Physicians and the American Academy of Emergency Medicine—has launched a media campaign and is circulating a petition to increase pressure on Tenet.
“What is surprising and alarming … is that at many of your hospitals, such actions are being contemplated without adequate input from, or notice to, the affected medical staffs and physicians,” the California ACEP chapter wrote in a letter to Tenet.
Other professional groups, including the California Medical Association, said they're also closely following the issue.
Although the coalition maintains that Tenet took similar actions in Florida, a spokesman for the Dallas-based chain emphasized that the move is being made at the local level and is not a corporate decision. In addition, the hospitals are seeking input from existing medical groups, several of which would be retained, he added.
“It was never our expectation or intent that our hospitals would choose to move to a single source for these services,” Tenet spokesman Steve Campanini said in an e-mail. “The hospitals' goals for reviewing their service options include maintaining high quality of care and patient service, better coordination of care among the services, increased stability of the physician groups, replacement of retiring physicians, and identifying partners having highly developed systems and support structures.”
There are signs that Tenet may be capitulating. Last Thursday, executives from Tenet's California hospitals met with Coalition members to discuss the proposal. Tenet, Futernick said, agreed to allow the decision to be made at the local hospital level—backing off a single contract across the chain's western region.
Chamberlain said the professional groups have been working with Tenet to find a solution and making progress. “At the moment, it seems to be going right,” he said. But he added that there is no timeline that he is aware of for when a final decision on the matter might be made.
Follow Beth Kutscher on Twitter: @MHbkutscher