Doctors say Tenet contract plan could hurt quality of care

kcarlson@modbee.comJune 12, 2014 

The corporation that owns Doctors Medical Center of Modesto is considering a contract with a national management company that would replace contracts with physicians who save lives in the emergency room, care for patients in hospital beds and put patients to sleep before surgery.

A hospital spokeswoman confirmed it’s a topic of early discussion to see if a contract with a “single-source” provider makes sense for the Florida Avenue hospital. Physicians opposed to the proposal said it could lead to departures from the medical staff and undermine the quality of care in affected departments at the hospital.

Dallas-based Tenet Healthcare, which operates 78 hospitals in the nation, is exploring whether to bring emergency physician, hospitalist and anesthesia services under a single management group at its 11 hospitals in California.

Tenet owns Doctors of Modesto and Doctors Hospital of Manteca and is working to complete the purchase of Turlock’s Emanuel Medical Center, which would become Tenet’s 12th hospital in the state.

Physicians at Doctors of Modesto said they were told at a meeting last week that changes to physician contracts were being considered. They are expected to discuss the matter during a medical staff meeting next week.

“The physicians have been involved with that process here,” said Carin Sarkis, director of business development for Doctors. “The hospital is always looking for ways to enhance efficiencies and enhance the services we offer to our patients.”

Sarkis said she was not aware of any timeline for a decision. “We certainly value the services and all the dedication that our medical staff has provided us for years,” she said. “Even if we did make a change, our goal would be to keep the physicians on our staff in their current positions.”

The same proposal sparked a recent outcry from physicians at two hospitals owned by Tenet in San Luis Obispo County.

The Tribune in San Luis Obispo reported last week that a proposal to bring emergency medical, hospitalist and anesthesia services under a single management contract had been dropped for those two hospitals after pushback from physicians. But changes to physician contracts still are being explored at other Tenet facilities.

Tenet is expected to entertain bids from management companies such as ApolloMed of Southern California and Dallas-based EmCare, a subsidiary of investor-owned Envision Healthcare, which also owns the nation’s largest ambulance company, American Medical Response.

An agreement with a national company would replace local contracts with doctors and other providers who have cared for patients at Doctors of Modesto for years, physicians said.

“I am sure some accountant in Dallas told the company they could save a lot of money if they do this,” said Dr. Robert Barandica, chief of the medical staff and emergency department at Doctors of Modesto. “On paper, it may sound like a good idea, but they are not realizing what the impact is on the local level.”

The hospital’s emergency department is staffed by 32 physicians and midlevel practitioners who are part of a physician-owned group that contracts with Doctors. If they are faced with joining another management company, Barandica said, many of those providers will work for other hospitals that contract with their group.

That would reverse years of effort to build the medical team that staffs the Level II trauma center at Doctors, which provides lifesaving treatment to car crash victims and other patients delivered from a six-county region, Barandica said. In addition, the department staff worked hard to earn accreditation as centers for treating stroke and heart attack victims.

“It was incredibly difficult to recruit them to this area,” Barandica said. “We built a core of people who live in the community and have relationships with subspecialists in the community. It would take a decade to rebuild that.”

The ER staff members are part of a sizable group, CEP America, which has 2,300 providers at locations in nine states, and would lose profit-sharing if they became independent contractors or employees of another management firm, he said.

On its website, EmCare says it provides “outsourced physician management services” for hospitals that are contending with staff shortages, regulatory changes and health care reform. The fast-growing company has contracts for services at more than 500 hospitals in the nation.

EmCare did not respond to a request for comment Thursday. Physicians with local groups that provide hospitalist and anesthesia services at Doctors did not return messages.

Sarkis said a contract with a management company would not jeopardize the status of the hospital’s trauma center or the emergency department’s accreditations as a stroke and chest pain center.

Bee staff writer Ken Carlson can be reached at or (209) 578-2321.

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