Three Aventura doctors who say they were recently fired or forced to leave HCA blasted the national healthcare chain Tuesday for what they characterized as inept handling of physician services.
It was a nightmare, interventional cardiologist Paul Vignola said of his 31/2 years with HCA, which owns Aventura Hospital. He complained about bill collecting and lack of administrative support.
Vignola said he was told he would have to take a 50 percent salary cut and decided to leave. Oncologist Enrique Davila and cardiac electrophysiologist Todd Florin said they were handed notices terminating them and saying their offices would be shut within 30 days.
HCA issued a statement, saying the company periodically reviews our positions to assure we are aligned with the community needs. Recently, we made the strategic decision to offer nine HCA East Florida physicians a transition from employed status into private practice. All but one have transitioned smoothly. Dr. Davila rejected the offer and will officially be leaving the practice on Tuesday.
All three doctors said they signed up with HCA as part of a huge hiring wave in the past several years as the hospital chain, like many others around the country, decided that the best way to prepare for the new emphasis on accountable care organizations known as ACOs was to hire doctors and integrate them into a seamless system of care.
Hospitals made a similar move in the 1990s, buying up physician practices only to lose huge sums and stop employing doctors. This time, many hospitals vowed, would be different.
They didnt make the mistake this time of paying big bucks for the doctors practices. They did guarantee the salaries of the doctors with the hopes that the doctors practices would grow into them, but the practices continued to lose money, said Mike Curtis, a former HCA vice president of physician practices who hired Davila, Vignola and Florin for the company.
Curtis, who left HCA in 2010, said that HCAs physician practices just grew too fast, hiring hundreds of doctors a year, and didnt have the infrastructure to support them at its headquarters in Tennessee. There were huge delays in getting claims, credentialing, and it just went on and on. It was not a well orchestrated process. Now theyre at a stage where theyre cutting doctors to reduce their losses.
Curtis said an additional problem was that many community doctors viewed hospital-employed doctors as possible competitors and preferred to refer cases to specialists who also had private practices.
Florin, who said he is studying for a degree of masters of business administration, said he decided to close his private practice and go with HCA because they said they had a lot of cash and they were investing in the future. I believed them. But as a doctor interested in business aspects, he said he found no control of costs. He said his HCA business cards cost five times what he paid as a small businessman, when the large chain should have been able to negotiate a better price, and his dictation service at HCA cost twice what he had paid in private practice.
Whats more, Florin said, management was not interested in hearing ideas from the employed physicians on how to improve the situation. Florin noted that the best organizations employing doctors the Cleveland and Mayo clinics are led by physician executives.
Vignola, the cardiologist, said HCA lost considerable income because it took the organization many months to get him a Medicare provider number so that he could get paid for treating seniors. He also said he wasnt quickly put in the network of a major insurer.
Sal Barbera, a former hospital executive who now teaches at Florida International University, said many for-profit companies have been careful about developing ACOs, but he finds it difficult to comprehend that HCA wouldnt know how to handle physicians because its a large company that has been running physician practices for many years now. ... Perhaps the terminated physicians had difficulty accepting HCAs plans for their practices.
Stephen Dresnick, a physician who has operated doctor practices, said in an email Tuesday that employing physicians is very complicated. ... I got out of the physician management business because even I felt that it was next to an impossible task to convert doctors to a big-corporation environment.
Davila, the oncologist, said in a May 22 letter to his patients that HCA told him on May 13 that his office would be closed June 13. He said he already had a vacation scheduled to start May 31, returning June 19, by which time his office will be closed. He said it will take months for him to set up a private practice, and hes concerned his patients might suffer from the lack of continuity.
In a statement Tuesday, HCA said of Davila: It is unfortunate that he has chosen a strategy that may upset patients, particularly when they are most vulnerable. Treatment will not be disrupted, and an experienced team of physicians will be on site to help transition the care of all patients.