Greater Baltimore Medical Center has added Orthopaedic Specialists of Maryland P.A. to its payroll, part of a national trend that is seeing an increase in hospital-employed physicians and a reduction in the number of independent practices.
The orthopedic practice already had a relationship with the Towson hospital — its office is located on the main campus on North Charles Street — but now its physicians are actually employed by GBMC HealthCare Inc.
Orthopaedic Specialists of Maryland has rented space in one of GBMC’s Physician Pavilions for more than 20 years. During that time, its physicians have been members of the medical staff, meaning they had permission to perform orthopedic surgery there.
As a member of Greater Baltimore Medical Associates — the employed physician group of the GBMC HealthCare system — any revenue the 18-person practice generates goes to the system, which is now responsible for covering all of its expenses.
The integration, which took effect with the new year, follows a national pattern in the health industry.
“Many physicians that have been in private practice are approaching hospitals to look for employment options,” said Bennett J. Beres, chief operating officer of GBMA. “The business side of medicine continues to get more and more complex. … Physicians want to focus on what they do best — taking care of patients, not [worrying] about all these new and complex mandates that are out there.”
For the health system, employing more doctors directly means the opportunity to expand its clinical offerings, Beres said, adding that the goal is to improve patients’ experiences and drive down the per-capita cost of health care.
Adding Orthopaedic Specialists of Maryland physicians to its ranks will enhance the health system’s ability to provide the best orthopedic care possible, he said.
“GBMA is working very hard on building a brand,” Beres said. “Adding this very well-established, high-quality group will be a great addition for us.”
GBMA, which is one of five entities comprising the GBMC HealthCare, now includes 41 physician practices spanning a variety of specialties, such as pediatrics, oncology and obstetrics/gynecology.
Beres said the health system will continue to “explore employment opportunities as more and more physicians seek that option.”
Dr. Lee M. Schmidt, one of the practice’s four surgeons, said the move will make it easier to coordinate with other doctors at GBMC.
“We will be able to offer our patients a stronger link [to] the wide array of advanced orthopedic programs and services available at GBMC,” Schmidt said in a statement. “Integrating our practice into GBMA will streamline the process of referring a patient, optimize the coordination of care between specialists and referring physicians, and reduce needless duplication of services.”
Patients, though, should notice little difference in the services provided by the office, which will be staffed by the same people in the same location, said Schmidt, who is also the medical director of the GBMC Joint and Spine Center, which is comprised of four physician practices.
“Our stationery may change, but our loyalty and dedication to our patients and care will remain the same,” he said.
The number of independent physician practices has been dwindling for at least a decade. Estimates vary, but American Hospital Association data show that the number of doctors on hospital payrolls has increased by about one-third since 2000.
The movement toward hospital-employed physicians was visible in the 1990s, long before passage of the Affordable Care Act, but there has been some discussion among health care experts about whether recent health care reform efforts have accelerated the trend.
For example, the law promotes Accountable Care Organizations, which are groups of providers who collectively assume responsibility for the health of a defined patient group.
A similar, and increasingly popular, model known as the Patient Centered Medical Home emphasizes collaboration among different specialists to provide a continuum of care for all the patients in their practice. Beres said the need to collaborate is one reason why it makes sense for a hospital to bring more physician groups under its wing.
“In the new health care environment, it has become more and more important that hospital systems integrate,” Beres said.
Some employed physicians generate revenue for the hospital, while others do not — it depends on the specialty. According to Beres, though, that doesn’t mean an orthopedic practice, which brings in a lot of revenue, is more attractive than other specialties, like primary care, that generate substantially less.
“Actually, in the new world order, primary care is just as important as specialty care,” he said. “In the Patient Centered Medical Home, the primary care physician is the quarterback making sure our patients receive the care that they need.”
In an integrated health system, he continued, the important number to look at is the total cost of care, not the profitability of any particular practice.
In some cases, hospitals bank on a steady stream of referrals originating from practices they purchase, even if some of those practices aren’t profitable themselves, to make the deal financially worthwhile. But GBMC does not expect to gain new referrals — or new revenue — by employing Orthopaedic Specialists of Maryland physicians, Beres said.
When care is delivered in a hospital-owned facility or using hospital-owned equipment, a “facility fee” intended to cover certain overhead and staffing costs incurred by the hospital is added to the bill. As hospitals buy up more physician practices, many of those practices’ patients could find themselves holding a larger bill despite receiving the same care.
Beres, however, said patients of Orthopaedic Specialists of Maryland will not pay more due to the integration.