Negotiations could end two decades of local management
The third largest group of doctors in the nation is negotiating with Dominican Hospital to take over management of the Emergency Room. If California Emergency Physicians Medical Group (CEP America) reaches a deal with Dominican, it will end 20 years of management by the Santa Cruz Emergency Physicians Medical Group (SCEPMG). As of press time, no decision had been made public.
“The message we are giving to them, which we think was well received, is that we want them to be partners with us and join our organization,” says Dr. Ellis Weeker, vice president of CEP America's Northern Division.
Although Dominican Emergency Room staff are unable to speak on the record about the negotiations, an emergency staff member did tell Good Times that “the community needs to know about this.” Dominican Communications and Marketing Director Mike Lee emailed GT this statement: “Dominican won’t be commenting on the [emergency department] contract during negotiations, and no decision has been made.”
CEP officials are, however, optimistic that they will be adding Dominican to their roster of 64 client hospitals in California. If a deal is reached, the changes could reverberate through the entire hospital. Their first move will be to assess the hospital as a whole in order to maximize efficiency in any area that would effect the ER, says to Dr. Todd Brandtman, ER medical director at Feather River Hospital in Southern California (a CEP-managed facility),
“Right from the very beginning ... they bring in someone to give you very solid ideas on what you need to improve,” says Brandtman.
CEP America's website boasts that their methods increase profitability at client hospitals by reducing wait times. This is accomplished through what they call “Rapid Medical Evaluation.” This system reduces wait times by having doctors make contact with patients in the waiting room to prioritize the most serious ailments, allowing hospitals to treat more patients and increasing revenues. Brandtman says the system has dramatically reduced wait times at Feather River, adding that patient satisfaction has risen, as has the likelihood they will pay for their treatment.
Reduced wait times are important, says Dominican nurse and Santa Cruz California Nurses Association representative Lorna Grundeman, but should not be prioritized over giving the highest quality treatment. She says that Rapid Medical Evaluation puts patients at risk of receiving inadequate treatment and could lead to repeat hospitalization for the same ailments. This would end up costing Dominican, because insurance companies refuse to pay for those visits.
“It's all based on industrial models. ... There are consultants the hospitals employ to find ways to get patients through quicker,” says Grundeman. “To get patients into beds, they sometimes push patients out of the hospital before they are ready which creates problems. ... It’s a corporate model and a push to make more money.”
The absorption of Dominican by CEP America would end the SCEPMG in name, but the staff currently in the ER would continue working under the new company name.
There were changes made to staffing at Feather River after they joined the large medical group to increase staff when they are busy most often, and to save money when ER traffic is slow, says Brandtman. They also adjusted doctors’ shifts from 12 to eight hours, which he says has made doctors much more attentive and better at their jobs. He insists that changes made after CEP takes over management are suggestions. Consultants from the group sit in on client hospital staff meetings and periodically suggest ways to improve efficiency and treatment.
However, Grundeman is skeptical about the purity of the CEP’s motives. In California there are strict nurse-to-patient ratios that would protect the number of nurses at Dominican from being downsized. But the idea of large for-profit groups taking over such large shares of the market makes her doubtful about the agenda behind further expansion. CEP America currently manages 25 percent of emergency rooms in California.
“They would call it more efficient, but it is really about having less stake holders to make money off people who are sick,” she says.
In a 2008 class action lawsuit entitled Cincotta v. California Emergency Physicians, more than 10,000 patients claimed they had been overcharged for treatment in several hospitals run by CEP. Some of the bills were written off as part of a settlement. CEP claims they settled because fighting the case would have cost them more than the approximately $10,000 they paid out to one of the plaintiffs. The original complaint claimed $27 million in excessive charges between 2003 and 2008. Alameda County Superior Court documents states that many more bills were canceled, but no specific dollar amount was listed. Attorneys for the plaintiff were involved in several lawsuits against other hospitals and doctor groups around the same time. They did not return calls to GT.
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