Agreement on catheterizations leaves out some cardiologists

A North Carolina hospital limits privileges to one group, sparking an outcry over the exclusive arrangement.

By Mike Norbut, amednews staff. Dec. 1, 2003.

While it's not uncommon for hospitals to sign service contracts with radiology or anesthesiology groups, one North Carolina facility plans to extend that courtesy to a local cardiology group, effectively closing privileges to other heart physicians in the area.

The Board of Trustees at Presbyterian Healthcare, an affiliate of Novant Health, recently decided to forge an agreement with a single group to provide diagnostic catheterization services at its facility in Matthews, just outside of Charlotte. Stephen Wallenhaupt, MD, executive vice president of medical affairs for Presbyterian, said that while no agreement has been reached yet, the expectation is the group will be Mid Carolina Cardiology, a 29-physician practice with six clinic locations.

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The decision leaves out two other large, prominent cardiology groups, though the health system's policy does not extend to its flagship facility in Charlotte.

"The real story is a hospital system is getting between patients and their doctors," said F. Scott Valeri, MD, a cardiologist and president of Charlotte Cardiology Associates, a 15-physician group with five locations. "It sets a bad precedent in our community to have hospitals not promoting good, board-certified physicians to practice in their facilities."

Dr. Valeri said his group had been asked by Presbyterian less than a year ago to create more of a presence in Matthews, and it responded by relocating a physician to an office next to the hospital. Now, there's a possibility they will lose their patients in that area, because if people choose to visit the Matthews location and undergo a procedure performed by a Mid Carolina cardiologist, they may continue to see that physician for follow-up care, he said.

"Our understanding is, if our patients aren't stolen from us, we're going to have to send them 30 minutes away to treat them," he said. "If the patient is [in Matthews], we'll have to send them to Charlotte. It's a little inconvenient, but we'll keep them within the Presbyterian system."

Dr. Wallenhaupt said the decision was made as a way to simplify scheduling issues in the Matthews facility and provide for a more seamless coordination of patient care between the flagship and satellite hospitals.

Presbyterian Hospital Matthews has only one catheterization laboratory and does not offer interventional services, he said. An increasing number of cardiologists applying for admitting privileges forced the hospital to weigh its options, he said.

"The influx of applications would have meant nearly 30 cardiologists on staff," Dr. Wallenhaupt said. "Coordination and trying to schedule services would have been a big headache."

He said the catheterization schedule at the hospital was not full, but volumes were growing, and he anticipated they would continue to grow with one cardiology group admitting patients.

Exclusive contracts for cardiologists are not unheard of, said John Leifer, CEO of The Leifer Group, a health care consulting firm based in Overland Park, Kan. An exclusive contract can help a hospital ensure ongoing viability and revenue, and it also can benefit the physician group if the doctors are granted some management authority over the cardiac care program, he said.

"Sometimes it's in a hospital's best interest to, for lack of a better term, lock in a cardiovascular group to ensure utilization," Leifer said. "Where I draw the line is when exclusivity bars other competent physicians from practicing there."

The Presbyterian contract will not be the first exclusive for cardiologists in Charlotte. The Sanger Clinic, a group with 62 cardiologists throughout North and South Carolina, has an agreement to provide catheterization services at Carolinas Medical Center in Charlotte, part of the Carolinas HealthCare System. Physicians from other groups have admitting and consulting privileges, but only Sanger Clinic doctors perform procedures, said Hadley Wilson, MD, an interventional cardiologist and chief of the cardiology division for the group.

While the Presbyterian arrangement has not been formalized, doctors in Charlotte recognize Mid Carolina Cardiology has had a close connection with Presbyterian for years.

Akinyele O. Aluko, MD, president of Mid Carolina Cardiology, could not be reached for comment.

Physicians from other groups speculated Presbyterian's decision had competitive undertones to it, saying perhaps it was driven by the alignments some groups have with competing hospital systems in Charlotte.

"I think the injury to us was a bystander injury," Dr. Valeri said. "I think this was a method to exclude a group. I think the Novant administration was afraid of Sanger Clinic, which I think is unfounded."

Dr. Wallenhaupt said the speculation was simply that, and pointed to the Sanger Clinic agreement with Carolinas Medical Center as precedent for contracts with cardiologists.

"This is not unique for this market," he said.