Colorado hospitalists' deal raises exclusivity issue

Some say the emerging specialty could join others in striking exclusive arrangements with hospitals.

By Katherine Vogt, AMNews staff. Sept. 20, 2004.

When a group of 14 physicians in the Denver area landed a deal that essentially gives them exclusive rights to provide hospitalist services at a small hospital, they might have unwittingly been part of an emerging trend in contracting.

Observers say the deal between Internal Medicine Pulmonary & Critical Care Associates (IMPCCA) and suburban Parker Adventist Hospital illustrates how some hospitalist groups are starting to seek contracts that protect themselves from competition by forging exclusive deals with hospitals.

Though such deals are not widespread, some observers say exclusive contracts with hospitals eventually could be the norm for hospitalists, as they are for emergency physicians, radiologists and other specialists.

"You don't have competing ER groups in a hospital, and I think the hospitalist movement is going in that direction," said Alan Puzarne, chief executive of the Irvine, Calif.-based hospitalist services company Cogent Healthcare.

But some critics say exclusive contracts erode patient choice and the choices that should be available to referring physicians. Some believe that restricting the number of hospitalist groups at a hospital could have a negative impact on the fledgling specialty.

"It's better for the profession early on to allow a wider choice," said Larry Wellikson, MD, executive director of the Society of Hospital Medicine. "SHM has clear policy on restraint of trade that really says in the early, formative time in hospital medicine, it makes more sense to allow a wider group of hospitalists rather than a restrictive group to be there."