Becker's Spine Review

29 PRACTICE MANAGEMENT Are hospitals getting more aggressive against private practices? By Patsy Newitt W hile COVID-19 is accelerating the migration of physicians to hospital employment, some hospitals have doubled down on measures that are making it hard for private practice physicians to remain independent. e decline of independent physician em- ployment is not new. Around 70 percent of physicians in the U.S. are employed by hos- pitals or corporations, according to a 2021 Avalere report. And during the first year of the pandemic, 48,400 physicians le inde- pendent practice for employment. In December, a lawsuit was filed against Duke University Health System by a physi- cian who alleges the health system is requir- ing clinical research faculty physicians to be- come its employees. e suit says the health system is attempting to "take over the [Pri- vate Diagnostic Clinic] over the physicians' objections and without paying for the prac- tice's fair value." e Durham, N.C.-based health system cre- ated a new faculty practice in July and man- dated faculty in clinical departments who perform research join the group and become fully employed by July 2022. e employ- ment requirement will force 400 members of PDC, a 1,850-member physician practice, to leave the group. Last week, University of Iowa Health Care raised concerns over Iowa City, Iowa-based Steindler Clinic's planned $19.2 million ASC. In Steindler Clinic's application, the clin- ic said the ASC will satisfy the area's need for competition, citing University of Iowa Health Care's new hospital and clinic. "e UIHC North Liberty project is clearly targeting the patient population traditionally served by the private practice community in Johnson County," the application said. "What payers, patients, the community and private physicians need, and what this certificate of need application represents, is a choice. at is competition." e clinic also argues that denying the appli- cation could lead to a monopoly by Univer- sity of Iowa Health Care and reduce access to private practice physicians in the area. e health system says the new ASC would du- plicate underutilized space at UIHC's exist- ing facilities. Physician migration from private practice doesn't look like it'll stop anytime soon. Early-career physicians favor employed op- portunities over private practice as declin- ing reimbursements, steep medical school debt and the cost of malpractice insurance premiums remain key factors driving career choices. Only 14 percent of physicians under 40 are self-employed, compared to 29 percent of physicians between 40 and 69 years old, according to Medscape. Some hospitals and private practices have found success in working together. e Bone & Joint Center, Albany (N.Y.) Medical Center and Saratoga Hospital joined forces to open a $19.1 million surgery center in Malta, N.Y. In designing the ASC, Jared Roberts, MD, the facility's medical director, visited ASCs in nearby cities and found that private practices have typically failed to form similar surgery center-hospital partnerships. "ere's no other that's like this in the coun- try that I am aware of, that has a relationship that's a true partnership with a hospital sys- tem and connected to a 24-hour emergent care," Dr. Roberts said, according to an Oct. 5 Albany Business Review report. n Employee at Illinois orthopedic group gets 1 year in prison for fraudulent opioid prescriptions By Alan Condon A n administrative assistant at Westmont, Ill.-based Hin- sdale Orthopaedics has been sentenced to one year in prison for writing fraudulent opioid prescriptions. From 2017 to 2019, Amanda Biesiada fraudulently wrote 85 prescriptions to an acquaintance for hydrocodone and oxy- codone, among other controlled substances, the Justice De- partment said in a Jan. 18 news release. Ms. Biesiada is not a li- censed physician and could not legally prescribe medications without the direction and approval of licensed physicians. Ms. Biesiada wrote the prescriptions on behalf of six pro- viders at Hinsdale Orthopaedics who did not direct or ap- prove them, according to the Justice Department. Prosecutors said Ms. Biesiada tried to conceal the pre- scriptions by marking them as "filed in error" in the prac- tice's prescription system. Ms. Biesiada was handed the prison sentence after she pleaded guilty in 2021 to intentionally dispensing con- trolled substances outside the scope of professional prac- tice and without a legitimate medical purpose. Hinsdale Orthopaedics is a 31-physician practice that merged with Des Plaines-based Illinois Bone & Joint Insti- tute, the state's largest physician-owned musculoskeletal group, in April 2020. n

• Cover