Doctors in McHenry County opting to align with local hospitals

Changing health care incentives a reason for shift

CRYSTAL LAKE – Dr. Sanjeev Gupta broke promises with his daughter about spending time together in the waning years of his Crystal Lake clinic to keep up with the rapid changes in health care.

The 51-year-old internist worked around the clock to treat patients and juggle the seemingly endless administrative work that comes with running an independent practice for 12 years.

A self-proclaimed "early bird," Gupta made a business decision in 2012 that an increasing number of independent physicians find themselves doing. He dropped his solo practice and joined Advocate Health Care as an employed physician.

"I always struggled between being a doctor and being a manager of my practice," said Gupta, who is on staff at Advocate Good Shepherd Hospital in Barrington. "I'm more focused on patients now."

Gupta still spends the majority of the time at the Crystal Lake clinic, but by working under Advocate, he works set hours and focuses on delivering care. A manager, provided by Advocate, now handles the administrative hassles, he said.

In an industry enduring massive changes, health care groups are increasingly attracting private physicians to salaried jobs within hospitals, as the systemwide business model begins to emphasize the value of care rather than the volume.

The American Medical Association found in a recent survey that 29 percent of physicians either worked for a practice partially owned by a hospital or worked directly for a hospital.

The percentage of physicians who owned a practice, meanwhile, dropped by eight percentage points between 2007 and 2012.

Nearly 60 percent of family doctors and pediatricians, 50 percent of surgeons and 25 percent of surgical subspecialists, like ear, nose and throat surgeons, were employees of a medical system rather than independent, the survey found.

Advocate Good Shepherd Hospital has intensified its efforts in the last five years to employ private physicians and align them with the hospital's standards to provide more coordinated care, said Mike Ploszek, vice president of ambulatory services and operations.

"It ultimately helps us continue to improve how we deliver care," Ploszek said. "In the future, we expect hospitals and physicians to be compensated on value as opposed to volume. That's where it's critical to have that alignment."

Officials from both Advocate and Centegra Health System agree that the traditional health care system is becoming a relic of past times.

It was a system focused on volume. Private physicians would receive payment for the number of procedures and tests they performed.

Many health experts nationwide have said it's one factor that drives the United States' ballooning health care costs since it encourages overuse.

"The system used to be the more work you did, the more you made," said Pasquale Bernardi, Centegra vice president of physician services. "That's a real bad system."

The "big shift" in health care is toward quality care that treats patients quicker and cuts down on readmissions, he said.

"To do that, it helps to have the physicians and providers aligned with the same goals," Bernardi said.

The move toward employed physicians also helps those physicians focus on the business of medicine, since a health care organization can "take care of the day-to-day headaches" of running a practice, Bernardi said.

Centegra helped Dr. Richard Lind's surgeon group convert their records system and trained staff to manage it, as government regulations have emphasized electronic medical records.

Lind, director of Centegra physician care surgery, joined the health care provider in October after spending nearly 30 years in private practice. Centegra also used its resources to expand his group from five to seven surgeons.

"My impression nearly six months into it is that this is what we kind of hoped for," Lind said. "I see advantages to both Centegra and our group."

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