NEW PRACTICE: UT-ERLANGER CARDIOLOGYDr. Walter PuckettDr. Mitchell MutterDr. Michael ZemaDr. Kinsman WrightDr. Carol GruverDr. Chris KlugewiczCARDIOLOGY SERVICES Open heart surgeries (1,340 total performed) Erlanger: 229, or 17 percent of totalMemorial Hospital: 799, or 60 percent of totalParkridge Medical Center: 312, or 23 percent of totalStents(3,350 total performed) Erlanger: 725, or 22 percent of total Memorial Hospital: 1,578, or 47 percent of totalParkridge Medical Center: 1,047, or 31 percent of totalSource: 2008 Joint Annual Reports filed with the Tennessee Department of Health
Erlanger hospital leaders are developing a new adult cardiology practice that officials say rounds out an in-house network of specialty practices, from pediatrics to urology.
The hospital, whichs has hired about 70 physicians in the past two-and-a-half years, most recently employed six cardiologists in its new UT-Erlanger Cardiology adult practice, said Roger Forgey, senior vice president of business operations.
"Cardiology really effectively completes a network," he said. "Cardiology was a piece we felt we really needed to grow bigger."
Erlanger provided just 17 percent of the 1,340 open heart surgeries performed at Chattanooga's three major hospitals in 2008, according to that year's Joint Annual Reports, which hospitals submit annually to the state. Competitors Memorial Hospital and Parkridge Medical Center, performed 47 percent and 31 percent, respectively.
Hospital officials declined to reveal how much the hospital is spending to hire the cardiologists, which spokeswoman Pat Charles said in an e-mail is considered "proprietary information."
Among the practice's doctors are Dr. Mitchell Mutter, who left Chattanooga Heart Institute for the job, and Dr. Kinsman Wright, who co-founded the Chattanooga Heart Institute and most recently worked as Memorial Hospital's vice president of cardiovascular services.
Earlier this year hospital trustees approved $1 million to build out space for the adult cardiology practice in the medical mall. The space now has room for nine cardiologists, but could be modified to hold 12, Forgey said.
UT-Erlanger Cardiology practice members will have an academic role at the University of Tennessee College of Medicine in Chattanooga. Physicians will participate in research opportunities and the practice will develop a cardiology fellowship program through the university, likely in three years or so.
The central goal of the new practice is to "try to develop a quality cardiology program that does more than just private practice cardiology, but also does teaching and research and things we feel like we have a mission to do," Forgey said.
Reaching out to primary care physicians for cardiology referrals also will be crucial to Erlanger regaining marketshare, one trustee said.
"We've got to cultivate (those relationships) to help them to have an appreciation for what is available at Erlanger, and then choose to refer their patients to Third Street," Jim Worthington said.
VOLUMES DOWN
Erlanger's mission to treat all patients, even those who can't pay for their care, can hinder efforts to recruit physicians, Forgey said.
The hospital has struggled to draw cardiologists in part because of the burdensome commitment of taking emergency calls, he said.
To ease that burden, last year Erlanger signed agreements with Chattanooga Heart Institute, located adjacent to Memorial, totaling $1.6 million annually to provide 24-7 on-call coverage and interpretation of cardiac test results. Some Erlanger trustees had expressed concern about the cost of the contracts.
That outside coverage from CHI likely won't go away soon, Forgey said.
"Down the road, as the thing develops further, we can have those discussions but we're not changing that right now," Forgey said.
Paul Farmer, CEO of the 23-doctor Chattanooga Heart Institute, said he does not consider Erlanger's new practice to be a competitor yet.
"We have 23 of the most sought-after cardiologists in the Southeast. We cover all subspecialties in cardiology," he said.
He noted that CHI has four doctors based at an office in Erlanger's medical mall, in addition to its main office next to Memorial Hospital and other offices.
"We have a vested interest in Erlanger. We have no intentions of leaving," he said.
EMPLOYED MODEL GROWING
In an employed model, hired cardiologists get a paycheck from the hospital and can be freer to treat all patients, including those who can't pay for their care, without having to worry about their overhead costs and keeping their private practice in the black, Forgey said.
Nationwide, pressure from the recession and health care reform - which resulted in reduced reimbursements for cardiology and other specialties this year - are pushing many hospitals and physicians nationwide to consider an employment-based model, and CHI is no exception, Farmer said.
The recession has resulted in fewer procedures, as patients delay elective treatments and preventive care.
"You never know when you might have to partner together. We have looked at some sort of an integration model for the last couple of years," he said.
Parkridge Medical Center had one employed cardiologist, Dr. Carol Gruver, who recently left to join Erlanger's new practice, said President and CEO Darrell Moore. But generally the hospital hasn't had the same challenges as Erlanger in recruiting cardiologists to practice there, although other areas - like pulmonology at Parkridge East - have required the hospital to employ a physician, he said.
"We have a core group of cardiologists who have been able to cover our needs so that's an area we have not had to do" an employed model, he said.
Jim Hobson, president and CEO of Memorial Hospital, said the employed-doctor model and other hospital-doctor partnerships are receiving greater attention as health care reform brings added incentives for collaborations and greater uncertainty.
"I expect to see these partnerships and alignments continue to develop," he said.