Medical Staff Privileges
ACR Bulletin
August 1997
Legal
Texas Radiologist Takes a Stand Against For-Profit Hospital Demands
Michael Rogers (Ft. Worth, TX) wasn't looking for a fight. He just wanted to continue his group's private practice of radiology with long-standing hospital affiliations, like thousands of other ACR members across the United States. But, as reported in the Wall Street Journal earlier this summer, the fight came looking for him in the form of Columbia/HCA Healthcare and a move to severely limit the hospital ties of physicians with privileges in the corporation's properties.
When Columbia/HCA bought 336-bed Plaza Medical Center in Fort Worth three years ago, physicians expected some changes. The Nashville-based corporation has a reputation for taking a no-nonsense business approach to hospital management. What Rogers-and other hospital-based physicians, including anesthesiologists, pathologists, and emergency groups-were unprepared for was the severity of the demands that would be made of them.
Stephen Bernstein, the new administrator sent in last year by Columbia/HCA, told Rogers to break away from the private group of 45 radiologists he headed and practice only at Columbia/HCA hospitals.
A compromise was offered in which Rogers would resign as head of his group of five members who practiced full time at Plaza, and the rest of the group would form a limited-liability company within the practice to work exclusively for Columbia.
But while Rogers and his group were looking for compromise, other hospital-based physicians at Plaza were unsuccessful in negotiations with the corporation. Both pathologists and ER physicians were asked to switch their affiliations to groups who worked only for Columbia properties, and most have reluctantly agreed. Bernstein demanded that anesthesiologists, who had previously practiced at Plaza without group affiliation, form a single practice with which the corporation could negotiate as "one voice."
Almost immediately the new group was required to make concessions, such as providing 13 nurse anesthetists previously supplied by the hospital. But Rogers and partners took a stand against Columbia's demands. "When we made this decision [to fight] we knew we were going to the mat," Rogers told the Wall Street Journal. What the Journal described as a "clash of cultures" has become a standoff of wills. Several other radiology groups have refused to work with Columbia at the hospital, and Rogers' group is supported by many other specialists there.
At press time a compromise had been reached, and the hospital signed a new contract with the 45-member group. Rogers continues to practice at the hospital.
There has been a reprieve for Rogers and hope for other radiologists facing escalating economic demands. The media attention given to his struggle with Columbia/HCA prompted immediate action in Texas. Fewer than three weeks after the story was published nationally, both houses of the Texas legislature passed and sent House Bill No. 812 to Governor George Bush. The law, signed by the governor June 17, 1997, contains the following provision, effective for contracts entered into or renewed on or after Sept. 1, 1997:
"A hospital, by contract or otherwise, may not refuse or fail to grant or renew staff privileges, or condition staff privileges, based in whole or in part on the fact that the physician or a partner, associate, or employee of the physician is providing medical or health care services at a different hospital or hospital system."
Rogers and his colleagues have won this round. But few doubt that other bouts, with changing issues and demands, will follow.
ACR's legal department has information on contracts and medical staff issues to assist radiologists and their attorneys in negotiations with hospitals and health systems. Contact the legal department at 703-715-3487 or by e-mail at legal@acr.org.