For the more than 40 doctors at Lakeside Family Physicians and Huntersville OB/GYN, the move away from Novant Health is a return to how they used to practice medicine. Both groups were independent before joining with Novant about 15 years ago.
To OB/GYN Ehab Sharawy returning to independent practice renews, “A level of self-determination that may have been lost a bit,” he said. “Again no good reason or bad reason. Big system. All big systems have some rigidness to them sometimes. Primarily our focus is to say, 'look let us create this independence to give us a little more freedom to go to the light.'”
That means focusing on what’s best for the patient in both care and value said Sharawy. He's leading the transition with partner, primary care Dr. David Cook.
“We will be unbridled from any responsibility but what’s best for you,” Cook said. “We can find the best physicians. We can begin to create a network that’s interconnected.”
This is the second large physician practice in the Charlotte area to leave a local hospital system within a year. That’s unusual because across the country hospitals have been gobbling up practices, according to research by the Physicians Advocacy Institute and Avalere Health. Between 2012 and 2018 the number of hospital-owned practices increased by 129 percent. The industry is watching to see how the local doctors’ groups fare as they buck the trend. Sharawy and Cook think joining the multi-state independent practice, Holston Medical Group, will allow them to better coordinate care for patients.
For example, say one of Cook’s pregnant patients is having a problem. Cook said she could easily see Sharawy either in the same office or nearby. Instead of by default sending her to the hospital.
“We have the ability to take care of a patient in the office,” said Sharawy, “And I’d say 70, 80 percent of the time you handle something that easily is handled within office that just the knee jerk reaction to send them off to higher cost environment.”
When doctors are independent, they don’t face the same financial pressures said Dr. Lisa Bielamowicz. She’s with Gist Healthcare, a Washington D.C. based consulting company. She explains doctors who are part of a larger health system can often have inherent conflicts of interest. Because those systems make money from expensive hospital admissions. Still, Bielamowicz said plans by doctors to make care more affordable by going independent will take time.
“But there’s a lot of steps between here and there. They have to establish themselves as an independent organization,” She said. “Have the resources to be able to manage care. Cut the right contracts with payers that reward that type of care management. It’s definitely not going to happen overnight.”
What did happen relatively quickly, were these large doctors’ practices exiting Charlotte-area health systems. First, there were the 88 doctors from Mecklenburg Medical Group who left Atrium Health in September. Then the 42 doctors from Lakeside Family Physicians and Huntersville OB/GYN who left Novant this month.
Bielamowicz said these moves have caught the attention of the industry.
“Health care leaders across the country are interested in the physician dynamics in Charlotte because it really has been a unique situation for two very large groups of physicians to leave established health system medical groups,” Bielamowicz said. “I think that leaders are watching to see if part of a larger trend. Will they see this kind of succession happening in their markets? And I think they are going to be looking closely to see where doctors go.”
Mecklenburg Medical Group joined Atrium in the 1990s. Like Lakeside and Huntersville OB/GYN, MMG kept its practice together under the umbrella of a hospital system rather than becoming an individual doctor employed by the health system. Bielamowicz thinks made it easier to leave.
But that’s where the similarities stop. The doctors who left Atrium formed their own independent practice. While the doctors who left Novant joined another larger practice.
“In a sense, the Novant physicians are joining an organized entity that gives them a lifeline to capital, to technology, to management infrastructure,” Bielamowicz said.
That’s not completely dissimilar from the appeal of joining a health system.
According to a study by the Physicians Advocacy Institute and Avalere Health, doctors’ groups have been joining hospitals at steady rates. Between 2012 and 2016 the number of practices employed by hospitals grew by 100 percent. As of 2018, a follow-up study found hospital systems now own about a third of physician practices. But the trend is starting to slow nationally. Growing 5 percent between 2016 and 2018.
In Charlotte, Atrium Health said it hasn’t acquired any practices, but did acquire a health system in Macon, Georgia. And Novant says it acquired six independent clinics.
There’s almost a renewal of faith in the independent practice that is going on right now.
Dan Bowles is with Aledade, a company independent practices hire to do some of the administrative stuff that big health systems do for their doctors. Including negotiating with insurance companies so the doctors can share in the savings that come from those deals. Both the doctors who left Atrium and Novant say they are not using Aledade services.
Nonetheless, Bowles said, “North Carolina is one of our most highly prioritized markets right now.”
Partly because the company has a contract with Blue Cross Blue Shield of North Carolina to work with independent practices on arrangements that would allow the doctors to get paid in part for how healthy they keep patients. Instead of just how many visits they have with patients. The company said it’s working with practices all across North Carolina and 23 other states.
Bowles said, “We have met individual physicians who have decided to leave a health system setting and decided to hang their own shingle as it were. We’ve also met group practices that are contemplating the same sort of move some of these groups have made in Charlotte.”
Indeed the 88 doctors who left Atrium to form Tryon Medical Partners caught the attention of the Novant doctors. They have been watching and talking to them. The CEO of Tryon Medical Partners, Dr. Dale Owen, said he’s not viewing other groups who want to become independent as competitors, rather as collaborators.
“Naturally physicians should be there to help patients first, help each other become and stay independent,” Owen said. “Because I think it’s very important that the doctors’ groups that are independent, that we all help each other remain independent.”
Owen said he is enjoying not feeling the pressures that came along with being part of a large health system, like seeing certain numbers of patients a day. Tryon Medical Partners has opened several offices throughout the area and Owen said new things are on the horizon. Including possibly opening an urgent care facility.