In many midstate hospitals, ER docs aren’t hospital staff

(Hanover) — A simple question can sometimes get a not-so-simple answer.

“Are you a Hanover hospital employee?”

“Yes and no,” answers Michael Denny, Medical Director for the Emergency Department at Hanover Hospital in York County. “[I] do all the quality assurances for the department. So I review charts, respond to concerns in the department, staffing issues, also any type of patient complaints.”

Denny’s responsibilities are right in line with what you would expect for a medical director.

But his check is not coming from Hanover Hospital. Instead, a company called Team Health pays his salary, his malpractice insurance, and for his continuing education.

The nurses who tend to patients? Hanover Hospital employees.

The physician though?

He’s an independent contractor with Team Health.

In fact, at least nine workers at Hanover get a Team Health paycheck. That’s how Hanover has run its ER for more than 15 years.

Why?

“It’s a lot of administrative burden of keeping tracks of CMEs, keeping a list or a roster of personnel that you can call on if someone calls in sick,” says Dr. Michael Ader, vice president of Medical Affairs at Hanover. He adds it’s partly because of the cost savings.

“It is sometimes harder to recruit, and they have more power doing that recruiting process, which also takes a lot of time, it’s also manpower to recruit, to bring in candidates, to show them around. And they do some of that, although again, we still evaluate when they come in.”

“What hospitals enjoy when they partner with us is that level of expertise. We’re not a staffing company, we’re a management company. We can help hospitals with flow in their emergency rooms, with flow when the person needs to be admitted and moving them upstairs and into an inpatient bed, what are best practices,” says Eugene Johnson, Executive Vice President of Emergency Medicine for Team Health’s Northeast Division.

Hanover is far from the only midstate hospital to use Team Health, or companies like it. A quick scan of job openings finds it also provides staff to PinnacleHealth’s West Shore Hospital.

There’s more though: competitor Apollo MD has a contract for Carlisle Regional’s Emergency Room.

And another group called EmCare is responsible for staffing at Heart of Lancaster Regional Medical Center in Lititz, Lancaster Regional Medical Center, and Holy Spirit Hospital in Camp Hill, Cumberland County.

They all declined to comment, or didn’t respond to requests for an interview.

On the surface, whether a physician is an independent contractor or staff employee really means little to nothing for patients. But sometimes, the system breaks down.

How it can impact you

Through WITF’s Public Insight Network, I heard from someone who had an experience with a fill-in at Holy Spirit’s emergency room.

“They were ready for us, we got in there, and did all the things you normally do, present your insurance card,” says “Jamie” who asked that her name be withheld because she works a full-time job at a health insurance company in central Pennsylvania. Nearly three years ago, her daughter needed emergency surgery after ripping her leg open on a fence.

“The surgeon did come in, and I noticed his ID badge was not the same one as the rest of the hospital staff was wearing and I asked him about it, and he said yes, he subs in different hospitals,” says Jamie.

Because of her background, Jamie considers herself a pretty well-educated consumer. She even made sure to go to an in-network hospital. And yet, she ended up with an $800 dollar bill, on top of the usual emergency room co-pay.

“You follow the rules, you pay your premiums, and you have insurance, and you go to a covered facility and you’re not expecting to be responsible for anything other than the copay that you would normally have,” says Jamie.

“And it really makes you feel like they’re not really there to help you. Your insurance is supposed to be insurance.”

Jamie’s account isn’t about firms like Team Health, EmCare, or Apollo MD. The surgeon was a fill-in, and patients can encounter that situation at any hospital.

But her experience illustrates what can happen when insurance companies and groups like Team Health fail to reach an agreement on reimbursements, which has been a problem highlighted in the past.

Insurance complications

Pennsylvania regulations restrict “balance billing” for some emergency services, which are often defined in the insurance plans terms and conditions. But the state doesn’t have the authority to regulate self-funded plans, often used by large employers.

An insurance company that wants to try to keep costs down may not make a deal with the ER staffing firm, leaving the hospital in network, but emergency room staff out of network. 

“Hospitals contractually traditionally say we need you to participate in all payers, in some payers, in some payers that must include a, b, c,” says Team Health’s Eugene Johnson.

“We use that as our guide and then, if it’s a new market to us, we go out and we try to negotiate with the insurance companies, and in the vast majority of cases, they’re easy to work with, and they want to make sure we get a fair and reasonable payment. There are times when we probably tussle a little bit.”

Representatives at insurance companies contacted wouldn’t talk on tape, but acknowledge there’s little a patient can do except ask questions, and ask more questions ahead of a scheduled surgery.

But that’s for something that’s planned. In emergency situations, you don’t have that luxury.

“After you contacted me, I thought about that a lot,” says Jamie.

“And no, I wouldn’t have done anything differently. My daughter was in shock, and needed to be taken care of, and our only option would have been to go to another hospital, and this was already our second medical facility and I could’ve run into the same situation at the next hospital so I wouldn’t have done anything differently.”Jamie says even after getting the $800 bill, she wouldn’t have done anything differently.”

Indeed, many of the companies are only adding divisions – expanding into hospitalists, anesthesiologists, and jobs traditionally occupied by hospital employees. And a Wall Street analyst expects ten percent growth in the industry to continue every year for the foreseeable future. All those changes might mean a patient will have to ask the same question of more people – are you in-network for my insurance?