Select Page

This was the lede to this morning’s Journal Gazette article. “A group of Fort Wayne doctors affiliated with Lutheran Health Network (LHN) have ended their employment with the network over a contract dispute, according to a statement issued Friday by a network spokeswoman.
The statement does not identify the doctors except to say they specialize in gastrointestinal medicine.”

NICHE has only minimal added information regarding what appears to be a contracting impasse, but coming during the holiday season it strikes a discordant note that is bad for patient care and creates obvious questions about priorities. The LHN statement was, in response to a JG query and therefore ex parte—that is: with respect to the interests of only one side. The impasse was blamed on disagreement about “quality metrics.” “According to Lutheran Health Network’s statement, (to the JG) the gastrointestinal specialists were offered a new contract with an increase in compensation but rejected it because it tied 5 percent of that compensation to what the statement calls “quality metrics” and patient outcomes. The doctors “demanded” that portion of pay be lowered from 5 percent, the statement says.”
Background: One supposes that there may be yet another side to the story—is it entirely accurate? What are the quality metrics? Are they measures that the GI physician can personally control, or are they outcomes measures that depend also on hospital processes? We are entering a healthcare discussion that is frothy with disagreement and the focus of new regulations (MACRA and MIPS) from CMS (Centers for Medicare and Medicaid Services.) More detail, some arcane, is here:…/quality-measures-in-gastroenterolog And here…/quality-measures-in-gastroenterology

Our point is that it would seem that we need more information. We may be talking about quality in terms of recently enacted government programs, MACRA and MIPS that are indeed directed at quality care, but also directed at value with an aim at cutting costs. From “In discussions of quality metrics, the reference is often to those measures that have been developed to support self assessment and quality improvement at the provider, hospital, and/or health care system level. These metrics represent valuable tools to aid clinicians and hospitals in improving quality of care and enhancing patient outcomes, but may not meet all specifications of formal performance measures.”

Questions Remain:
NICHE is told that the Gastroenterologist physicians (GI docs) were removed from the LHN website and that their email accounts were closed when negotiations ceased. Our morning check shows that only Nurse Practitioners remain on the LHN Gastroenterology website. The choice of a physician is the right of the patient, not the hospital. Will patients who inquire be able to reach the GI docs through hospital information?

Medical staff membership is a privilege extended by the hospital. Ordinarily one would expect that the GI docs would have privileges and remain on the medical staff at LHN unless denied, as stated in the bylaws, after consideration by the Medical Staff with final recommendations to the Board of Directors who then have final say. From April 2015:…/Medical%20Staff%20Bylaws%20… Was the medical staff and what remains of the LHN Board of Directors consulted?

The current status of the GI docs is unclear to NICHE in that there are options for them to continue to treat and follow their patients without reference to being hired by LHN—or so the bylaws would suggest. Will the GI docs be given “visitation and follow” privileges?

NICHE believes that until time has been allotted for reasonable discussions that include the medical staff and the Board of Directors, that the sole consideration should be patient care with continuation of the existing physician-patient relationship. What are the ethical considerations?
It is good that LHN has arranged for physician coverage, but how can that equate to patient benefits that come from long standing relationship with their physicians?

Gastroenterologists are in short supply nationally. Will LHN be able to replace so many gastroenterologists during this national shortage?

And lastly, the Fort Wayne community will benefit from knowing what quality metrics are under discussion. It seems unfair to suggest that the GI docs denied a commitment to quality without knowing more. Some quality metrics may depend on factors beyond the physicians’ control—for example being provided adequate staff or up-to-date software that captures data. Is LHN’s Cerner software installation complete and up to the task of managing this data? Will LHN provide adequate staff for the physicians to guarantee such CMS mandate quality measures as patient communications and satisfaction?

We look forward to learning more. As NICHE said 6 months ago: No matter how thin you make a pancake, there are always two sides.…/2…/lutheran-loses-gi-doctors The Journal Gazette