Rex Healthcare's surgical program rankles local doctors

A North Carolina hospital may set the tone for physician employment at acute care facilities in the future, the Raleigh News & Observer reports.

Rex Healthcare in Raleigh established an in-house surgery program, and there is a catch: surgeons not directly employed by the hospital won't be able to participate, according to the hospital.

As a result, Rex assigns four of its employed surgeons to its emergency department to cover cases that may require operations--a move that could deprive other area surgeons of lucrative opportunities to "cover" the hospital emergency room. The staff surgeons, or surgicalists, will work 12-hour shifts for seven days straight, then be off for the next seven days.

Surgicalists aren't new. Many hospitals employed them over the past decade. Advocates claim surgicalists allow patients in a dire medical situation to be operated on sooner, and that physicians are happier because the practice provides more uniform hours.

However, area surgeons say the practice not only gives the hospital more control over its medical staff, but allows it to charge insurers about 20 percent more than if independent clinicians performed the procedures.

"This is all about money; it's more empire-building," David Zeiler, an independent surgeon with Triangle Surgical Associates, told the News & Observer. "They're scrambling for every nickel. They're looking under the sofa."

Another regional provider, WakeMed, also uses surgicalists, but they also employ outside doctors as well to provide coverage, according to the News & Observer. Rex officials said the change is in response to the need to improve the quality of care and patient outcomes, and that it would initially lose money on the program.

In 2011, Rex paid $1.9 million to settle claims that it had overbilled Medicare by classifying minimally invasive spinal procedures as inpatient surgical cases in order to be paid at a higher rate.

To learn more:
- read the News & Observer article