Bergan Mercy Medical Center has relied heavily on temporary emergency room physicians this year after breaking with its longtime ER group in February.
The physicians cost more for the hospital’s parent company, Alegent Creighton Health, but officials there say they have absorbed those expenses without adding to patients’ bills. Furthermore, the officials say, patient surveys indicate that the quality of care has improved compared with last year.
The temporary physicians are working in place of a group called Critical Care Associates, which existed to staff Bergan’s ER and is now defunct.
Bringing in for temporary service a physician known as a locum tenens (Latin for a temporary substitute) isn’t rare for hospitals. Emergency departments bring in temporary physician help when a doctor is ill or on maternity leave, or when a contract changes hands and there are staff vacancies.
Nevertheless, Bergan faced a special challenge when it had to replace its entire group of seven or eight emergency room physicians. Some locum tenens physicians were brought in from out of state and have stayed for weeks or months in temporary housing.
“It just takes time,” Marie Knedler, Bergan’s chief operating officer, said last month of finding a new, permanent staff. “I would say we’ve been very methodical about it and very timely.”
Locum tenens physicians tend to be expensive. Dr. David Romano, chief medical officer for Premier Physician Services, said they cost at least 25 percent more than Premier’s permanent, local ER physicians.
Knedler said 25 percent was high but declined to be more specific. “That’s not my experience,” she said. “I can’t speak to that person’s experience.”
The relationship between Critical Care and the hospital’s parent firm, Alegent Health (now Alegent Creighton Health), was uneasy as far back as 2003. That’s when Alegent proposed that Premier Physician Services of Ohio oversee the Bergan emergency room.
Bergan’s medical executive committee rebelled against the notion, and ultimately Critical Care remained in place. Premier currently provides permanent, locally based ER physicians at Alegent Creighton’s Lakeside Hospital, Midlands Hospital in Papillion and Mercy Hospital in Council Bluffs.
A year ago, it was the leaders of Bergan Mercy’s medical staff, a group of about 20 physicians, who moved to terminate Critical Care’s contract, said Dr. John Ferry, chief of Bergan’s staff.
Ferry declined to say why the decision was made. “It’s over and done.”
Dr. Kenneth Colaric, who headed the Critical Care group, said Alegent had concerns about one emergency room doctor’s interaction with staffers, but he said that was being addressed. Ultimately, he said, some or all of the Critical Care doctors were offered employment with Alegent, and none consented to that. Critical Care and its physicians left Bergan in February.
Colaric now heads an emergency department in Blue Springs, Mo.
“It was business,” he said of the divorce from Bergan Mercy. “I wouldn’t say it surprised me, but it disappoints me.”
He said he believed Alegent Creighton didn’t care for Critical Care’s independence. “I don’t think this was a malicious attack on a single physician or even a group of physicians,” he said. “It boils down to being in control.”
Knedler said Bergan hired a new emergency room director, Dr. Nate Brackett, four months ago from a Milwaukee hospital.
Four emergency room physicians had signed on as of late November, Knedler said, and are to begin work in January. Alegent Creighton spokesman Steve Pacholski said the hospital since then had achieved its goal of signing a full staff of eight ER physicians.
No decision has been made about whether the new group will be independent or Alegent-employed, Knedler said. Besides her role at Bergan, she oversees emergency services for Alegent Creighton.
Dr. Joseph McCaslin, director of Methodist Hospital’s emergency room for the past 10 years, said he has never had to bring in temporary physicians. McCaslin said he worried that he would have to use some when Methodist Women’s Hospital opened two years ago, but he was able to hire a full permanent staff in time for the opening.
Knedler said any additional cost from using the temporary physicians has been borne by Alegent Creighton’s budget and not by increasing patient fees, and she added that temporary ER physicians have provided excellent care and service. Patient satisfaction scores are high and better than they were last year, she said.
Other ER standards, such as how long it takes an ER patient to receive heart catheterization, have been solid as well, she said. From March through November, 100 percent of those patients received catheterization within 90 minutes, she said, which is a goal. “This is an outstanding place to come for emergency care.” Knedler said.
At least two of Critical Care’s doctors were certified through the American Board of Physician Specialties, which doesn’t require a residency in emergency medicine and is viewed by some ER physicians as less than adequate certification for major ER work. The physician specialties board honors experience in an ER and has some other requirements, including testing.
The American Board of Emergency Medicine requires certified ER doctors to have three or four years of residency training in an emergency room. That certification is viewed by most as the gold standard of ER training.
It’s not clear whether certification played any role in Critical Care’s removal. Knedler declined to discuss the history with Critical Care or the group’s departure.
Some other local hospitals, including Bellevue Medical Center and Immanuel Medical Center, use some ER doctors who don’t have ABEM certification.
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