Recently, one of my wife's trusted doctors sold his practice to a local hospital.

Now, instead of owning his own surgical practice, he is an employee of a large and growing hospital system. This is a trend that is revolutionizing how our health care is being delivered. By the end of 2012, 55% of all doctors in the US were employed by hospitals, and the number keeps growing-largely because of the rising costs of maintaining private practices and hospitals' desire to keep their beds full by having their own sources of referrals. By 2020, only about 20% of US doctors are expected to be in their own private practices.

If your doctor has notified you that he/she is joining a hospital system or if you're looking for a new doctor, be sure to ask these questions…

  • Will your doctor refer his patients outside the hospital's system? Referrals among hospital doctors, including specialists, are easy and usually don't require long waits for appointments. And because they work for the same entity, these doctors more frequently consult with one another than independent physicians do. That type of coordinated care often results in better outcomes. But what happens if the best referral is outside that hospital's system?

Did You Know? The States with the Safest Hospitals Are…

Arizona, California, Illinois and Ohio. Patients in those states had a 55% lower risk of dying and a 42% lower risk for complications, on average, than patients in the lowest-ranked locations-Alabama, Arkansas, Georgia, Nevada and Oklahoma.

Believe it or not, some hospitals require doctors to refer only in-house even when they believe an outside colleague may be better.

To protect yourself: Ask your doctor whether he can refer outside the hospital system. If not, do not use that doctor.

  • What happens if your doctor leaves the hospital? Some hospitals require doctors to sign a noncompete clause that prohibits them from practicing in the local area if they quit or are let go by the hospital.
  • To protect yourself: Ask your doctor whether he would still be available to treat you if he leaves the hospital for any reason. If not, consider choosing another doctor so that you can be ensured continuity of care.
  • Will you be shuffled around? Some people who have followed their doctors to hospital practices have been disappointed because they are sometimes forced to see other doctors in the practice when they show up for their appointments.
  • To protect yourself: Ask your doctor whether you will be notified in advance and given a chance to reschedule) if he is not available to see you at your appointment time.
  • Are your medical records transferable? Every hospital now uses electronic medical records, which help ensure that your care is coordinated because all your tests, treatments and medical history are in one electronic file. The problem is, most hospitals have their own unique electronic medical record system that is available only to their personnel. If you use doctors outside the hospital system, the hospital practice is not likely to handle the transfer of a paper copy of your records.

To protect yourself: Ask for paper copies of your medical history, the results of all your tests and doctors' notes on major treatments you have had. This way, you can take these records with you when you see practitioners outside the system rather than relying on the hospital practice to take care of it.

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