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October 4, 2012
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OB-GYN contracts not renewed at Barton

Barton Health is looking to hire new obstetricians and gynecologists after two physician groups decided not to renew their contracts with the hospital.

Negotiations fell through after Barton decided to stop managing the Tahoe Women's Care offices in South Lake Tahoe and Minden, Nev. And some of those physicians say they won't be taking on any new patients.

As a Californian nonprofit and under the Corporate Practice of Medicine Act, Barton cannot legally employ physicians. Instead, it contracts with a number of physician groups to treat patients at the hospital, physician offices, the community clinic and the surgery center.

Barton entered into contract renewal negotiations with Tahoe Women's Care and Emerald Bay Center for Women's Health in January, but was not able to come to an agreement with the physician groups. According to obstetrician and gynecologist Dr. Kris Kobalter, Barton told Tahoe Women's Care that the practice was losing too much money and they would need to downsize the number of doctors and decrease costs.

Barton was offering competititve, fair market value salaries, Barton Health's Chief Medical Officer Dr. Clint Purvance said, but negotiations fell though.

The groups weren't able to come to an agreement, Kolbalter said, and Tahoe Women's Care will no longer be practicing in South Lake Tahoe come Jan. 1. That doesn't mean the physicians who currently work in the clinic won't open a new private practice in the basin or renegotiate independently with the hospital, but in Kobalter's case, he said he's leaving the South Shore. And as far as he's heard, none of the other doctors plan to do business with the hospital.

"None of us are pleased with the outcome," Kobalter said. "We're not abandoning the patients at will. I believe the contract negotiations were disingenuous on the part of the hospital. I don't think there's a future in medicine here."

Barton, which owns the Tahoe Women's Care building, is currently looking to hire new obstetricians and gynecologists to replace the four physicians whose contacts will expire on Dec. 31.

As for the location in Carson Valley, unless another health care provider steps in to manage the practice, the clinic might shut its doors at the end of December, gynecologist Dr. Gary Willen said.

"We have a very vibrant practice and we want to keep providing health care to those patients," Willen said. "Barton doesn't view it the same way we do. Medicine has become business. But we still care about those patients. It would be a sad day."

When Tahoe Women's Care aligned with Barton five years ago, it was the economically sound choice, Kobalter said. The health care provider took care of the day-to-day management and paid the physicians group high wages. Without that management, Tahoe Women's Care couldn't continue at the South Shore.

Kobalter said he understands Barton's need to cut costs. What he doesn't understand is why the hospital wouldn't work with the practice.

"These small facilities are going to be under huge pressure, and it's very realistic for businesses to be looking at cost-cutting measures. We thought we were a willing participant, but it wasn't enough. It's unfortunate for our patients. I feel bad for the community, but things change," Kobalter said.

Purvance said the changes are a result of health care reform that has hit medical providers with cuts in reimbursements for patient services from government and private payers to help pay for expanded coverage. The decrease in reimbursement plus a declining residential population in South Lake Tahoe presents significant fiscal challenges, he said.

"There are substantial savings to running a leaner organization and we have to take a service line and make it viable. With health care reform, everything changes," Purvance said.

Consolidating the clinics could mean a seven-digit savings figure, Purvance said, but he did not have specific numbers available.

Now Barton has three months to hire new obstetricians and gynecologists. It's a tight deadline, Purvance said, but he doesn't anticipate a change in the services offered.

At the moment though, Kobalter said he's not seeing any new obstetrics patients and Willen said he thinks the other obstetricians are likely following suit. It's a decision that comes down to ethics, he said.

"Pregnancy is a nine-month relationship, and I have no expectations that I'll be here to see the care through," Kobalter said.

Stacey Hamburg received a call Tuesday from a Barton receptionist canceling Hamburg's first obstetrics appointment. The receptionist said that since the hospital will not be renewing the contracts with the obstetricians and gynecologists, the obstetrician could not take on any new patients, Hamburg wrote in an email on Thursday.

"It is all quite stressful and disheartening for women living in South Lake. I will be seeing a new obstetrician in Carson City tomorrow and when I go into labor will be driving over the pass, down to Carson in mid-April. Not exactly ideal," she wrote.

Barton is the only women's health care provider on the South Shore. The next closest hospital is in Carson City, while Tahoe Forest Health System in Truckee, Calif., also has several independent obstetricians and gynecologists. As far as South Lake Tahoe goes, there are midwives and there is Barton, Kobalter said.

Purvance said nothing like this has happened at Barton for at least the past decade, and that all previous renegotiations have been successful. He said the hospital plans to continue providing women's heath care to South Lake Tahoe residents. It's just a matter of hiring doctors before time runs out.


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Tahoe Daily Tribune Updated Oct 5, 2012 12:30AM Published Oct 4, 2012 10:47PM Copyright 2012 Tahoe Daily Tribune. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.