MARCH 2017 ON HEALTH CONSUMER REPORTS 11 CR.ORG/HEALTH M y gastroenterologist of seven years recently began working at a new practice, one owned by a large medical center. When I contacted her about a colonoscopy, we discussed my precolonoscopy prep and diet and the scope she’d use, then scheduled an appointment at her new hospital. What my doctor neglected to share with me was that because of the changes related to her new practice, she wouldn’t be performing my procedure. Like my gastroenterologist, doctors throughout the country are leaving their practices in droves to become employees of hospital-owned practices and multi­ specialty clinics. From July 2012 to July 2015, the number of hospital-employed physicians increased by 50 percent, and it’s estimated that only about 1 in 3 doc- tors remain in private practice. (This is largely because hospitals and healthcare systems are buying up practices to attract more patients and because government and insurance regulations are becoming too labor-intensive for small practices.) These changes in doctors’ employment status come with a host of new condi- tions that can affect your care. Three key examples: YOUR OFFICE VISIT MAY CHANGE When your doctor leaves private prac- tice for a hospital-owned one, you may find that he or she has new office staff and hours, and new rules about cancel- lations, and that appointment lengths have changed. Even if you’ve been seeing your doc- tor for years, you’ll probably need to fill out new registration forms at your first appointment. And because the new prac- tice may use a different electronic medi- cal records system and might not yet have access to your information, take a list of your medications, supplements, surger- ies, and diagnoses. Your doctor might also Proactive Patient get slowed down while learning that new system, as mine was, so be patient. YOUR COSTS MAY INCREASE Several factors might affect what you’re asked to pay. For example, when doctors join a hospital-owned practice, they’ll probably begin accepting some new insur­ ance plans and dropping others. So ask the billing department whether the practice still participates in your plan; otherwise you could be stuck with out- of-network bills. Even if your doctor still accepts your insurance, your coinsurance (the per- centage of the bill you pay out of pocket after insurance pays its portion) could go up. This is because your doctor may start charging his new employer’s prices for tests and other services. Check before­ hand with the office billing staff. The hospital that bought your doc- tor’s practice may designate his office an outpatient clinic and can legally charge you a facility fee if procedures or tests are performed there. Ask about facility fees ahead of time. (The 2015 Bipartisan Budget Act prevents health systems from billing those on Medicare for facility fees at practices acquired on or after Nov. 2, 2015, but systems can continue charging for those purchased beforehand.) YOU MAY SEE NEW PROVIDERS By joining a larger group of healthcare providers, your physician is likely to pro- vide you with access to a broader network of on-call and consulting doctors who can easily share information about your health. This can usually be beneficial. But not always. Just before my pre­ colon­ oscopy sedation was adminis- tered, it occurred to me to make sure my doctor—who had not yet approached my bedside in the outpatient procedure suite—would be performing the test. I was stunned to discover that a doc- tor in training was scheduled to do the test and that my doctor would only be supervising. Her new medical center is a teaching facility, and trainees perform such tests as part of their education. (I ­ requested she do my colonoscopy herself.) Most patients’ bills of rights give you the right to know the names, posi- tions, and functions of all hospital staff ­ involved in your care and to refuse their treatment, examination, or observation. And doctors in training are mandated to inform patients of their respective roles. But as in my case, these rules are sometimes overlooked. So if your doctor changes practice settings, it’s important to ask ahead of time who you will be see- ing in the office and who will perform any scheduled tests or surgery. ORLY AVITZUR, M.D., M.B.A., is Consumer Reports’ medical director. Board certified in neurology, she is a fellow of the American Academy of Neurology, a clinical instructor at the Yale University School of Medicine, and a medical consul- tant to the New York Rangers hockey team. When Your Doctor Has a New Boss As more and more physicians leave private practice behind, many aspects of your care may change Many doctors are leaving their own practices to work for hospital-owned practices. Orly Avitzur, M.D., M.B.A. ILLUSTRATION BY: DAN PAGE/THEISPOT.COM