Nexus, Christus St. Vincent dispute flares up again after hospital revokes doctors’ privileges | Local news

In other words, according to an email from Christus St. Vincent spokesperson Arturo Delgado, the hospital has chosen to make these services exclusive to salaried or contract providers.

“Having a ‘closed’ or ‘exclusive’ service means that only those providers who are employed or contracted with the hospital can provide services at the hospital,” Delgado wrote.

Hospital leaders declined interview requests, but in several rounds of responses to email questions defended the decision and pushed back on Herbert’s complaints.

The dispute fuels tensions that have been simmering between the two organizations for the past two years, when Nexus was formed from a practice that was previously a longtime partner of Christus St. Vincent. Throughout the bitter division, the groups have discussed contracts, supplier poaching and patient care.

Christus St. Vincent President and CEO Lillian Montoya wrote that exclusive service lines are common at hospitals across the country.

“Every hospital in the country has exclusive service line arrangements and follows a similar process for identifying hospital needs and notifying providers,” Montoya wrote in an email.

But Herbert told it The new Mexican it is extremely rare for a hospital to revoke a provider’s hospital privilege — an agreement he said is typically considered “sacred.”

“We are completely blindsided by this decision,” he said. “All our doctors have up-to-date privileges at Christus, these were not reviewed and we had consistently told everyone we intended to continue using them.”

Herbert and four of the affected doctors – Dr. John Garcia, Dr. Melissa Covington, Dr. Luke Bulthuis and Dr. Robin Hermes – have asked Christ’s leaders to reconsider the decision and restore their privileges.

Herbert said if that request is not granted, providers will explore other options.

“There are legal solutions to this that I don’t think anyone wants to test,” he said.

Although Nexus is a relatively new practice, bad blood with Christus St. Vincent has been part of the story from the beginning.

The independent, multi-specialty outpatient practice was spun out of a longtime contractor of Christus St. Vincent, formerly called New Mexico Cancer Care Associates, in the wake of the hospital’s 2022 decision to terminate a contract with the oncology provider, a move that Cancer Care Associates reportedly left thousands of people at the time. of patients who are unsure about how their treatment will proceed.

It was not a smooth divorce. Christus St. Vincent at one point accused the oncology group of breaching its contract by engaging in discussions about joining Nexus and trying to poach Christus St. Vincent’s suppliers. The cancer clinic sued one of its former oncologists who went to work for Christus St. Vincent.

Just months after parting ways with its former cancer treatment contractor, Christus St. Vincent broke ground on its own cancer center, an $80 million project on the St. Michael’s Drive campus.

Today, Nexus Health has approximately 37 providers representing more than a dozen specialties, including orthopedics and pain medicine, dermatology, physical therapy and primary care. Herbert said about 80% of Nexus providers at some point worked directly for Christus St. Vincent or had a contractual agreement with the hospital.

Some of these specialties, including orthopedics and pain management, overlap with the services Christus St. Vincent also offers.

Hospital privileges give non-employee physicians the ability to admit and treat patients at a facility.

For patients of affected Nexus providers who need a procedure in a hospital, Herbert said, Presbyterian Santa Fe Medical Center is still an option, but with an asterisk.

“The problem with that is the two facilities are not equivalent,” he said, and the smaller scale of Presbyterian’s Santa Fe hospital means some procedures can’t be performed there.

For example, if a relatively healthy person needs a hip replaced by one of Nexus’ orthopedic doctors, that is no problem at Presbyterian.

“But if you need a hip replacement and you’re older or if you have heart or lung disease, for example, and there’s a chance the surgery would be riskier, you can’t have that done at Presbyterian Santa Fe,” Herbert said.

In that scenario, the patient would have to find a new provider, as Nexus Health doctors also do not have privileges at Albuquerque hospitals.

For Nexus patients who do seek care at Christus St. Vincent, Herbert claims the repeal could create an information gap.

For example, a situation may arise where a patient who has been operated on for a sports injury by a Nexus doctor may end up at Christus St. Vincent Regional Medical Center with a fever.

“You don’t know if it’s a postoperative infection, you don’t know if it’s a complication (of the surgery),” Herbert said.

But the Nexus surgeon was not allowed to visit that patient in the hospital.

“The doctors at the hospital have no insight into what happened to you out there,” Herbert said. “They are going to care for this patient, from scratch, and without any communication with the patient’s primary care physician.”

In response to these concerns, Dr. David Gonzales, chief physician at Christus St. Vincent, said in an email that while it is true that physicians would not be able to visit the hospital without privileges, patients will still receive care.

“Christus St. Vincent has a full team of infectious disease, hospital medicine and orthopedics specialists who have the expertise to address and treat any patient condition,” he wrote in an email. “A primary responsibility of our clinical staff is to ensure good communication with a patient’s primary physician, to ensure a smooth transition to the community provider.”

Montoya defended the decision as common practice, writing in her email that the hospital’s local administration made the call partly based on a desire to control quality, including as it expands services across the region.

“In a state where medical malpractice and liability are a significant and growing problem, this Council decision also took into account the importance of aligning hospital-based and contracted physicians with clinical quality and patient safety,” Montoya wrote. “This is just one way we can ensure we achieve our goals of care and better protect physicians and our clinical practices.”

Herbert said some of the biggest problems with the medical system in the Santa Fe area are long wait times, difficulty finding a doctor and poor communication between providers.

“In what universe is limiting access to providers the solution to these three problems?” he said. “It does not make any sense.”

Herbert said he believes the decision was driven more by business reasons than clinical reasons.

“It feels anti-competitive,” he said. “This sets an incredibly dangerous precedent for this community. … The message they’re sending is, ‘If you don’t work for us, you can’t practice in this facility.’ ”

Montoya denied that accusation, calling it “ironic” and pointing out that Nexus’ predecessor had an exclusive pact with the hospital before the divorce.

“For more than a decade, New Mexico Cancer Care Associates (now Nexus Health) was a contracted provider … and therefore enjoyed an exclusive clinical and financial arrangement to provide medical oncology services throughout our health care system,” she wrote. “Under that arrangement, no other medical oncologists could provide services at the hospital.”

Herbert also questioned whether the revocation decision can be traced back in part to the recent change in the hospital’s ownership structure.

Until last year, local nonprofit Anchorum St. Vincent owned half of Christus St. Vincent, which includes the hospital as well as all other local Christus entities. In the fall, that nonprofit transferred its shares to Texas-based Christus Health.

Anchorum St. Vincent was replaced by the Anchorum Health Foundation, which is expected to realize $500 million from that equity transfer over the next decade. The foundation plans to use that money for an ambitious plan to combat health disparities throughout Northern New Mexico.

But the move also marked a change in oversight of the hospital and other Christ businesses.

“When Anchorum sold the remaining 50% of the hospital… there was no longer community ownership of that hospital,” Herbert said. “And that’s why you have to wonder where the decisions are made.”

Montoya wrote that the hospital’s local board of directors, which currently includes representatives from Anchorum, made the decision to close the pain and orthopedic services. She emphasized that the company has invested in local staff and that the hospital operates under a local management team.

“When this health care system was struggling 15 years ago, it was CHRISTUS Health’s commitment to our Northern New Mexico community that kept its doors open,” Montoya wrote. “Since then, the significant investments in services and facilities speak for themselves. … It’s not about decisions being made from one state away, but it’s about trusting this team and the board to ensure the strength of CHRISTUS St. Vincent.