*An article in the Oct 10. edition of the Tribune incorrectly stated the number of contracts renewed at Barton Health in the past year. The hospital renewed contracts with 25 physicians in the past year, and around 63 physicians in the past few years.

As the debate on health care reform continues to take center stage across the country, some very real effects of the 2010 Affordable Care Act have already reached California and the Lake Tahoe Basin.

Barton Health's failure to renegotiate the contracts with the two obstetrician and gynecological physician groups has roots in the act, aka Obamacare. The hospital, which expects large cuts in reimbursements during the upcoming years, has been forced to make some changes to streamline their system, Barton's Director of Public Relations and Marketing Monica Sciuto said.

Contract negotiations with the groups fell through after Barton decided to stop managing the Tahoe Women's Care and Emerald Bay Center for Women's Health offices in South Lake Tahoe and Minden, Nev. According to a statement from Chief Medical Officer Dr. Clint Purvance, both practices were losing a significant amount of money the hospital could not provide the exact amount because of privacy issues and they were asked to consolidate physicians and services.

According to Dr. Kelly Shanahan, the obstetrician and gynecologist with the Emerald Bay Center for Women's Health who worked directly on the contract proposals, the doctors were never told the exact amount they needed to cut, but they'd heard the number ranged from $500,000 to $700,000.

Shanahan said the physicians agreed to combine offices in Tahoe and Minden and they laid off one doctor. She said she estimated those savings would cover the practices' losses.

The physician groups' original proposal asked for a base compensation amount in addition to continued management of one Tahoe office, one Minden office and the Barton obstetrician clinic, according to Shanahan.

That compensation amount which neither Barton nor the physicians specified was considerably higher than the current compensation structure, Purvance wrote, and Barton responded with two counter offers: the groups could become an outpatient department or they could accept a daily amount to cover the obstetrician clinic. Management of the practices was not mentioned in the second proposal, Shanahan wrote in an email.

(There was) no base compensation just payment based on productivity, pay for providing coverage of the Barton clinic obstetrical patients at a rate that was half of what Dr Kobalter and I were paid 20 years ago when we were moonlighting as residents, and only payment for roughly half of our malpractice expenses, Shanahan said of the first option.

The physician groups responded by calling for a meeting with Barton's senior administration. Barton replied with their final proposal: there would be a set amount of obstetrician services and no management of the practices, according to Shanahan.

Originally posted here:

Health care reform at heart of Barton, OB-GYN conflict