Bacon's Rebellion

Democracy Thrives in Sunlight

COPN Drives Richmond’s Tuckahoe Orthopedics to Be Acquired to Survive

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sherlockj
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Bon Secours’ St. Mary’s Hospital, in the same medical complex as Tuckahoe Orthopaedics.

by James C. Sherlock

This is pretty straightforward.

COPN is driving a physician shortage in Virginia because doctors are not granted the independence to practice the way they want to with the facilities and equipment they need and that in turn is depressing their incomes. Reversing Robin Hood, COPN takes from the physicians and gives to the hospitals.

I offer in this essay a direct example.

Pre-COVID projection physician shortages in Virginia

The Medical Society of Virginia is of the opinion that: 

“Virginia’s COPN has failed to improve access, control costs, and ensure quality. … COPN laws prevent private health care providers from competing with larger providers to bring patients the same service at a lower cost in a more convenient location.”

A story yesterday in the Richmond Times Dispatch announced that Richmond-based Tuckahoe Orthopedics is getting a new owner, Bon Secours. Bon Secours operates five hospitals in the Richmond area.

This story validates MSV’s view, and reminds that COPN negatively affects physicians practices even in Richmond, the one Virginia metro area with competitive hospital systems.

HCA, Bon Secours and VCU Health compete, but act as one successfully to beat back competition from physicians’ practices using the COPN process. 

And then they buy the ones they want, because those physicians practices, limited by COPN in the services they can provide, are worth far more to the integrated hospital systems as sources of patients than they are to the practices’ partners as independent places to practice. The ones without major scale, an exception being massive OrthoVirginia, have a very hard time competing

Tuckahoe Orthopedics has been in business for 40 years.  

The sale of the practice to Bon Secours says a lot about the struggles of independent physicians practices in general and orthopedics practices in particular in Virginia, even in the Richmond area. From the RTD article:

“This acquisition will allow Tuckahoe Orthopaedics to continue to provide the highest quality orthopedic care to our patients with the many resources and efficiencies available to us through the backing of the region’s premier community health system,” Dr. Jed Vanichkachorn, president of Tuckahoe Orthopaedics, said in a statement.

Resources and efficiencies indeed. Resources and efficiencies denied to independent competitors by COPN.

Physician shortage in Virginia

There is a significant and growing shortage of physicians in Virginia as reported in every study, the most thorough of which was conducted at the request of the General Assembly in 2013.  There are many reasons for that, including  the wage suppression in Virginia for physicians and other health professionals that follows their lack of ability to compete independently like night follows day. 

The shortage is about to get worse than predicted from the stresses of COVID on the profession.   

Single point Virginia solution. COPN is the one reason for that physician shortage that Virginia’s General Assembly and its Governor can independently do something about if they have the will to do so.    

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15 responses to “COPN Drives Richmond’s Tuckahoe Orthopedics to Be Acquired to Survive”

  1. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    One can certainly find fault with COPN, but you seem to blame every ill in medicine on COPN. Take the shortage of physicians in Virginia. The Commonwealth is not alone; there is a national shortage of doctors. There are many reasons for such a shortage. For example, federal policies a generation ago that restricted the number of medical school slots is cited as a major factor. https://www.niskanencenter.org/the-planning-of-u-s-physician-shortages/

    Nowhere in that RTD article did I detect any intimation that COPN was driving the merger of Tuckahoe Orthopedics with Bon Secours. If anything, I would think greed is the main factor. Several years ago, my primary care physician gave up his two-person practice and joined the HCA system. When I asked him why, he just said, “I’m making more money than I ever thought I would.” I think the scale of having to provide one’s own billing, scheduling, and fighting with insurance companies is also a factor.

    Tuckahoe has obviously been trying to merge with someone for several years. A planned merger with Advanced Orthopedics fell through when that practice went with OrthoVirginia. COPN certainly did not seem to be a factor.

    As for diagnostic equipment and surgical centers, those orthopedic services operate their own. According to Tuckahoe’s website, they provide MRI procedures. https://tuckahoeortho.com/mri-services-main-tuckahoe-orthopaedics/. Earlier this year, I went to OrthoVirginia due to some pain in my hand. One option that the physician offered was surgery to repair a severed tendon. That surgery would be done in their office, with an MRI in their office preceding it. (I have elected not to have the surgery at this time.)

    In summary, COPN has its shortcomings, but it is not the sole, or even the main, source behind the problems facing American and Virginia medicine.

    1. James C. Sherlock Avatar
      James C. Sherlock

      Your friend was right. He makes more money working for a hospital system that being frozen out. Thus my two op-eds showing how that is because of the vast imbalance of power provided to the hospitals by COPN.

      Our problem here in Virginia when competing for medical talent region-wide and nationally is that any physician finishing up his or her residence and looking for a place to practice need not pick Virginia.

      Many of the best of them want to practice medicine in an environment they can control.

      If so, they won’t come here and work for the business majors who run many of the hospital systems, many of whom could not have gotten into medical school without a visitors pass.

      It doesn’t have to be that way, and is not in Maryland. That state, which permits physicians to operate a single OR ASC without a certificate of need, has 386 physicians per 10,000 people. Virginia has 263 per 10,000, in the middle of the pack of states.

    2. James C. Sherlock Avatar
      James C. Sherlock

      Dick, Tuckahoe offer MRI services at their St. Mary’s (Bon Secours St. Mary’s Hospital) office. I’m going to speculate that it is a Bon Secours machine and Bon Secours revenue.

    3. James C. Sherlock Avatar
      James C. Sherlock

      Certainly not the main problem facing American medicine, but we make the situation unnecessarily much worse here in Virginia.

  2. Stephen Haner Avatar
    Stephen Haner

    A recent defense of how wonderful it is to have COPN from two former legislators…just for you, Cap’n:

    https://richmond.com/opinion/columnists/christopher-k-peace-and-rosalyn-r-dance-column-copn-program-helps-virginia-meet-community-needs/article_ac84d683-7c69-50b5-b193-20bd28d500b0.html

    There are quite a few economic factors driving doctors into group practice, and then groups into the orbit of hospital companies. COPN is one but not the only one. I suspect that the doctor in that particular ortho practice I will soon be seeing will just do what he does and get paid what Medicare offers, and I won’t even notice. He is one of the better shoulder surgeons in town, I hear.

    1. James C. Sherlock Avatar
      James C. Sherlock

      Thanks for the link. Not a word of that op-ed is true, but those are the arguments. I particularly like the sentence

      “COPN has faced opposition from special interests lobbying to repeal the program, promising it will improve Virginia’s health care system.”

      Those special interests include the Obama Justice Department and the Federal Trade Commission.

      I wonder what Ms. Dance will do with all of VHHA’s campaign money now that she is out of office.

      1. Nancy Naive Avatar
        Nancy Naive

        “Not a word of that op-ed is true,…”

        A very convincing rebuttal. I’ve never seen that used on the internet before.

    2. James C. Sherlock Avatar
      James C. Sherlock

      I checked VPAP for the biggest donors for both Dance and Peace. Each of their campaigns is/was primarily financed by the health care sector by a huge margin over the next industry sector. The General Assembly remains coin operated, and I will lay a large bet that the op-ed was handed to them by VHHA.

      1. Stephen Haner Avatar
        Stephen Haner

        I will not take that bet.

  3. Nancy Naive Avatar
    Nancy Naive

    It’s a game. You’re not a player. You’re the ball.

    1. James C. Sherlock Avatar
      James C. Sherlock

      Then they are those who, trembling in fear of the unknown, never enter the arena.

      1. Nancy Naive Avatar
        Nancy Naive

        Oh, you’ll enter the arena alright. We all do.

        Where I’m from
        Nobody knows.
        Where I’m going
        Everyone goes.

  4. James A. Bacon Avatar
    James A. Bacon

    The surgeon who gave me a new hip was affiliated with Tuckahoe Orthopoedics, and my surgery took place at St. Mary’s. I thought the medical care was outstanding. But one thing really pissed me off. I arrived for appointments when I was scheduled to arrive. I ended up waiting a half hour or even an hour every single time. Really, you think my time is of so little value that you can squander it like that? You don’t even come out to apologize and let me know it’ll be only a few more minutes?

    I couldn’t help but think of those hospital dramas where some doctor is boinking some nurse in the janitor’s closet, and wondering if that was what was going on. I’m sure the reasons for the delays were more prosaic, but…. I couldn’t help thinking.

    Anyway, there’s a management issue with a physicians’ practice that is so consistently disrespectful of its patients’ time. I’m in no hurry, though, to go back and see if the service has gotten any better.

    1. James C. Sherlock Avatar
      James C. Sherlock

      My wife and I have spent more time at Sloan Kettering than we ever hoped to, but though they have earned the right to keep some people waiting, they never availed themselves of it. No one should accept treatment from a poorly run medical office. It unlikely to be the only thing that practice does sloppily.

  5. Nancy Naive Avatar
    Nancy Naive

    So Cappy, how’s it all compare with the military system?

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