A year ago I was seen by a local cardiologist for an irregularity observed by my primary care physician, a suggestion of a heart murmur. In the end there was nothing of consequence, but better safe than sorry. As part of this encounter I became an entry in the cardiology practice’s electronic health record.

Imagine my surprise when I received two letters, the first from the University of Rochester Medical Center, the second from Rochester Regional Health, a pseudonym for what was the merger of the Unity HealthSystem and the Rochester General Hospital, that both purported to help me continue my care, albeit in different ways.

The University of Rochester reassured me that even with the changing allegiance of the Rochester cardiopulmonary group there would be no need for me to change cardiologists. They would continue to offer every cardiac specialist I could possibly need, state-of-the-art offices, and even free parking. In the event that hospitalization was required I would be admitted to Strong Memorial, Rochester’s leading heart hospital (according to the US News and world report).

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Rochester regional health countered with two pages of full-color physician photographs, including a large number of practitioners whose fellowships at the University Of Rochester School Of Medicine were prominently listed. When I checked their web site the old relationship with RGH still appeared, but I’m sure that’s an oversight.

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As a patient I should be pleased. I clearly have competition working in my favor, and surely I can do nothing but benefit from the situation, regardless if I stay the path with the doctor I have met, or select somebody new. For one thing, there are now two large entities who have more purchasing power with my health insurance company, and potentially can pass that saving onto me.

Unfortunately, it’s really not clear which of these situations is in my favor. To make a sensible decision I need additional information, particularly about the form of relationship between my doctor and the employer, or their new partner. Will my doctor become a hospitalist who is paid a fixed salary for the first few years of his employment, at the cost of his independence, or, will he remain an independent party in a business relationship with the parent group? How will my health insurance reimburse them for my care in the context of this changed relationship?

At this point these questions probably cannot be answered, but they certainly have the impact to greatly change my financial position, as well as potentially changing the way that I am cared for.

It’s well known that there is little rhyme or reason to the cost structures of the American healthcare system. For cardiologists, the cost of treating a patient in the hospital can be significantly higher than treating them at the practice, simply because of the way Medicare reimbursement works. There are so so-called “facility fees” that may arise out of the blue when a patient is treated on what is termed “hospital equipment”, that may in fact be the same exam room prior to acquisition at a substantially lower cost.

From the care perspective interventional cardiologists may actually have fewer options within the hospital due to quality initiatives that proscribe the use of specific makes and models of medical devices for cost reasons. While you could hardly agree that this is an improvement in terms of arriving at better cost structures, I don’t really want to be the patient on whom my doctor learns to use a new device when he has spent years accumulating experience on a different device; one with which he has had excellent outcomes.

As I talk to my friends and colleagues everybody is telling me that I need to talk to my doctor, but at this point I have no active condition and there is no reason to do so. I suspect that were I a patient with at high risk of stroke, or with one of a myriad of cardiac conditions, I would ask these questions; but what can my doctor tell me? He’s probably completely unaware of the insurance and financial implications of this merger. He almost certainly has not been with the new institution for long enough to know what procedures they allow, devices they use, and other general policies and procedures they have in place which may be counter to his normal practice.

At this point all I really have some pretty color photographs to compare to a doctor whom I have met, as well is a lot of assurances from hospital executives.

There really isn’t enough information to make a good decision.

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