Starting November 1, DCH Regional Medical Center in Tuscaloosa will change their hospitalist care to coincide with their sister hospital Northport Medical Center, whose changeover began October 1. Both facilities will now be served by Capstone Health Services Foundation and IN Compass Health.

The transition began in February when DCH Health System, which includes both hospitals plus Fayette Medical Center, began requesting proposals for hospitalist contracts. The evaluation was conducted by DCH with expertise from PYA, a nationally recognized consulting group specializing in coordinating RFP processes and evaluating the responses.

On June 22, DCH announced the outcome of their evaluation. "Partnering with these two healthcare leaders to staff and manage both DCH Regional Medical Center and Northport Medical Center helps ensure quality, continuity and consistency of care, since the same providers, using the same care models, will be delivering care at both locations," Bryan Kindred, president and CEO of the DCH Health System said in a press release. "This is the right thing for our patients and the community."

Prior to the change, Northport had contracted with Pinnacle Physician Group to provide hospitalists for the last six years. "But our physicians have been doing it for 16 years there," says Charles Abney, MD,

owner and founder of Pinnacle, explaining that all their physicians had been employed by DCH Health System as hospitalists.

Abney formed Pinnacle in 2009 with another physician in order to serve as hospitalists at Noland Hospital, a 26-bed, specialty facility catering to long-term acute care also in Tuscaloosa. The following year, a local pulmonology group hired Pinnacle as their hospitalists.

In 2013, DCH Regional Medical Center asked Pinnacle to help cover their hospitalist needs. The physicians at Pinnacle, who were still employees of DCH Health System as hospitalists at Northport, took on that task for free. "We were in the position of employees at the time, and it didn't feel right to ask them for money. We kind of had to do it," Abney says.

By 2015, the physicians ended their hospital status as employees of DCH to continue performing all the same work under the Pinnacle name. "That would be eight years we've done it at Regional and received not one extra penny," Abney says. The group grew to cover about 23 percent of the hospitalist services at the 583-bed hospital. Northport, at less than half the bed count of Regional, continued the paid contract with Pinnacle.

Since then, Pinnacle expanded their clientele to serve as hospitalists at those two facilities for another 14 private physicians.

Abney says the end of the contract with the hospitals is a major hit and unexpected. "We felt safe. That's what we misjudged," he says, but it won't be their collapse. "All of us have alternate sources of income." However, the staff and 11 nurse practitioners could likely lose their positions.

The biggest hit and possible downfall for Pinnacle will be a rule recently imposed by DCH to exclude any possibility of competition to their own hospitalist program. "We don't have a problem with them having an exclusive contract," Abney says, "but they should have the same contract that we had without this provision to cut out competition." Pinnacle is pursuing legal means to make that happen and retain their access to serve as hospitalists for at least their current private physician clients.

According to the new contract for hospitalist service at Northport and Regional, IN Compass out of Georgia will now provide operational oversight and expertise and will be responsible for day-to-day operations of the hospitalist program. They will also work with Capstone in recruiting, selecting, and hiring those physicians.

Capstone Health Services Foundation will employ the physicians that will work as hospitalists. The non-profit corporation is affiliated with University Medical Center and the current employer of University Hospitalist Group physicians, which held the previous contract for hospitalists at Regional.

Richard Friend, MD, dean of UA's College of Community Health Sciences explained in a press release the advantage of utilizing the two entities together. "Partnering with IN Compass will allow Capstone Health Services Foundation to collectively offer DCH local and national knowledge along with the best practices of a leading medical center and a leading hospitalist management company."