Nexus, Christus St. Vincent discord reignites after hospital revokes doctors' privileges

Apr. 20—Several doctors at a Santa Fe practice are up in arms after learning Christus St. Vincent Regional Medical Center leaders revoked their hospital privileges last month, a move the group's president described as "anti-competitive."

Two orthopedic and three pain specialists at Nexus Health received notices of the change in mid-March, said Nexus Health President Dr. Scott Herbert. According to two letters provided to The New Mexican, the change was referred to as "administrative in nature."

The letters told providers orthopedic and pain medicine service lines were closing "as part of an effort to more fully integrate these services with Hospital and clinical leadership direction and oversight."

In other words, according to an email from Christus St. Vincent spokesman Arturo Delgado, the hospital has chosen to make those services exclusive to employed or contracted providers.

"To have a 'closed' or 'exclusive' service means that only those providers that are employed or under contract with the Hospital can provide services in the Hospital," Delgado wrote.

Hospital leaders declined requests for an interview, but, in several rounds of answers to questions via email, defended the decision and pushed back on Herbert's complaints.

The dispute reignites tensions that have been simmering between the two organizations for the last two years, when Nexus was formed from a practice that formerly was a longtime partner of Christus St. Vincent. Throughout the acrimonious split, the groups have sparred over contracts, provider poaching and patient care.

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

"Every hospital in the country has exclusive arrangements for service lines and follows a similar process for identifying the hospital's needs and informing the providers," Montoya wrote in an email.

But Herbert told The New Mexican it's extremely rare for a hospital to revoke a provider's hospital privilege — an agreement he said is typically viewed as "sacrosanct."

"We were completely blindsided by this decision," he said. "All of our physicians have up-to-date privileges at Christus, they were not under review, and we had consistently said to everyone we had planned to continue using them."

Herbert and four of the affected physicians — Dr. John Garcia, Dr. Melissa Covington, Dr. Luke Bulthuis and Dr. Robin Hermes — have asked Christus leaders to reconsider the decision and restore their privileges.

Herbert said if that request isn't granted, the providers will explore other options.

"There are legal remedies to this that I don't think anybody wants to test," he said.

Bad blood

While Nexus is a relatively new practice, bad blood with Christus St. Vincent has been part of its story since the outset.

The independent multispecialty outpatient practice evolved out of a longtime Christus St. Vincent contractor previously called New Mexico Cancer Care Associates in the wake of the hospital's 2022 decision to cancel a contract with the oncology provider, a move Cancer Care Associates at the time said left thousands of patients uncertain of how their treatment would go forward.

It wasn't 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 by trying to poach Christus St. Vincent providers. The cancer clinic sued one of its former oncologists who departed to work for Christus St. Vincent.

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

Today, Nexus Health has about 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 either worked directly for Christus St. Vincent at one point or had a contractural agreement with the hospital.

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

What's it mean for patients?

Hospital privileges give physicians who aren't employees the ability to admit patients to a facility and treat them there.

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

"The problem with that is that the two facilities are not equal," he said, adding the smaller scale of Presbyterian's Santa Fe hospital means some procedures can't be done there.

For example, if a relatively healthy person needs a hip replaced by one of the Nexus orthopedic doctors, that's not a problem to do at Presbyterian.

"But if you need a hip replacement and you're older or you have, say, heart disease or lung disease and there's a chance that the surgery is riskier, then you cannot get that done at Presbyterian Santa Fe," Herbert said.

In that scenario, the patient would need to find a new provider, as Nexus Health physicians don't have privileges at Albuquerque hospitals, either.

For Nexus patients who do seek care at Christus St. Vincent, Herbert contends the revocation could create an information void.

For example, a situation could arise in which a patient who underwent surgery for a sports injury with a Nexus doctor could end up at Christus St. Vincent Regional Medical Center with a fever.

"You don't know if it is a post-operative infection, you don't know if it's a complication [from the surgery]," Herbert said.

But the Nexus surgeon would not be allowed to come see that patient at the hospital.

"The doctors in the hospital have no insight to what's happened to you out there," Herbert said. "They're going to take care of this patient starting completely from scratch, and then with no communication with the patient's primary doctor."

Responding to those concerns, Dr. David Gonzales, Christus St. Vincent's chief medical officer, wrote in an email while it's true the physicians wouldn't be able to visit the hospital without privileges, patients will still receive care.

"Christus St. Vincent has a full complement of specialists in infectious disease, hospital medicine, and orthopedics that 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 back to the community provider."

Anti-competitive or common practice?

Montoya defended the decision as common practice and wrote in her email the hospital's local board made the call based in part on a desire to control quality, including when expanding services throughout the region.

"In a state where medical malpractice and liability are a significant and growing concern, this Board decision also considered the importance of aligning Hospital employed and contracted physicians in its clinical quality and patient safety objectives," Montoya wrote. "This is but one way we can ensure our care goals and greater protection for physicians and our clinical practices."

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

"In what universe is limiting access to providers the solution to those three problems?" he said. "It makes no 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 amazingly dangerous precedent for this community. ... The message they're sending is, 'If you don't work for us, you can't practice at this facility.' "

Montoya denied that accusation, calling it "ironic" and pointing out that before the separation, Nexus' predecessor had an exclusive pact with the hospital.

"For over 10 years 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 system," she wrote. "In that arrangement, no other medical oncologists could provide services in the hospital."

N.M. or Texas decisions?

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

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

Anchorum St. Vincent was replaced by Anchorum Health Foundation, which expects to see $500 million from that share transfer over the next decade. The foundation plans to use that money on an ambitious plan to fight health inequities throughout Northern New Mexico.

But the move also meant a change in oversight of the hospital and other Christus holdings.

"Once Anchorum sold the remaining 50% of the hospital ... there was no longer a community ownership of that hospital," Herbert said. "And therefore you have to wonder where the decisions are being made."

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

"When this health system was struggling 15 years ago, it was CHRISTUS Health's commitment to our Northern New Mexico community that allowed the doors to remain 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 the confidence in this team and Board to ensure the strength of CHRISTUS St. Vincent."