If you are a physician and work for “hospital system A”, and want to send your patient to a specialist that is outside of “hospital system A”, can you?
Legally yes, but practically no.
A hospital wants you to send all of your referrals inside the system, even if you aren’t a fan of the specialists in a certain department.
You could be a PCP who has had an excellent relationship with a private practice rheumatologist for 20 years.
If your practice gets bought by “hospital system A”, they will not want you to send to that rheumatologist, even if it is the best option for the patient.
They won’t explicitly put it in a contract or writing that you can only refer internally, but they will make sure that you know that in one way or another.
A general orthopedic surgeon I know used to refer to this one spine surgeon that he knew personally was very good, in a different hospital system.
The hospital he worked at told him that he couldn’t do that anymore.
Again, putting profits above patients.
This is actually the whole reason why hospital systems buy PCP offices.
They want the patients not for the profits made from primary care, but for the referrals to their labs, their imaging, specialists etc.
Physicians accept this because of the “don’t make any waves mentality” that was instilled in us from residency training… by the hospital systems.