St. Charles Health System announced plans Monday to open two new family practice clinics in Sisters and Bend this year, and the hiring of four primary care physicians to staff them.

The clinics will serve as key components of the integrated delivery system the hospital has been working to create over the past two years. It will be open to all patients regardless of their insurance coverage or ability to pay for the services.

With the new clinics, the hospital system will have primary care offices in Bend, Sisters, Redmond and Prineville, all operating under the name St. Charles Family Care.

“By focusing on primary care in all communities that we serve and providing a medical home for patients, we are laying the groundwork for a system that will provide better care and promote better health at lower costs,” said Jim Diegel, president and CEO of St. Charles Health System.

The new physicians include two familiar faces. Dr. Joseph Bachtold is a family practice doctor with Bend Memorial Clinic and had previously practiced in John Day. Dr. Stephen Greer had worked for 18 years with BMC in Bend and Sisters, before leaving to practice at a tribal clinic in Juneau, Alaska, four years ago. For the past two years, Greer has also spent time working at an urgent care center in Redmond.

The hospital also hired Dr. Mark Gonsky, currently working in Yakima, Wash., and Dr. Meghan Brecke, coming from Scottsdale, Ariz.

The Sisters clinic will open this summer in a still-to-be-determined location. Sisters, with a population of 2,000 people, is currently served by BMC and High Lakes Health Care.

The Bend clinic, to be located in the Pacific Source building on Conners Avenue, is scheduled to open Sept. 6. Bachtold and Greer initially will split time between the two clinics, but eventually will practice in Sisters only. Dr. Jeff Absalon, chief physician officer of the St. Charles Medical Group, said the Bend clinic would house six primary care physicians in the near future.

The new clinics will provide additional options for those with private insurance, but could significantly ease access issues for Oregon Health Plan, Medicare or uninsured patients. Because St. Charles is a nonprofit hospital, its clinics must accept all patients regardless of their ability to pay.

“There’s a lot of unmet need for primary care in Oregon, and I know a lot of people have access issues,” Greer said. “St. Charles is committed to providing access to anybody who needs care. I think it’s a really great thing.”

The four physicians will be employees of the hospital, receiving a salary plus some additional payments based on their practice patterns. In other hospital systems, such arrangements have reduced the incentive for doctors to order tests or perform procedures that add little to the care of the patients, but increase physician revenue and patient costs. And when physicians are employed by large organizations, their employers can offset losses in one area with profits from another.

Doctors in private practice often feel the need to limit the number of Medicare, OHP and uninsured patients they see because they lose money on those patients and must make up for those shortfalls with a higher percentage of patients with higher paying commercial insurance.

“It certainly makes it more difficult to have to worry about that,” said Greer, who also contemplated going into private practice. “My motivations in medicine are to take care of people, not to be in big business. I really enjoy practicing medicine, and that’s what I do best.”

The employment of physicians, particularly primary care doctors, has been a flash point in the Central Oregon medical community. Many doctors have complained that the hospital model forces physicians to choose between becoming employed or affiliated with the hospital system but losing their independence, or watching the hospital hire and bankroll their competition. Those doctors are likely to view the latest move as the realization of their fears.

Absalon countered that the hospital system has left the doors open for all providers, and those that don’t want to be employed can choose an affiliation model.

“For some practices or clinicians, employment makes the most sense. That’s the option they quite honestly prefer. For other physicians and practices, affiliation fits them much better,” he said. “When we set out to build this system, we felt if we made employment a mandate to be part of our team that that would not be responsible to the physicians and practices that have done such an excellent job in our community.”

The hirings also may widen the divide between St. Charles and its affiliated physicians and BMC and their allies. BMC announced last week that it would create an accountable care organization, with many of the same goals that the hospital system espouses. Both organizations continue to grow in size and influence, and both are positioning themselves to take advantage of new payment methods being tested in health care.

Meanwhile, a group representing independent physicians is pursuing another model for improving care in Central Oregon, under which physicians would police each other to ensure appropriate utilization of services and better quality of care.

It’s left the entire provider community in a state of flux, with many independent doctors unsure of where to place their allegiances.

But Absalon suggested the various initiatives are not necessarily mutually exclusive.

“I do think to whatever extent we can work well with each other will potentially be to the advantage of the community,” Absalon said. “I think the exciting thing to me is people recognize that things have to change. We can’t keep operating health care the way that we have. We have to be more efficient and more quality-driven. I think at St. Charles we respect what others are doing. We just have a really strong platform to try to accomplish those things.”