Saturday, August 15, 2009

Harbinger of healthcare?

Listening to the news list the multitude of players who are on board with healthcare reform, you might think it foretells a lot of cooperation and sacrifice toward the common good, no?

Ya might wanna rethink that, if this unfolding news story is any indication, because it's sort of a real-life application of things to come.

Take this hospital in southwest Houston. It's part of the for-profit Hermann Hospital system, which is reputable and leading-edge and has locations all over Houston. Last week, officials announced that Hermann had entered into an agreement to sell this particular facility in the heart of super-busy southwest Houston to the Harris County Hospital District. In short, the plan is to make it a county hospital to help alleviate the horrendous overcrowding and undermanning of the much-maligned Ben Taub and LBJ county hospital facilities just south of Downtown. People with gunshot wounds report sitting and bleeding for hours before getting treatment, on a busy night. Our county taxes support these hospitals, sheriffs, and roads, and little else. Both are huge money drains. Ben Taub is where everyone ends up going who don't have insurance and arrives in an ambulance. LBJ is where all women without insurance go to deliver their babies.

Today, I read this story in the Houston Chronicle:

Proposed sale to hospital district draws firestorm
Doctors: Many staffers say they will leave facility if deal goes through

Aug. 14, 2009, 10:32PM

The majority of the Memorial Hermann Southwest Hospital medical staff is unhappy about the facility's proposed sale to the Harris County Hospital District and will leave if the deal goes through, according to a number of doctors there.

The staff members, whose retention is crucial to the hospital district's hope of consummating the transaction, believe the district's plan to market the facility to private insurance patients and make it financially viable is doomed, they said Friday. They also argued it is not what their patients want.

Doctors here believe a county facility is not the place to bring private-pay patients,” said Dr. Owen Maat, a gastroenterologist with a busy practice at Memorial Hermann Southwest. “They want to go to an attractive hospital where they get a private room and are treated well. That doesn't happen at a county hospital.”

Maat said a “letter of opposition and pledged non-support” will be sent to the Harris County Commissioners Court, the Memorial Hermann Healthcare System board, and the hospital district administration and board early next week. It is being written this weekend and could be brought to medical staff members to sign Monday.

The doctor's resistance follows vocal opposition earlier this week by Harris County Commissioner Steve Radack, whose district includes Memorial Hermann Southwest, and some measure of skepticism from County Judge Ed Emmett.

The deal requires the approval of the five-member Commissioners Court.

District President and Chief Executive Officer David Lopez said Friday he'd heard a letter is in the works, but is still optimistic that Memorial Hermann Southwest doctors can be persuaded to stay. The plan is for the facility to have both private and academic doctors.

“Retaining the medical staff is our No. 1 priority,” said Lopez. “We just hope they will meet with us one on one to give us the chance to let them know who we are and how we operate and to develop a trust in us.”

Raucous forum
Reaction at Memorial Hermann Southwest has been strong since officials of both institutions announced last week that they have agreed on key elements of a sale of the medical complex at Beechnut and the Southwest Freeway, which includes a 629-bed hospital; four office buildings; and vascular, cancer, surgery and outpatient imaging centers.

Lopez said the rumored price tag of $165 million to $185 million is “in the neighborhood.”

Post-announcement meetings with employees — particularly a Tuesday night forum with 150 physicians — made the recent health care reform town halls with members of Congress “look peaceful,” said Memorial Hermann Healthcare System President and CEO Dan Wolterman.

Radack has said he has received numerous calls of concern from doctors since the proposed deal was announced.

Unknown percentage
Lopez said it's too early to know what percentage of the medical staff it would need to retain for the deal to remain feasible.

Memorial Hermann Southwest has 425 active members on its medical staff, according to a hospital spokeswoman, though one doctor estimated that 80 to 100 doctors account for about 80 percent of its business.

The spokeswoman objected to the characterization of widespread unhappiness among doctors about the deal. She described it as a vocal faction.

Tax hike needed?
Retaining the hospital's physicians and their private-insurance patients is crucial if the hospital district wants to avoid imposing a tax increase, as it has stated. Such patients help defray the cost of care to indigent patients the hospital district serves.
“If the district thinks they can do this without raising taxes, they're insane,” said Dr. Michael Kleinman, a Memorial Hermann Southwest surgeon. “It might take a while, but there's going to be an exodus of doctors from here.”

Kleinman added that “there's a reason you don't see doctor's office buildings next to Ben Taub and LBJ,” which are hospitals currently operated by the district.

No contracts
Kleinman and Maat said that even if doctors wanted to stay and bring paying patients to a new county hospital, they couldn't because the district has no managed-care contracts. They noted that such contracts typically take at least a year to put together.

Lopez responded that he doesn't see that as a problem because he thinks the district will be able to negotiate to take over Memorial Hermann Southwest's existing managing-care contracts when they expire. He said that is why he wants to meet with the doctors — to clear up confusion.

District officials already have met twice with doctors as a group. They have not met with them one on one.

The sale is scheduled to close by late November, but Lopez said the date can be extended if there are still unresolved questions.

The Chronicle's Cindy George contributed to this report.

Whoa! We don't even have legislation yet, but let's just take a moment and do what I did in my professional life for 30 years: Let's look ahead and extrapolate a bit.

Once a bill passes and the dust settles, there are going to be deals like this popping up all over. Why? Hospitals are going to want to dump their least-profitable facilities. Government entities like counties are going to feel a need to expand even more than at present. Everyone involved in care-giving is going to be figuring out where they stand in all of it, and there will be lots of moving around, lots of reorganizing.

Obama may have sent signals recently he'd be willing to drop the single-payer idea and the government insurance option, but Congress has said no such thing. Besides, when is the last time Obama told the whole truth and nothing but? {Crickets chirping...}

I had to laugh when I read this, because of all the hoopla surrounding the AMA's recent endorsement of reform. Here's ya a little known fact: only 15% of AMA's membership includes currently practicing doctors. Yes, you read that right. Who the hell make up the other 85%? That's a good research topic for another day, but the point is, maybe that endorsement ain't saying much if you expect it to mean that doctors are all in favor.

I'd say the docs in this news story represent the prevailing doctor viewpoint. Kind of like AARP's position is not the same as its members.

Oy, fasten your seatbelts...when Margot Channing said it would be a bumpy ride, she wasn't kidding!

No comments: