Jason Sandford
Jason Sandford is a reporter, writer, blogger and photographer interested in all things Asheville.
The Mission Hospitals issues I’ve been blogging about recently (examples here and here) are not new. In fact, it’s been brewing since at least November 2008, as the comments excerpted below show. The comments come from a Topix forum attached to an Asheville Citizen-Times news story about Mission Hospitals planning to hire more doctors.
Sounds like the bottom line is whether or not the hospital’s hiring of doctors will hurt the quality of health care offered.
Here are a few of the comments. The thread is here.
Excerpt of comment from watching with interest:
Maybe it’s time to have an open session on Missions’s mission and current objectives so the public is aware of what “changes” Damore wants to make, and what that will mean to quality of care and what services within the hospital will be negatively impacted (yes Virginia, that may happen).
AVL is blessed with one of the finest and most active medical societies in the country, with a succession of fine (certainly including the currewnt)Executive Directors. If integration is to become a way of life, let’s have it transition with all parties being heard in public forum, rather than have a hospital administration force it upon the medical (and local) community. Given the incredible talent within our retired population, a panel of highly qualified physicians and former health administrators could easily be convened to if nothing else ask questions as to how, what and why either side has a problem in the best way to proceed.
Excerpt of comment from hemorrhoid:
The Medical Staff at Mission has rendered high quality medical care to the citizens of WNC for years. That quality has been made possible by the close working relationship of the previous hospital administrations and the medical staff developing and sustaining programs to serve the region.
The Damore Regime has accomplished the following:
1. Replaced 100% of the Mission administrators who were committed to and instrumental in sustaining that quality and those relationships with business people with no roots in or awareness of this region or its healthcare history.
2. Greatly expanded the number of administrators and their staffs (none of whom care for patients, much less understand patient care)and added increased layers of inefficiency.
3. Destroyed the longstanding trust and shared vision between admin and Medical Staff. 4. Methodically excluded physician leaders from strategic and tactical planning.
3. Done nothing to recruit and retain skilled nurses, therapists and physicians to serve this community and region.
4. Resorted to fear mongering and heavy handed dealings to “encourage” physician integration.
5. Betrayed the existing hospital employed physicians who, before the new administration, had been specficially recruited to develop programs to fill regional needs.
6. Essentially destroyed the spirit and esprit de corps that was such a pleasure at Mission prior to his arrival.
Another comment from watching with interest:
As one experienced in both private and public sector (and non-profit), take away incentive and quality follows. It’s all about negotiation. If a doctor chooses to be on staff and work the hours they do, they’re entitled to incentive, and any doctor in a practice that cares about his patients still MAY BE on call at any given time. It should be their choice, not what is dictated by the hospital.
See the following which is now being circulated. Integration can work, but it can also produce a disaster for the community. Over 50% of wages in AVL are produced by the health care industry. We can’t take a chance on disturbing that.
“You and your friends may also find the Carillion Hospital experience in the article about it in the Wall Street Journal (August 28, 2008)( http://blogs.wsj.com/health/2008/08/28/the-lu… ) an interesting read. Carillion was one of the highly integrated systems touted as an example of what was possible. It now seems that the integration experience and the monopoly which was developed in Roanoke Virginia was not good for patients (ended up an extremely high cost provider-unchecked by competition) and not good for the physicians who subsequently have created the Citizens Coalition for Responsible Healthcare to combat unfair practices.(http://www.responsiblehealthcare.org/ ). Mission administration subsequently developed their own “white paper” with a series of responses from why Mission Hospital is not like Carillion. Clearly once they had suggested the Roanoke experience as a shining example and then found out it was something less it was necessary to be prepared for damage control. And while there are clear differences there may be lessons which can be learned.”
My point is that to get involved in any situation like this, get the emotions out, look for what is fair, and don’t let either side strong arm the other.
They do not understand how invested the physicians in this community have been in creating an elite medical center in a relatively small town. It is clear to us that it is more important to have ‘control of the franchise’ than to deliver quality healthcare to the citizens of Asheville.
Asheville was singled out along with 10 other communities for providing "low-cost, high quality" health care service. Joe Damore recently traveled to Washington D.C. to make a statement that health care needs as little change as possible.
Atul Gawande, M.D. a Harvard professor recently wrote an excellent piece for the New Yorker about health care cost and quality.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
It revealed that McAllen, TX has very poor quality and very high cost because the community follows a profit/procedure-driven model. It contrasted this with the Mayo Clinic in Minnesota which provides excellent quality at a very low-cost when the physicians are salaried and work as teams.
And as mentioned in a previous comment he singled out Asheville on NPR for providing quality at low cost.
http://www.npr.org/templates/story/story.php?storyId=111922774
Unfortunately, the accolades are for previous performance and do not reflect the direction Joe Damore and Frank Ford are angling for.
Under Damore’s leadership, Mission hospital is attempting to force on Mission’s physicians a procedure-model of physician compensation based on RVU’s (relative value units). This is much like the model of the lowest quality in the country, McAllen, TX. It is the exact model that drives quality down, and hospital revenues up.
This model would be excellent for Mission Hospitals’ coffers, as insurance companies and Medicare would be billed as much and as often as possible. Unfotunately it is also proven that this method is bad for patients.
His hypocrisy in accepting credit for high quality while attempting to force-feed a proven low-quality system on physicians speaks for itself.
To the "Inside Mission" commentator:
In case you have forgotten we live in a democracy where it is not only our privilege but our responsibility to call attention to those in positions of power that are abusing our trust! While I find it difficult to condone the leaking of a document before it has been sent to the intended recipients I applaud these physicians for standing up and speaking the truth. They should not have to be placed in such a position to begin with. It is the responsibility of a hospital administration to include the physicians in every major strategic decision that effects the hospital in which they are working and caring for their patients. As a matter of fact this is a requirement per the Joint Commission! Physicians, and staff, deserve the right to have a voice in these matters. It is how trust is built and maintained not to mention it creates an environment of transparency so desperately needed in all of our companies in the United States. I hope that this negative dig at those willing to place themselves in harms way will not be lost in the current administrative teams attempts to lie and further obfuscate the truth. Please focus on the FACTS that have been presented in these blog postings and lets begin a process of open communication and healing for our community hospital. If you notice that was what they were sincerely trying to accomplish.
For any that have not done so, I think it important that you scroll back to the top of this article and read all 65 entries that were posted in response to the November article. It is done by clicking on the word "here" in the line "The thread is here."
After having done so, the obvious (at least to me) questions are (1) Why wasn’t action taken by the Board to investigate the basis of claims now proven to be true? (2) Where was the AC-T, and why have they ignored this story? Is it because of pressure from Missions or one of the very prominent board members who knew about JD’s history? (3) Where is the l;eadership in Asheville that, having read the insinuations, did not ask for an investigation? (4) Why are Damore/Aston still allowed in the building?
Time for board action. You blew it in November. How long are you going to sit on it this time?
PLEASE don’t fall for the Joe Damore spin!!!
The tension between physicians and hospital administration is NOT about integration and NOT about the rapidly changing healthcare environment (as WLOS quoted MH as saying on Monday night.)
The tension comes from strong arm tactics on the part of JD and his team that show little respect for physicians or the patients of our region.
JD et. al. treat physicians as ‘commodities’ rather than partners in health care. They do not understand how invested the physicians in this community have been in creating an elite medical center in a relatively small town. It is clear to us that it is more important to have ‘control of the franchise’ than to deliver quality healthcare to the citizens of Asheville.
Many of the physicians of this community have invested decades of their lives into building Asheville into a medical center of excellence. It has been maddening and heartbreaking to watch it unravel at the hands of a team with little vision and certainly no compassion for the people of WNC.
It’s all a game to them.
I only found 2 "positive" posts regarding Mission Admin Leadership – a portion of one is just laughable because the person said they are posting as an outsider: "… Again from an outsider looking in as a recent healtcare organization who has partnered with mission, we partnered with mission due to some of these same people being accused of running the place badly. …" Your organization just partnered with Mission – you are not an outsider – just sadly lacking actual, honest information about the current administration! Pathetic. The recently departed VPs and physicians won’t say anything.. they CANNOT say anything, as I suspect they signed confidentiality agreements on the way out the door, forcefully – I suspect. It’s easy for a "journalist" to say the blogs are unsubstantiated… etc… No kidding – the fear is so high at Mission now – it’s a hostile work environment in many areas, but none so much as in the Administration area.
Ten or twelve years ago hospitals in Ohio started buying up physician practices. Five or six years later they sold or gave them back. Hospitals aren’t good at running practices and clinicians aren’t meant to punch time clocks.