How Healthy Are We?

Local hospital CEO's speak their mind in a round table discussion focused on our country's health care system.

Story by Deanie Gudac
Photography by Christopher Frame

It seems that everyone, from the President on down to the lowly reporter, has an opinion on what is wrong (or, for that matter, what is right) with our healthcare system.

Is it ripe for major overhaul or does it just need a little tweaking? Is there a crisis or are we merely an accident waiting to happen?

Here are some sobering facts gleaned from a recent report by the American Association of Retired Persons, one of the leading proponents of health reform in the country:

Since 1999, health insurance premiums have risen three times more than wages.
The average family's employer-sponsored health insurance policy has risen by 119% during that time.
In 2000, the typical family policy was less than $500 per month. Today it averages more than $1,000.
The U.S. spends nearly $7,000 per person per year on healthcare while other developed countries spend just over $4,000.
The U.S. now ranks well below many other countries in key measures, such as life expectancy and infant mortality

One question many people here in Charlotte County ask is where do we rank in this national debate? And, how is our healthcare delivery system holding up as we muddle through this second year of a national economic downturn?

For some candid answers, HARBOR STYLE hosted a roundtable discussion with the three men most likely to know, the heads of the three largest medical centers in Charlotte County: Thomas Rice, CEO of Fawcett Memorial Hospital, HCA; Brad Nurkin, CEO of Charlotte Regional Medical Center, HMA-Corp.; and David McCormack, CEO of Peace River Regional Medical Center, HMA-Corp.

Just How Healthy Are We?

One of the first questions to be addressed was the general health of Charlotte County's citizens. Nurkin gave the population, as a whole, a "C."

"We're not any worse off or better off than anywhere else," he said. "We do have a somewhat homogenous population, mostly from the Midwest and basically urban. Most had the means to relocate here. And while they're older than the national median, they tend to have pretty good health.

"We also have a county that provides excellent healthcare resources, with its clinics and our emergency medical technician teams. The equipment and training of our current EMT teams are simply excellent, and they have saved many lives."

Rice concurred to a point. He noted that while the population tends to be generally healthy, his hospital does see a high rate of diabetes, childhood obesity and respiratory problems in the elderly, primarily from years of smoking.

"These factors all play into people's well being and their general outcome," he said. "You can't address it only in the emergency room; you have to have the total involvement of the community - foremost the parents and the schools - if we're going to have a healthy population in the future."

Rice noted that all three hospitals have a campus-wide no smoking policy. "The idea is to set an example. We offer support to employees who want to quit smoking with comprehensive smoking cessation programs. As a result, productivity is up with fewer cigarette breaks, and absenteeism is down. We would hope that the county would institute a smoke-free workplace as well."

Rice thought that raising the state tax on cigarettes should be the legislature's easiest decision to make this year, as long as the monies raised are used for smoking cessation programs. Florida currently has one of the lowest cigarette taxes in the nation.

McCormack also believes that considering our particular demographics, our senior population is very healthy. When compared to many other places in the country, especially in the rural south where he used to work, Charlotte County measures up quite well. "We have excellent hospitals, doctors and staff. I think we're better than average," he said. "Heck, we have 85-year olds playing tennis and working as hospital volunteers."

Emergency Rooms are for Emergencies

The major challenge, as Nurkin sees it, is that we have great delivery of services and superior capacity, but all three emergency rooms are over-utilized to treat mundane ailments that should be treated in a physician's office.

"We have excellent hospitals and physicians, plus we have the [Virginia B. Andes Volunteer Health Clinic] that's geared to treat chronic disease and provide preventive care to the uninsured and the underinsured. The delivery and capacity is here. We just have to educate people to use these facilities wisely," Nurkin said. "Emergency room treatment is one of the most expensive places in which to treat a common illness. It's just not cost effective."

McCormack also believes the medical services are here, but the medical community needs to get the word out that the emergency room is not the place to treat a chronic backache or a sore throat. He believes the clinic is one of the best things that's happened to this community and that more people should utilize it.

Stimulus Money Will Help

When asked about the recently passed stimulus and what affect it will have on each of the hospitals, Rice was the first to respond that it will definitely help minimize the short-term impact on his hospital's bottom line by bolstering the state-run Medicaid program and S-Chip program for children of the working poor

"It just kind of keeps us whole," he said, "at least until other reforms can be adopted." He noted that many states, including Florida, were running low on funds to pay for these programs.

All three men agreed that the stimulus bill would help temporarily, but that fundamental change will have to come from Washington in the form of health insurance reform. "Until we fix insurance, we won't be able to address the healthcare crisis," Rice said.

"It won't be easy. More people need to have to access to some form of coverage. On the other hand, those who have coverage don't want to see what they have changed. It'll be difficult to get a consensus.

"Everyone thinks that the indigent are the reason for healthcare reform and expanding coverage to more people. But, that's not necessarily true. What we've been seeing, even before the recession, was folks who are working full-time jobs but who don't have insurance. Either their employer doesn't offer it, or they can't afford it. These are the folks who usually come to the emergency room. But, the ER is the last place you want to come for basic care. We just aren't set up for it," Rice said.

All three men agreed that the stimulus bill will help temporarily, but that fundamental change will have to come from Washington in the form of health insurance reform.

McCormack had a more nuanced view regarding stimulus money and the total overhaul of the healthcare system. "Fortunately, we'll be getting dollars for the immediate future from the stimulus package, but in the end, we have to revamp our entire system. I think it can be done as long as everyone is prepared to give up something.

"One positive sign I saw [at the President's healthcare summit in March] was that every stakeholder is going to pay a price. If everyone feels a little pain, we can get the job done. We just don't feel that hospitals should be the only ones to give."

Heavy Financial Burden

McCormack believes the financial burden has fallen too heavily on hospitals and healthcare providers, who have had to write off huge amounts of bad debt. He blames both the federal government and the insurance industry for helping to create our current crisis. And, he does believe we are in a crisis. He just isn't sure if the insurance companies are the main culprits or if the federal government is to blame. One thing is certain, he's frustrated.

"We have staff that does nothing but beg the insurance companies to pay us. We hear it from businesses every day, and we hear it from the patients. There has to be a change in the way healthcare is reimbursed. We don't object to a single payer system; we just want to know what the rules are and want to know up front what we are going to be paid for a specific procedure," he said.

"The insurance companies [and Medicare] tell us what they'll pay; it's not the other way around. No business can operate that way and stay in business. Right now, every insurance company has different policies. Their primary goal is to pay as little as possible or not pay at all. I guess holding off payment allows them to invest the money and make more money in return."

"Insurance, or rather the lack of it, is certainly a problem," Rice said. "We see patients come in who claim to have insurance, but what they have is a medical savings plan, often with a $5,000 deductible. These folks are what we call under-insured. Unfortunately, we have to write off much of this as bad debt. Yet, we still manage to show a profit."

McCormack has heard that several insurance companies have supposedly come forward with lower rates for small businesses struggling to provide coverage to their employees. He also suggested that the government and insurance companies should consider a person's income when it comes to premiums.

Everything should be on a sliding scale," he said, "and that includes higher income seniors who should be paying more for their Medicare premiums than lower income individuals."

Rice believes that insurance portability is another issue that needs to be addressed. Since insurance laws are regulated by the states, many people get caught up in the issue of portability when their insurance company refuses coverage when they move from one state to another and then get sick.

"We are a very transient society, and as a result, the portability issue needs reform. We are all looking for change," Rice said.

"We just need to have a consistent set of standards," McCormack said. "And we need to streamline the system. The idea of a single payer [like the government] may not be all that bad, especially since our present system of multiple payers has been so horrible.

"I guess what I'd like to see is a single system and a uniform protocol. Not necessarily a single payer."

Hospitals are Businesses

All three CEO's stressed that their hospitals are businesses, not charities.

Health Management Associates, headquartered in Naples, owns both Charlotte Regional Medical Center and Peace River Regional Medical Center. "We are a for-profit company, and we pay taxes," McCormack stressed.

HCA Corporation, based in Nashville, Tenn., owns both Fawcett Memorial Hospital and Englewood Community Hospital. HCA owns 40 hospitals in Florida and it, too, is a for-profit corporation.

All three hospitals have a local board of directors. Board members have legal and fiduciary responsibility but do not set up budgets or raise funds. They also have oversight responsibilities.

The hospitals do compete with each other and with those in DeSoto, Lee and Sarasota counties. All three firmly believe that competition makes them better. "If you are all owned by the same entity, then it's easy to get complacent," Rice said.

Still, the hospitals do cooperate with each other. Along with Englewood Community Hospital, they've formed an area consortium with the two hospitals in Sarasota County (Sarasota Memorial and Doctor's Hospital), DeSoto Memorial Hospital and the Charlotte County Health Department to measure the health of the community and make recommendations for better lifestyles and healthier outcomes.

Officially named the Provocateurs, the group meets regularly and tries to establish broad goals that will improve the overall health of their respective communities.

All three hospitals have been affected by the prolonged recession in Charlotte County. With a payroll of 1,000, Charlotte Regional has not had to cut staff thus far. But, many staff members have been impacted according to Nurkin.

"We have staff members who are in bankruptcy or have lost their homes to foreclosure; as a result, we have more people on staff full time this year as opposed to last because they're the main breadwinner," he said, adding that the hospital offers "a family support program to help staff who are facing an economic crisis and are in need."

Likewise, Peace River has not had staffing cutbacks, but the recession has affected the hospital's bottom line. Physicians see it more than the hospitals as a whole as people who are in tough economic straits typically put off elective surgery, McCormack said.

Fawcett monitors staffing every hour of every day and has not yet made any cutbacks. "Many of our employees are two-wage earner families, and they need the income to stay afloat," Rice said.

Measuring Up Nationally

Nurkin believes that one would be hard-pressed to find better care anywhere in the southwest Florida area. "We have everything here that a larger metropolitan area would have, only better," he said. "Our physicians and our staff members live here in the community, and they care about their patients. It's important for the community to know that all three of us are good, and we all provide high quality care."

Rice agreed. "If folks haven't evaluated our hospitals recently, I'd suggest they do so. Check the statewide indicators and that will tell you how good our care is.

"We are all rated and graded by national studies, and all three of us score quite high. Our medical community has really evolved over the last five years. We have a quality system in our hospitals and our medical professionals. And, we have attracted young, highly trained physicians to this area. There is no longer a need for patients to look outside the county for specialists."

"I am in awe every day with the compassionate care and professionalism of my staff," Nurkin added. "And our volunteers are fantastic. In fact, we could not operate without our volunteers. They provide hundreds of thousands of man-hours annually. They bring joy to our patients. We have many elderly volunteers, but we have a lot of teen volunteers at our hospital, too."

McCormack noted that his hospital often gets former patients or family of former patients to sign up as volunteers. "That says a lot about the care they received while they were with us," he said.

Despite the excellent resources and medical staff available at each hospital, several challenges remain before Charlotte County can be seen as a truly healthy community.

All three men agree that the biggest issue is the negative impact personal habits - smoking, drinking too heavily and eating the wrong foods - can have on your health. When combined with the large numbers of uninsured and underinsured residents in the county, the results are highly detrimental to the total health of our community.

"People have to practice a healthy lifestyle if they expect to have positive outcomes," Nurkin concluded. "We just can't stress that enough."