Area doctors, patients fear restrictive care

By JENNIFER BOOTH REED
http://www.news-press.com

When Barbara Lentz’s hip gave out, the 72-year-old self-proclaimed Cape Coral gym rat researched implant options and came to believe a metal part best suited her needs.

Her surgeon said Lee Memorial Health System administrators asked doctors to use plastic implants in older patients, Lentz said. The plastic parts were cheaper, yet durable, and seniors wouldn’t outlive the devices’ expected 20-year lifespan, Lentz recalled the surgeon telling her.

Lentz felt uncomfortable, but chose not to doctor-shop. What was the point, she decided, if all implant surgeries in the county were done at Lee Memorial hospitals?

Here’s the crux of the community’s health care dilemma.

Ever since Lee Memorial’s 2006 purchase of competitors Southwest Florida Regional Medical Center and Gulf Coast Hospital for $535 million, the No. 1 concern among residents and medical providers has been lack of choice.

Jim Nathan, the system’s president, insists the concerns are dissipating.

They aren’t. New events instead appear to have strengthened the public outcry. Last month, a hospital consultant recommended that Lee Memorial integrate the medical community — in other words, coordinate care by employing doctors or striking other partnerships with them in an effort to drive up quality, drive down costs and streamline care.

The News-Press solicited reader feedback. A few people wrote or called supporting the idea. Most did not. The hospital system’s board of directors will meet Aug. 7 for a planning retreat, and some medical providers and residents fear the 10 elected members aren’t hearing the other side of the story.

“Our health care choices are severely limited in this county. Since when is a monopoly good for consumers? Where is the incentive to do better?� demanded Charlene North, a 22-year Lee County resident.
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And some medical providers say they’re fed up, too.

“They want to put us out of business. That’s their goal,� said Andrea Clark, the president of Sleep Management Centers, an accredited sleep lab in Fort Myers.

She doesn’t think integration will improve patient care, but instead will hamstring doctors as they try to make decisions for their patients.

Lentz would agree.

“Only my chronological age had been considered. I believe that it was easier for a surgeon to face a broken patient than it is to face the board (Lee Memorial Board of Directors),� said Lentz. Her implant ultimately failed, and she had a revision surgery — and a metal part.

It’s impossible to know where the majority opinion lies — there has been no comprehensive surveying of either medical providers or residents since a limited Lee County Medical Society poll in 2006. That survey found most of the 300 respondents objected to Lee’s expansion.

In Sunday’s The News-Press, Lee Memorial administrators made their case for wanting to shake up health care. Today, others in the community detail why they don’t want Lee Memorial to assume any more power.
Improve services first

Lee Memorial cannot assume more roles until it improves its existing operations, several providers and patients said.

Among the myriad issues they raised: Emergency room complaints, disorganized services that have doctors — and sometimes patients — dashing from place to place, questions about financial management and failures to address doctors’ concerns.

In fairness, Lee Memorial scores in line with state and national averages on how it treats heart attack patients, prevents pneumonia and other standards monitored by the federal government. The system also works with the Institute for Healthcare Improvement, a Massachusetts-based organization trying to curtail medical errors.

But doctors and patients say the system is far from ideal.

“There were things that just never should have happened,� said Ann Gillett of Ohio, who recently spent six weeks in Fort Myers caring for her mother and seeing her through two hospitalizations.

During one, her mother’s leg swelled, needlessly, said Gillett, a retired medical social worker who thought the fluid build-up should have been noticed early on. Gillett also questioned what she saw as poor communication between the hospitalists — the doctors under contract with Lee to care for hospitalized patients — and her mother’s physician, even though the primary care doctor was a Lee Memorial employee.

“Services can stretch themselves too thin,� Gillett said.

Clark, the sleep medicine practice president, said her father had a hip replaced at Gulf Coast Hospital, and he appeared to suffer a small stroke during recovery. Clark asked for a neurologist to see him. None was on call.

“Every hospital should have a stroke protocol. Every hospital. Especially in this market,� she said.

She had him transferred to Southwest Florida Regional Medical Center.

That wouldn’t have happened three years ago, said neurologist Dr. Edward Davis, raising doctor-hospital issues that he and others fear may only get worse if Lee Memorial gains more clout.

Davis said neurologists used to maintain a rotating call system that covered Lee Memorial’s five hospitals. Then, he said, a multi-doctor neurology practice pushed Lee to agree to a scheduling system that dropped Gulf Coast from the mix and required neurologists to be on call seven days straight.

He said he felt betrayed by the administration, which he said initially indicated it would listen to doctors’ concerns.

Davis, a solo practitioner, no longer practices in the hospitals.

How many more doctors might do the same?

“Physicians as a group are individualistic. They do not like being told how to practice medicine by non-physicians,� said Dr. Charles Jones of Pine Island, a retired trauma director from Kansas City. “If I were contemplating a practice in Lee County and saw the medical community as it now exists, I would look elsewhere.�

Lee Memorial officials have said they’re trying to adjust by putting administrators at its sites to speed decision-making and react to concerns. Next month’s board retreat will deal, in part, with rearranging hospital services to make care more efficient.

Administrators say they are trying to create more leadership roles for physicians.

Some doctors, however, still feel physicians lack true say in the system. No local health reform will work, they say, until doctors feel like they have clout.
Doctors develop practices

Health care, Dr. Raymond Kordonowy said, is a cottage industry. And the people running practices are entrepreneurs.

“This concept of ‘integrate all health care’ is doomed to failure,� Kordonowy said.

“The fact of the matter is doctors have been doing such a good job that in my opinion, we have too much hospital.�

Practices big and small have sprung up in Lee County and developed over the years to meet the needs of patients, doctors and market conditions.

Nathan said doctors are clinging to an outdated model and their survival — like his — will require adapting to Medicare changes he and his analysts see coming, and adjusting to fewer health care dollars and the growing demands of an aging population.

But why, asked Dr. James Penuel, would he want to fold into a money-losing Lee Memorial when he believes he can deliver services more quickly and at lower cost?

Penuel is with Digestive Health Physicians, a five-doctor, two-office practice that includes an endoscopy center.

Lee Memorial has not made budget projections for months, and shaved more than $20 million out of this year’s operating budget. Lee administrators blame the county’s troubled economy; some independent doctors, though, say they think the system is management-heavy and inefficient.

“The doctors aren’t trying to be difficult, but the doctors are not going to let Lee Memorial ride roughshod over them,� Penuel said.

Why would Dr. Stephen Zellner, who runs Internal Medicine Associates, want to share business with Lee Memorial? He’s one of its biggest competitors, with his practice’s labs, imaging, urgent care and other services.

“What’s starting to happen now is the (independent) doctors are starting to get together to discuss how we combat this juggernaut,� said Zellner, who was a founding member of Southwest Florida Regional Medical Center, established in the 1970s to offer doctors an alternative to Lee Memorial.

Phillip Lotti has been in health care administration for 36 years, including a stint as a senior vice president at Southwest Florida Regional. Today, he’s the practice administrator at The Heart Group, though he said he speaks for himself, not the group.

“When a community has multiple choices, multiple providers are vying for your business as a patient, and then you (the patient) have power,� Lotti said.

He’s worried that as Lee Memorial absorbs more outpatient and diagnostic services, they’ll be able to steer insurance contracts, too. The independent medical community won’t stand a chance.

And where will that leave patients?

Rolland Saltz, 78, of North Fort Myers wants his doctors to have autonomy.

“I feel the personal relationship between doctor and patient would be strained and lost,� Saltz said.
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