The Healthcare Challenge

An hours-long wait at the emergency room. An expensive but necessary treatment not covered by insurance. A patient who won’t listen and makes his or her condition worse.
Just about everyone has at least one healthcare horror story.

Southwest Florida, where the high quality of life draws many retirees, who often have more contact with healthcare providers than younger people do.

To better understand the challenges facing the industry here as well as possible solutions, Gulfshore Business turned to five experts in healthcare-related fields. Our question was simple: If you could fix two or three big problems with healthcare in Southwest Florida, what changes would you make?

Here are their responses, in their own words.

THE HOSPITAL ADMINISTRATOR \\ Dr. Allen Weiss
Weiss has a broad background in many facets of medicine from the doctor’s office to the boardroom. He spent 23 years as a practicing physician, specializing in rheumatology, internal medicine and geriatrics. Now he is leading the NCH Healthcare System as its president and CEO.

1. Address lifestyle issues
Encourage and educate everyone to care for themselves. Seventy percent of all illnesses are self-induced. We are the fattest nation in the history of civilization. In 1999, an estimated 61 percent of adults were overweight or obese, along with 13 percent of children and adolescents. Obesity among adults has doubled since 1980, while in adolescents it has tripled. Forty percent of us are not active in our leisure time. Seventy percent of adults do not get enough physical activity to provide health benefits.
The single largest preventable cause of premature death is tobacco use. Tobacco causes one-fifth of all deaths and costs $70 billion each year with an additional loss in productivity of $25 billion.
Try joining a wellness center, walking on your own and stop using tobacco. You control your own destiny.

2. Value and quality
Shop for value in healthcare by understanding the value of quality. More than three-quarters of patients use the Internet at some time during a healthcare encounter. If you go to an emergency room, you have about a one-out-of-three chance of sleeping in the hospital that night. According to HealthGrades [research], your chance of surviving at a top five percent hospital is 29 percent greater than at [another hospital]. Go online, check out quality [of care] for whatever conditions you might have. This is an evolving area with much more to come as the payers demand quality outcomes, which ultimately cost everyone less.

3. Record keeping
Develop an electronic network for medical records.
The estimated waste in healthcare is about 30 percent. One of the major causes is poor communication among caregivers. The electronic medical record (EMR) is a tool used in some hospitals and physicians’ offices currently but [currently] the information can’t be shared in the region. Just as the Internet provides a common platform to share, there are areas of the country and whole countries [that] already have this ability. We are in one of the wealthiest, most sophisticated communities, and yet we are behind.
Getting everyone to agree to one system with one common language as banks have done with great success (think of an ATM machine) would add value by improving quality and decreasing cost.

THE FAMILY PHYSICIAN \\ Dr. Andrew Oakes-Lottridge
Oakes-Lottridge has made a name for himself in Southwest Florida as one of the few area physicians who still makes house calls. He attended the University of Florida Medical School.

1. The "pay for volume" mentality
Over time, this has led to the current system [in which] doctors see more patients [than before] to cover costs due to reduced reimbursement rates. Increasingly, my primary-care colleagues are spending less time with patients, referring patients to specialists more often, and no longer admitting their patients to the hospital. Rather, physician reimbursement should be based on the quality of care we provide. By increasing reimbursement for a physician who takes more time to manage complex issues, we would reinforce the doctor-patient relationship, reduce the chances of medical errors, increase patient satisfaction and improve quality of care.

2. The need for mental healthcare
Mental healthcare is in a state of crisis nationwide, and Southwest Florida is no exception. There is a noted lack of an adequate number of healthcare providers and inpatient treatment facilities. This is especially true for those relying on Medicare or Medicaid. The situation will not change until we as a society agree to commit the funding to treat mental [illness]. We’ve come a long way in the last 10 years, but we have a long way yet to go.

THE INSURANCE SPECIALIST \\ Jane Willis
Willis is a longtime team member at Oswald, Trippe and Company, a Florida-based independent insurance agency. She is also a board member of the Southwest Florida Association of Health Underwriters.

1. Complexity of medical plans
Let’s go back to a simpler time [when] you had an annual deductible and an 80/20 co-insurance plan. You knew what the insurance company was going to pay and what you were responsible for.
The co-pay system distorts and confuses the true cost of services. The question is "Why not get that MRI? It will only cost a $25 co-pay," instead of "Do I really need an MRI instead of a lower-cost X-ray?" If we would just go back to paying our fair share of the bill at the time of service, our premiums may decrease by lowering indiscriminant usage. Would it not be better to pay a higher fee at the time of service rather than higher premiums every month, regardless of usage?

2. Complexity of provider networks and contracts
If you are a provider (doctor, hospital, lab), you may have to enter into multiple contracts with the same carrier, each offering a different fee schedule: PPO, HMO or Medicare, for example. In this situation, the same service is performed but the pay is different depending on the patient. To make matters worse, you may not be elected to be a provider for all platforms.
Not all doctors are contracted with every carrier; even if they are, they may not be contracted with each one of [the carrier’s] products. Here is how it goes: You’re seeing a doctor you really like. Your employer either changes carriers or changes plans. You must find another doctor because the one you are seeing is not contracted either with the new carrier or the other plan. Simpler contracts and networks can reduce administrative paperwork, which may lead to lower fees.

THE ACADEMIC \\ Gary Jackson
An economics professor in the College of Business at Florida Gulf Coast University, Jackson is also the director of the Regional Economic Research Institute. In this role, he recently completed an extensive study of the healthcare industry in Southwest Florida on behalf of several healthcare and nonprofit organizations.

1. The problem of third-party payments
The healthcare system has moved to a third-party payment system where the government and insurance pay the majority of the costs. It is estimated that out-of-pocket costs were only about 16 percent in 2002 while in 1960 they were 55 percent. Economic theory predicts that if healthcare service is paid by a third party and not the person receiving service, then patients will not have an incentive to economize on the use of services and procedures. Medical insurance costs are higher when the healthcare insurance covers most costs and procedures and have low deductibles and co-payments.
Some solutions to the increase in healthcare costs and resources are to ration or limit the availability of service and procedures. Others have suggested that the payments for procedures be set by government to limit overall costs. The healthcare system needs to move to a position that provides the appropriate care, but where decisions are not based on the assumption that healthcare has little or no cost.

2. The obligation to serve in emergency rooms
The obligation to serve creates serious quality-of-service issues in emergency rooms due to an influx of patients using the hospital emergency room instead of a clinic. Many hospital emergency rooms are tied up for hours treating non-life-threatening health issues and it creates problems in treating the true emergency patient in a timely manner.
The cost of providing emergency room service to non-paying patients is very high and society would be better off providing basic patient care at a clinic. The solution would require an alternative clinic system to screen and work with non-critical low-income patients.

3. Training of healthcare providers
The growth of the healthcare industry requires additional highly skilled professionals. Unfortunately, many of our healthcare providers are not able to fill all their positions and have to import temporary workers. Many of the hospitals and clinics are not fully staffed, resulting in long hours and waits for both staff and patients. The solution would be to fund and expand educational programs designed to meet the region’s need for the healthcare professionals.

THE PATIENT ADVOCATE \\ Sylvia Bocwinski
Sylvia Bocwinski is the new ombudsman for Physician’s Regional Medical Center in Naples. With a background in customer service with the Ritz-Carlton, Naples, she knows how to please people. In her new role, she will act as a patient advocate helping patients and hospital staff work and relate better together.