Friday, September 05, 2008
Carilion's goal is community service
From the RoundTable blog
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James A. Hartley
Hartley is the chairman of the Carilion Clinic Board of Directors
In recent weeks, questions have been raised about Carilion Clinic that deserve answers. One such question is whether Carilion is a monopoly. In the Roanoke Valley, health giant HCA's Lewis-Gale Medical Center is a strong, high-quality health care provider and provides Carilion with robust competition. While there are numerous communities throughout Virginia for which there is a single, sole source hospital provider, Roanoke is not one of them.
The same is true for physician services. Fewer than half of the physicians in the region work for Carilion. We believe that more physicians are required to address the region's growing patient-care needs. In fact, Carilion regularly provides independent practices with financial support to help them recruit additional physicians. This is a practice we will continue.
Some have suggested that as Carilion Clinic grows, patient choice is reduced. Again, the facts support the opposite conclusion. Carilion regularly recruits doctors to provide services that are in short supply or would otherwise not exist in our region. Two recent examples include our recruitment of a dermatologist who brought new skin cancer treatment to the area and a pediatric gynecologist, a new specialty to the region.
Even when a private practice doctor or group joins the clinic, choice is not reduced. All of the same options in that specialty still exist. Indeed, sometimes choice increases. For example, when the cardiac surgeons joined Carilion, they were the only such group in Roanoke. In response, Lewis-Gale recruited additional cardiac surgeons, thereby adding a second cardiac surgery group to the region.
It is important to know that Carilion Clinic physicians honor patients' referral choices. The group's policy, practice and obligation is to respect patient wishes. While doctors have an obligation to provide patients with advice and counsel, health care decisions are always the patients' and must be respected. To do otherwise would be unethical.
Carilion's prices have also been questioned. Our prices are consistently below the average of similar hospitals around Virginia and below the statewide hospital average. This can be seen by visiting www.vapricepoint.org, a Web site that compares hospital prices in Virginia.
It is true that hospital-based services are more expensive than free-standing community services. There are numerous reasons for this. Hospitals provide care for patients with the most complex medical needs. Hospital services are open to all patients, including Medicaid. As a result, many patients pay less than the cost of the service they receive. Also, hospitals carry the cost of vital community services that operate at substantial financial loss such as high-risk obstetrical services, pediatric cancer care and Level I Trauma Service.
That said, we are very concerned by the fact that health care costs are too high and rising too rapidly. We feel the status quo is unsustainable and a burden on our society. Consistent with positions taken by the Institute of Medicine and the Congressional Budget Office, we believe reducing unnecessary health care services is needed. Authorities agree that "over treatment" and unnecessary duplication of services amounts to some $700 billion per year.
Carilion has served our community for more than 100 years. Service to the community is our mission. It is a responsibility that the board is committed to and takes seriously. Our primary focus is community benefit and this will not change.
Two years ago, with this in mind, Carilion's board of directors recognized that major change in health care was needed and took a bold step to do something about it. We began the work of transforming Carilion into Carilion Clinic. We chose to hire doctors and pay their salaries so they could focus on how to provide the best possible care to our patients. Their mandate is to make care more accessible, less fragmented and overall more effective.
This is a 10-year plan that will require hard work and focus. It won't happen overnight and it won't be easy. But the building blocks are coming into place. Developing a medical school and research institute with Virginia Tech will train more doctors and provide an atmosphere of learning and medical breakthroughs. It will also bring jobs and economic benefits to our region.
We understand that not everyone supports this plan and that it threatens the status quo. Not everyone embraces change even when it is for the better. Meaningful change is never easy and we can expect some opposition. But it will not keep us from doing what is required to make a positive difference for our patients and our region.
