A healthier state of local health care?

04/08/2010 12:00 AM |

“They are still the Goliath, and we are still the David.”

These words from Peconic Bay Medical Center’s president and CEO Andrew Mitchell came only hours after announcing a long-awaited agreement with Empire Blue Cross Blue Shield.

Mr. Mitchell, Eastern Long Island Hospital’s president and CEO Paul Connor, and Southampton Hospital’s president and CEO Robert Chaloner spoke to a crowd of about 50 people at a dinner at Blackwell’s in Wading River Monday night, hosted by Eastern Long Island Executives, a business networking group. The CEOs summed up the state of the area’s health care, the progress that the East End Health Alliance has made after two years of existence, and the endless battles East End hospitals and patients face with medical insurance companies.

Even with the agreement with Empire finally in place, one man in the audience said he was still wary of the way the health care system operates.

“It seems like you’re willing to take whatever Empire is willing to send you, and the patient has to advocate for themselves — do you see that changing?” he asked.

All three chief executives agreed that patient advocacy is difficult working with a myriad of managed care plans provided by insurance companies, who often argue that certain types of treatments are not covered because they “aren’t necessary,” Mr. Mitchell said.

“It’s like walking into Macy’s, putting on a tie, then telling the clerk you don’t have to pay for it because it isn’t necessary,” he said. “That happens to us every day with insurance companies.”

“Most of us in the field can’t even understand the hundreds of managed plans out there, so how do we expect an 80-year-old grandmother to get through the barrage?” Mr. Chaloner said. “It’s enough just staying ahead of the billing … but doctors don’t need to spend their days with billing. They should be spending their days talking to their patients.”

Mr. Mitchell said that on the bright side, health care on Long Island was the only industry to experience growth in business volume during the past two years of recession, and that the East End Health Alliance has helped attract qualified health care professionals to work on the East End.

“They have to know that they have the support of all three hospitals in order to come out here,” Mr. Mitchell said.

The Greenport, Riverhead and Southampton hospitals came together in June 2008 to form the East End Health Alliance as a parent company and as a more powerful collective to help improve the quality of local health care. At the dinner, Mr. Mitchell talked about the importance of local hospitals responding to demographic changes on the East End, and how the alliance is helping each individual hospital evolve with those changes.

“The East End is growing rather dramatically, and the population that is growing the most is the retired or near-retired population,” Mr. Mitchell said. “For those of us in the health care business, that means that we need to prepare ourselves to provide a volume and scope of services like we’ve never seen before.”

But the challenge of keeping medical staff — especially specialists — remains, said Mr. Chaloner.

“Doctors find it increasingly difficult in this community to stay and to grow in practices,” he said. “The old days when a doctor would come to town and set up practice are really gone. Very few young doctors are able to do that and most of them are unwilling to do that.”

The alliance has been addressing “out-migration,” meaning the tendency for people to seek help from specialists on western Long Island or in New York City, Mr. Mitchell said.

“We believe that people who live here ought to be able to get quality health care where they live,” Mr. Mitchell said. “And we have to change the way health care is delivered. Waiting until a disease becomes so severe, that is the most costly way to treat a patient.”

But the struggle for all three hospitals to stay afloat financially and the fight for reasonable rates from insurance companies is far from over, Mr. Connor said.

“Every transaction we do is very expensive in health care,” he said. “Since 1997, we’ve been unable to keep up with inflation, we’re getting paid less to do more, and with the [fiscal] status of the state, we end up having to raise money. The incentives are all wrong … but ultimately, we should be focusing on the outcomes in quality and satisfaction. It might not happen in my lifetime, but we should not be subject to the arbitrary rules of health care.”

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