A physician heading up the private hospital under construction in Springfield speaks out
Sunday, April 27, 2008
Dr. Richard Nedelman, spokesman for the group of physicians opening the Ohio Valley Medical Center, a private surgical hospital, was interviewed recently about health care in Clark County.
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Q When is your hospital going to open and what kind of services are you going to offer right know?
A We anticipate the hospital to open March 2009.
Q What do you think a private hospital does that a nonprofit hospital like the Springfield Regional Medical Center can't?
A I think a nonprofit has a role, I think advantages are that anyone can walk through the door and receive care. Being a nonprofit, you can't turn people away. I think that is a good and necessary thing; the downside is struggling in managing and trying to do everything. They have to take care of the uninsured and insured. They have to do all different aspects of care. Then what happens, unfortunately, is they try to make sound decisions and areas of care become compromised. I think surgical hospitals can focus in on a specific area and do it better. The surgery hospital is going to help people recognize that we have a good place to go and we have good doctors, and they will stay here for their health care.
Q Were there problems that doctors saw in the hospitals, like nursing staff ratios, or problems in patient care?
A Yes, I think, I was confused and dismayed about the huge financial losses that were being seen after the merger. Prior to the merger, both hospitals were at the break-even point or even making some money. Within a short period of time, huge financial losses which were unexplainable — explanations were given, but didn't make sense. A $20-million loss in one year was extremely disconcerting, and, from a standpoint of a clinician, the way that is translated is when you as an institution are losing $1.5 million a month, you are cutting back. You are streamlining. You are really trimming the fat. Even when there is no fat, you are continuing to trim. That was translated to us as decreased staffing, decreased services, the inability to purchase certain pieces of equipment. That became very frustrating for physicians. I don't think the community as a whole had a good sense of that. Hats off to (Springfield Regional Medical Center CEO) George Miller for being up front when he was brought in here to address these issues with the community.
Q Do you think health care in Springfield, Clark County has suffered?
A In quality, I still think that we have some of the most outstanding delivery people here and nurses and staff. They care a lot. I think the answer would be better answered by how the consumers perceive care. If you look at in-patient satisfaction surveys, look at decrease revenue, decrease surgeries, decrease in services, I would say the perception is that has decreased in quality.
Q What is the mood of the hospital staff?
A I think morale is low. I think there are a lot of very skilled veteran nurses and managers who have been here for 15, 20, 30 years, and are choosing to leave or retire. Change is difficult, merging is a difficult. Some people are leaving and it is time for them to leave. The overall morale has been low.
Q Will that change when the process of change is over?
A I think so. I really want Community Mercy Health Partners (CMHP) to succeed. I think the perception is that George Miller and I are butting heads. We talk a lot and have a similar vision. We both care about achieving a lot of similar goals. We want people to have pride in the medical services in the community, we want people to stay here, and we want employees happy. I think when we get downtown cleaned up and both hospitals built, that this a very important morale builder, to walk into a new, fresh environment.
Q What cooperation will there be between the two hospitals?
A I don't know. I tell you I initiated a meeting (several) weeks ago because I thought we had not had enough communication. I met with CMHP board members, George Miller, administrative staff, representatives from the surgical hospital to please maintain communication. I think an urge that we are going to meet on more of a regular basis has come from that. It is not yet defined if it is possible to partner and compete. It is a difficult thing to figure out. I know we are competing, but we still want to be able to make sound decisions for the community.
Q How will you avoid duplicaton of services?
A It is not a duplication of services, it is really a question as to where you as a patient or provider choose to deliver the care. It is not a duplication of services, it is just a different area where the care can be delivered. Outside of imaging, there are no plans for duplicating services.
Q Will you take the high-profit cases away from the regional hospital?
A The biggest criticism is we can't let the doctors do this because they will take all the people who can afford to pay away, and send the uninsured over to us. That has never been said or ever been planned. There are penalties from the state if you don't take care of Medicaid (patients), you have to pay into some kind of fund. The physicians take care of people. There are people who walk in the office with insurance, no insurance, Medicaid, etc. We take care of people.
Q Are you going to have an ER?
A No.
Q What do you think about the union effort?
A Employees should have the right to decide. People should be careful about making decisions that may take them to the front of the fire. People can get so frustrated with certain things they may say anything is better than this. That is not always true. I have concerns about outside institutions looking out for our best interests. Employees have the right to decide.
Q You been not approached by either union at this point, what if they approach you and say they would like to unionize all hospitals in Springfield?
A I have not given this any thought. I think unionization occurs when people are unhappy or people feel they are being treated wrong. In general, when you look at surgical hospitals, physicians-managed entities, there is a high employee satisfaction.
Q Are there problems with scheduling surgical rooms at Springfield Regional Medical Center or getting the right personnel to work with surgeons at the needed times?
A It comes back to financial restraints. The day of surgery, if there are cases that run over and staff is told to go home at a certain time, there is one room to operate in. If I was in my office seeing patients, and see a patient needing surgery, I would call and say I need to get this patient in. We only have one room and two people already added on cases. You will probably get done around 10 p.m. That is frustrating. If it is 10 a.m. in the morning, and they are telling me I can't help my patient until 10 p.m. that night, it is not in the best interest for my patient. If there are more choices, OK, let's try to get you over to the other place and get this done within two hours. It is more efficient for me and the patient.
Hopefully, an emergency doesn't happen. If you look back at the history of specialty hospitals, it originated from exactly that.
Q What has happened to the emergency rooms?
A CMHP has made a decision no matter where the contract is staffed CMHP merge with one group. They awarded the contract to the local group here. That is who is staffing the ER.
A Are patients experiencing longer waits in emergency rooms?
Q I think it is a trend. It is real. I don't think people lie about their experience. I am not an ER physician. I know it is complex. I cannot comment on the reasons for it. Part of it may be people utilizing the ER for their first stop, using it as their primary care. The ER is then full of people who don't need to be there.
