HealthLeaders: Do you feel you have the right pieces to thrive in a value-based environment? If not, what's missing?
Harrington: At that time [two years ago], we were looking at a lower census and asking ourselves what's causing this and how low will it go. We think that got answered last year. This year, our numbers are up substantially. ER volumes continue to be strong. We're still growing at 13%–17% in the ER. But a big question is why aren't these guys hooking up with a primary care physician instead of using the ED?
One of the reasons we believe we're getting busier is that a lot of the physicians tell their patients if they get sick, to go to the ED. What they should be telling [patients] is that they will deal with their issue. It's a convenience issue because it's a lot easier for them to just tell [patients] to go to the ED. And what's surprising about it is we have our own urgent care, too.
Those numbers are climbing as well. We've brought on more midlevels in the last three years than in the past 10 years prior, and we have a significant number of mature physicians who are now 70 or so and still working. That's good for us. We're competing with the Kaisers, and it's very difficult if you don't have shift work available for your physicians. The medical foundation model is what we're forming. We're trying to move all our docs into that which will create the foundation in 6–9 months.
We think that's important for integration. So to answer your question, I do think we have the pieces but I don't have a real high confidence level. I'm always thinking: do I have enough backup strategies in place? It's more of a feeling than knowing for sure, and it's not unique to us. Is what's happening evolutionary or revolutionary? We think evolutionary. We'll have a number of people in the exchange by '14, but in our county, 20% of the population is uninsured, and another percentage consists of illegals who still won't be covered, so we'll continue our free clinic. We're going to need more primary care physicians but we're competing with heavy hitters.