Fairview Health Services CEO Mark Eustis will retire this summer amid allegations that the Minneapolis-based health system he led for five years used strong-armed and possibly illegal debt collection tactics against patients.
Eustis, 59, joined Fairview in 2007 and his contract was due to expire on July 31. Fairview's board of directors met in a special session Wednesday and voted not to renew it.
"Mark committed to five years as Fairview's CEO," Board Chair Chuck Mooty said in prepared remarks. "During that time, he established a clear, compelling vision for the future of healthcare delivery at Fairview."
Mooty will serve as interim CEO at the seven-hospital system, effective August 1, until a successor is named.
Attempts by HealthLeaders Media to contact Eustis on Thursday were not successful. The health system said it would have no comment beyond the media release announcing Eustis's departure.
The Star Tribune newspaper reported that Eustis announced his departure in a memo to employees on Thursday morning, saying in part: "I believe deeply in Fairview and the vision we have set in motion. I can retire knowing that what we have worked so hard to establish will carry forward."
Fairview had come under the scrutiny of the Minnesota Attorney General Lori Swanson, who issued a scathing multivolume report detailing strong-armed bill collection tactics that allegedly were recommended by Accretive Health Inc., a Chicago-based consulting firm that Eustis had hired.
Fairview severed its contract with Accretive in April.
After the board ended its ties with Eustis this week, they had only kind words for him and no mention of Accretive or the AG's investigation. In the media release announcing his departure, Eustis was credited with "spearheading transformation of Fairview's care delivery and core business model to improve clinical outcomes, enhance the patient experience and reduce total cost of care. Under Eustis' leadership, Fairview created a new care model focused on improving the health of defined patient populations, developed and implemented one of the first shared-savings contracts in the country, and became one of only 32 Medicare Pioneer Accountable Care Organizations in the country."
The Pioneer Pressreported this month that inspectors from the Minnesota Department of Health visited the hospital to conduct an on-site inspection and the Centers for Medicare & Medicaid Services has launched an investigation to determine if Fairview's billing tactics violated the federal Emergency Medical Treatment and Active Labor Act (EMTALA). The law requires hospitals that take Medicare money to provide appropriate care for emergency room patients regardless of their ability to pay.
Accretive has denied any wrongdoing but told the Chicago Tribune this month that it is considering ending its debt-collections services, which represent about 5% of total revenues.
Mooty said the search for Eustis's successor will begin immediately.
"We will be looking for a dynamic, proven executive to lead Fairview's highly skilled and committed leadership team and its mission-driven employees and providers, and to continue to elevate Fairview's leadership position in the national health care community," Mooty said.
The nation's leading urology associations are fuming over a federal panel's report this week that discredits the widely used prostate-specific antigen screening test for prostate cancer.
The U.S. Preventive Services Task Force said in a report that the PSA test is too inaccurate, creates needless anxiety for patients, and can lead to costly and potentially harmful follow-up procedures.
"The USPSTF concludes that there is moderate certainty that the benefits of PSA-based screening for prostate cancer do not outweigh the harm," the report stated.
Major urology associations knew in advance about the USPSTF recommendation and urologists launched a counterattack when the report was made public this week.
"It's an absurd recommendation. It is ill-researched and ill-conceived," Sanford J. Siegel, MD, a board member with the Large Urology Group Practice Association, told HealthLeaders Media. "This will only do damage to all the great work that has been done for prostate cancer awareness and to control the deaths from prostate cancer."
American Urological Association President Sushil S. Lacy, MD, said in prepared remarks that he was "outraged" by the report. "It is inappropriate and irresponsible to issue a blanket statement against PSA testing, particularly for at-risk populations such as African-American men," Lacy said. "Men who are in good health and have more than 10-15 years life expectancy should have the choice to be tested and not discouraged from doing so."
A similar statement was issued this week by the American Association of Clinical Urologists, which called the USPSTF recommendations "misleading and harmful." The major urological associations say the USPSTF ignored new studies supporting the value of PSA tests, and that the panel refused to address concerns they raised about the conclusions during the comment period. In addition, the urologists complain that there were no urologists or oncologists on the panel.
Siegel, who is also the president and CEO of Maryland-based Chesapeake Urology Associates, says urologists have long understood that the PSA test can lead to a high percentage of false positives, but he said that doesn't mean the test should be discounted.
"It is just a screening test, one of several things we look at when we decide whether a man needs a biopsy or not," he says.
Siegel concedes that PSA testing could lead to needless and costly procedures performed out of fear or caution.
"There is no question that men get prostate biopsies that obviously in hindsight shouldn't happen. But we are looking at improving PSA testing and other testing to help us find out which men will progress with more advanced prostate cancer," he said.
The problem, he says, is that no one has yet come up with an alternative to determine which patients will develop advanced prostate cancer.
"Yes, it is true that many men can live with this disease their whole life. That is why active surveillance has become a treatment option," he says. "If we knew in advance who would and who wouldn't advance in the cancer, that'd be great!"
USPSTF said it could find no evidence to support claims that PSA tests are responsible for "reduction in all-cause mortality."
"In contrast, the harms associated with the diagnosis and treatment of screen-detected cancer are common, occur early, often persist, and include a small but real risk for premature death," the report said. "Many more men in a screened population will experience the harms of screening and treatment of screen-detected disease than will experience the benefit."
The report said that over-diagnosis and overtreatment becomes an "inevitability" with PSA testing, which "means that many men will experience the adverse effects of diagnosis and treatment of a disease that would have remained asymptomatic throughout their lives. Assessing the balance of benefits and harms requires weighing a moderate to high probability of early and persistent harm from treatment against the very low probability of preventing a death from prostate cancer in the long term," the report said.
Siegel said the report ignores or fails to explain the dramatic decrease in deaths from prostate cancer over the last several decades.
"About 250,000 men are diagnosed with prostate cancer each year. That has stayed pretty stable. It is the death rates that have come down significantly," he says.
"In the last 30 years the deaths have dropped from 48,000 to 28,000 a year. The surgery is better. The radiation is somewhat better. But there haven't been significant advances except in some of the surgical techniques to explain this, other than screening."
Siegel says he is concerned about "the greatest damage" the report will have on prostate screenings for African-American men, who are disproportionately affected by prostate cancer.
"I have been a urologist for almost 30 years. When I started training, 40% of African-American men at that time presented with metastatic disease. Now that number is miniscule," Siegel says. "Tell me how that happens without early screening? How do death rates go down from 48,000 when I trained to 28,000 now? How do you explain that without screening? You can't! It's impossible!"
Even though the test is being discouraged by the task force, Siegel says he believes many men and their physicians will want to keep the option on the table.
"If I am with a patient, I'm going to tell them 'we have a blood test to help diagnose prostate cancer. Yes, there are false positives. But if you have prostate cancer, do you want to know or do you want to play Russian roulette?'" he says. "Of course, I wouldn't say it like that. But that is the question. Who's going to say no?"
We compartmentalize population health issues in this country. Perhaps it is because the challenges are vast and daunting and there are usually exceptions to any consensus. Therefore, using reams of data to carve national healthcare issues into smaller bits based on region, race, gender, or socioeconomic class makes issues seemingly more digestible and solvable.
However, one of the unfortunate ironies of population health in the United States is that the people who live in the most remote sections of the country often face the same health and healthcare access issues that plague people in large cities.
Robert L. Ludke, PhD, a co-editor of the compilation and a professor of family and community medicine at the University of Cincinnati, told HealthLeaders Media that the "common denominators" for the poor health status of many people in Appalachian hollows and inner-city slums are "poor environment, low socioeconomic status, and lifestyles behaviors."
Ludke says Appalachian inhabitants from coal-producing regions, for example, would feel the ill effects of living in a contaminated environment, just as any urban inhabitant might suffer from living near an industrial complex, or from moldy and substandard housing.
There are lifestyle behaviors, particularly around high-fat diets and high incidences of tobacco use in Appalachia and among lower-income Americans regardless of their neighborhoods that contribute to health problems.
There is a high incidence of mental illness and substance abuse. Finally, there is the poverty—the grinding, stubborn and notorious pockets of blight that can be found in the shadows of mountains and sky scrapers.
"When you put together the environment, the lifestyle behaviors, the socio-economic status, and couple that with this overlay of the healthcare system and the difficulty to access services because of where they are located, they all contribute to the greater disparities," Ludke says.
He was talking specifically about Appalachia, but the words could apply to the health issues that are seen every day at urban safety net hospitals.
Of course, not everyone who lives in an inner-city neighborhood or a backwoods tract is poor, uneducated, or unhealthy. And before we can gain a better understanding of the healthcare challenges that face many inhabitants of Appalachia, Ludke says, we must first get past the hillbilly stereotypes that have plagued the region for decades.
"The Appalachian culture in many respects is no different from other cultures. These aren't people that follow those stereotypes. They are people like you and me in many respects," he says. "What we try to do in the book is to raise the questions about what is underpinning the health of the people living within the Appalachian region as well as those individuals who have migrated to the region to urban areas such as Cincinnati, Detroit, Chicago, Pittsburgh, Cleveland, and Indianapolis."
For example, when it comes to access to care, Ludke says, the challenges in Appalachia as a region are about the same as anywhere else in the country, and that is not necessarily a good thing.
"When you look at it more carefully, you see that about half of the Appalachian region is rural and what you see which is comparable to other rural areas in the country is that those are the areas where there are limited healthcare services," he says.
"Just like the country as a whole, it's not necessarily where we have shortages of healthcare professionals or facilities. What we have is a maldistribution issue where they are concentrated in the major population areas. Therefore, people who live away from those areas have a much more difficult time to try to get care."
One disturbing commonality between the urban and rural poor is the effect of stress on their health. "It's not just thinking about stress as 'what kind of a day do you have?'" Ludke says. "There is clearly a body of literature out there that says that early in life, even before we are born, we are exposed to stress and it builds up over time to the point where it leads to the onset of disease."
Are people poor because they are stressed, or are they stressed because they are poor? It's a chicken-or-egg question. Regardless, Ludke says there is a link.
"People living in lower socioeconomic conditions are living in environments where there is a higher degree of negative environmental exposure," he says. "They are living under higher stress than people not living in those environments to the point where they would be more susceptible to disease."
Bottom line: No matter where you live, poverty isn't easy.
Four former healthcare vendors have been sentenced to prison terms of up to three and a half years for their roles in a bribery scheme that directed cash, goods and services to South Florida hospital executives in exchange for contracts worth $15 million, federal prosecutors said.
The four vendors are among the nine people, including three hospital executives, arrested last June in the bribery probe at two hospitals in Fort Lauderdale-based Memorial Healthcare System.
Sentenced for federal bribery convictions this month in U.S. District Court were: Thomas Kennedy, 44, of Davie, FL, to three and a half years in prison and three years of supervised released; Richard Cohen, 45, of Wellington, and Paul Chaiet, 48, a CPA, of Dania, to 18 months in prison and three years of supervised release each; and Thomas Pacchioli, 52, of Weston, to three years probation with 180 days home confinement. The four former vendors were ordered to pay restitution.
Court documents and trial testimony showed that co-defendant Adil Osman, 64, the former director of facilities management at Memorial West in Pembroke Pines, accepted kickbacks from the vendors for thousands of dollars in home improvements, including new gutters, a swimming pool, fencing, and an electric generator.
In exchange, Osman awarded inflated contracts to the vendors that concealed the value of the services they provided for him, federal prosecutors said.
Prosecutors described a "nearly identical kickback scheme" that involved former "team leaders" Elliot Gordon and Anthony Merola at Memorial Regional Hospital in Hollywood, FL. Both men pleaded guilty last year and are now serving prison sentences. Osman is scheduled to be sentenced on June 1, along with former vendor Robert Andrei, 70, of Davie.
Kerting Baldwin, a spokeswoman for Memorial Healthcare System, said the provider fully cooperated with the investigation. "The United States Attorney's Office has commended our management and security personnel for their assistance in this investigation," Baldwin said. "Ever since we discovered irregularities in the Plant Engineering Department and turned over the case to the proper authorities, we have been proactive with all of the investigating agencies to bring this case to conclusion."
For those who embrace the wellness movement, two federal departments have just issued two separate reports that hearten and frustrate for the same reason.
First, the Department of Agriculture issued a report on Wednesday that found that healthful foods such as fresh vegetables cost no more "per calorie" than processed foods and junk foods. That bit of economic analysis eliminates a lame excuse that many of us have used while waiting in the $1 menu line at McDonald's.
One day after this report was released, however, the Treasury Department issued a report that found that 24.8 million Americans live in areas with limited supermarket access, what the feds call LSA, a problem significant enough to warrant its own acronym.
The Treasury report, Searching for Markets "identifies 1,519 communities where supermarkets do not exist, and where the unmet demand within the community is large enough to support a full-service grocery store." Treasury says LSA communities are 2.28 times more likely to be low-income and have larger minority populations.
These reports underscore a stubborn hurdle that faces well-meaning wellness advocates. While it is heartening to know that fresh foods are just as affordable as junk food, that information is teasingly useless for 25 million generally poorer Americans who could greatly benefit from healthier diets but have limited access.
And these two reports should give pause to advocates of "skin-in-the game" punitive financial measures such as higher health insurance premiums for overweight or obese people. It's not that simple.
Let's be clear: Lack of access to fresh produce does not give anyone license to simply forfeit responsibility to maintain his or her health. It is imperative that we find the incentives that make people adopt healthier lifestyles. However, it is also unfair to hold everyone to the same weight measure or dietary standard when it is not so readily available to all.
It is legitimate to say that if a person doesn't take the initiative for his own health, nobody else will. Action is needed, but it shouldn't be a one-size-fits-all strategy that penalizes the people who can least afford it.
Businesses establishing a wellness program should take the time to tour neighborhoods where their lower-wage employees live to better understand the advantages and challenges they may face in their home environments.
It's not just about access to healthy food. We can advocate fitness measures and exercise programs, but does that take into account neighborhoods with no sidewalks or parks, or inadequate street lighting, or higher crime rates? Does the supervisor who devises an exercise plan while sitting at a desk all day understand that some workers might be standing on their feet for eight hours a day or longer and are therefore less enthusiastic about that after-work Zumba class?
For safety net healthcare providers that see firsthand the debilitating effects of the overweight and obesity epidemic, the problem is even larger than an employee wellness plan. How can we hope to improve health outcomes if patients who live in LSAs are sent home with a simple admonishment to eat more greens?
It is not enough to restate to people the obvious fact that they need to eat healthier diets. Even armed with that knowledge, no person can follow that directive if they can't regularly and easily access the healthier food.
In April I spoke with Chip Johnson, the mayor of Hernando, MS, a city that was recently identified as one of the healthiest in the Magnolia State. Johnson is one of those innovative types who understands that a problem as big as the obesity epidemic can't be solved with one sweeping mandate.
Instead, Hernando has taken a long-term incremental approach towards improving the health of its residents with simple steps that include building more sidewalks and bike lanes, and improving access to healthier food. The city situated its farmers' market within walking distance of its poorest neighborhoods.
"We can't expect people to eat healthier and be healthier if they don't have access to those foods. So a farmers' market is one way to do that," Johnson told me. "And you have to make sure your farmers' market is in places that are within reach of your poorest communities, your underserved communities."
This is a good first step for healthcare organizations and community wellness advocates who find that they may have an LSA in their service area.
It is time to promote not just eating healthier food but access to healthier food.
Tuesday, May 22 marks the one year anniversary of the devastating tornado that killed 161 people in Joplin, MO and hobbled the city's healthcare delivery infrastructure.
In seconds, an EF5 tornado packing winds in excess of 200 mph destroyed the 367-bed St. John's Mercy Regional Medical Center. It was the most infamous and deadly event in a spate of natural disasters that plagued the Show Me State in 2011. Floods, blizzards, and other ferocious tornadoes across Missouri resulted in fatalities, thousands of injuries, hundreds of millions of dollars in property damages, and severely strained healthcare services.
The Missouri Hospital Association this month issued a report that suggests that hospitals that successfully overcame these disasters in 2011 depended in no small part upon the emergency preparedness plans they've been developing for the last decade.
"This wasn't something that they just learned the day before the event started. This has been a labor of love for the last 10 years," says Jackie Gatz, director of emergency preparedness at MHA.
"We have done a tremendous amount of training and staff competency development around emergency preparedness using hospital preparedness grant funding. We did training on evacuation and incident command and surge management that really improved and assisted all the hospitals as we went through the response."
In Joplin, for example, staff at the devastated Mercy Regional no longer had the systems that they relied upon for routine communications. The tornado hit at about 6 p.m. on a Sunday afternoon, when key administrators were not at the hospital. Land lines and cellular telephone towers were inoperable.
"They had to rely on their instincts and what they had learned in the past. That is a huge takeaway and it really shows the value of training and planning for healthcare workers," Gatz says.
Gatz says there is no way that any hospital can plan for every contingency in an emergency. However, hospitals can focus on the competencies that will be needed regardless of the disaster event. "We look at communications capabilities and their ability to operate different modes of communication, evacuation procedures and patient movement, and medical surge," she says.
"Regardless of the event a lot of those pieces are going to come into play and the consistency is the staff will be involved regardless of the event."
MHA says the disaster at Mercy Regional underscores the need for ongoing emergency response training, and will shape future hospital response strategies. With an emergency plan in place, Mercy Regional staff had safely evacuated patients to interior hallways before the tornado it, and in the minutes after the tornado left the hospital inoperable staff was planning patient evacuations to nearby hospitals.
"If your building is destroyed there is no plan to pull off the shelf. You have to be comfortable with your staff competencies in how to respond," MHA Vice President David Dillon says. "They felt confident they understood how best to respond within the scope of what an incident command should look like and who should be in charge and who is available and what needs were they going to have."
Other key takeaways identified by MHA as lessons learned include a focus on resources and assets, safety and security, staff, volunteers, and utilities. Dillon says the ongoing training that many hospitals were involved in before the disasters creates an emergency response mechanism that is not unlike muscle memory.
"The more you drill it and deeply learn it, the less you will have to think about it when it comes to engaging in that process," he says. "I don't think anyone, if you haven't been to Joplin, could understand the scope of that disaster. But before that disaster I would suspect the folks in Joplin would never have thought they'd need the extent of training or resources they put aside to deal with it."
"How do you prepare for something that is almost incomprehensible? You do it with repetition and realistic training that gives you as close and bad a scenario as you can envision with the hopes that if that comes along you are as prepared as you can be."
It didn't make headlines, but more than 250 U.S. military medical personnel quietly deployed into a stubborn pocket of poverty this month on a relief mission that spent two weeks treating people with little or no access to medical care.
Many of the 12,000 or so people treated by the medical specialists had chronic ailments such as hypertension and diabetes, or neglected health issues such as decaying teeth and vision problems. Access to healthcare has been elusive for the people of the region. Several told their caregivers in camouflage that they hadn't seen a doctor in decades nor ever visited a dentist.
This deployment is a heartwarming story about the generosity and sacrifice of Americans in uniform providing desperately needed medical care for people with few alternatives.
Sadly, the military did not have to leave the United States to provide these badly needed services. The patients all lived around Selma, Hayneville, and Demopolis in Alabama's impoverished Black Belt, which is named for the region's dark, fertile soil.
For a third straight year military medical personnel including physicians, nurses, dentists, optometrists, and even a veterinarian—from the reserve ranks of the Air Force, Army, Navy, and National Guard—came from all over the nation to provide the care that the Department of Defense calls Innovative Readiness Training, or IRT.
"It's a win-win for us and the military," says Chris Masingill, federal co-chair of the Delta Regional Authority, a joint federal-state board that promotes economic development in the eight-state area. "Our part of the world is one of the most economically distressed areas of the country and you can add on top of that our poor health attainment issues and our medically underserved population that we have in the Delta region, Masingill says.
"The military gets to put in place the procedures and plans that it would use during a time of natural disaster or war. This is an opportunity for them to test their supply chain, medical training, staffing levels, logistics, you name it. They run the gauntlet in those two weeks that they are setting up their field medical units in our part of the world."
Masingill says the military has estimated that it provided about $3 million in free medical care during the two-week mission. "The military folks absolutely love this. Instead of going overseas to do their two weeks of annual training they can do it right here at home and the benefit is enormous," he says.
For many of the military medical providers, a trip to the Delta can be illuminating.
"Some of the physicians and particularly the dentists who practice in more affluent areas in their private practices, when they participated in our IRT program their reaction is 'Wow!'" Massingill says.
"You hear about it. You read about it. People tell you about it. But now they've seen the kind of poverty that has an impact on somebody's oral health and it is pretty tremendous. We had one case where every tooth in that individual's mouth was extracted. That is something you don't see every day."
IRT has been operating in the Delta since 2009. The training program was in Mississippi and Arkansas in previous years. Massingill says IRT looks to expand in 2013 and beyond to include multiple missions simultaneously in several Delta states in great part because of the demand for care.
"It affirms in my mind how important it is that we address the issue of affordable accessible quality healthcare in our part of the world, particularly in areas that are economically distressed and medically underserved," he says.
"You can see the sheer numbers of people and the stories that come out when they go through their IRT program and have the opportunity to have their eyes checked or have a cavity filled or see a physician for hypertensions or diabetes, which are big issues in our part of the world."
With a mixture of pride, appreciation, and frustration, Massingill laments that it take a military exercise to bring quality healthcare to the nation's poorest regions.
"We still suffer tremendously from the issue of affordable accessible quality healthcare in rural America and particularly in the Delta region," Massingill says. "If we don't address these issues it impacts our ability to be competitive and maintain strong communities and strong economies."
"You cannot have a healthy workforce without a healthy community," he says. "And there are many people, many Americans in our part of the world that simply cannot afford or have the ability to access quality healthcare."
Three in four healthcare organizations had to find temporary physicians at some point in the last 12 months because they couldn't find permanent physicians, survey data shows.
A survey of more than 100 healthcare organizations conducted by Irving, TX-based Staff Care also found that 41% of healthcare organizations are currently looking for temporary physicians.
"We have seen consistent demand for locums across the industry for five or six years now," says Bonnie Owens, Staff Care's senior vice president of client services. "The demand is still there. If you look at why facilities are using locums there is pretty wide variety, but they are using them mostly until they can find someone in a permanent position."
Some of the blame for the physician shortage has been placed on the nation's medical schools, where enrollments for many years failed to keep pace with overall population growth. This month the Association of American Medical Colleges reported that medical schools are on track to boost enrollment 30% by 2016. However, they may not have residency slots available for all of their new graduates.
"This is the tsunami that's been waiting to happen," Owens says. "Without those residency spots, the number of students isn't impacting the demand like we need it to."
Owens says 20% of the positions that Staff Care was asked to fill in 2011 were for primary care physicians. That was followed by 19% for behavioral care providers; 16% for anesthesia providers; 10% for hospitalists; and 8% for surgeons.
"We are also seeing a fusion of behavioral health and primary care," Owens says. "We are seeing patients come in for a variety of different needs, for instance, diabetes or obesity. Some of that can be caused by depression or onset depression."
The respondents in the survey said they liked the convenience of using locum tenens, mainly for care continuity and preventing revenue loss. However, 86% of the respondents identified the high cost of temporary help as the most significant drawback when hiring locum tenens.
Owens says the costs of any particular locum tenens physician will vary depending upon the specialty, the need, and the geographic areas. "But oftentimes hospitals are able to capture all of the expenses by billing for third-party billers, Medicare, Medicaid, or private pay," she says. "So, the expense would come in sometimes with the travel and hotel costs of putting up a temporary person. But by and large they are able to recuperate through reimbursements the fees they charge for locums."
Owens says the number of locum tenens physicians in the United States has grown in recent years because many physicians find the temporary work satisfying.
"More and more physicians are looking for a different lifestyle that locums provides," she says. "If we look back just five or six years ago there were probably about 26,000 locums. Now we are estimating there are about 38,000. You think about the demands of the practice environment and doctors are trying to find more flexibility for their schedules first of all. Secondarily, they want to avoid the politics that exist in hospitals nowadays. They get to keep their hand in medicine, and not in the business of medicine."
Sometime in late 2013 the doors will open on a $35 million, 230-unit apartment complex in downtown Orlando that will offer its residents a five-minute walking commute to Florida Hospital Orlando.
Florida Hospital won't own the building, which is centerpiece of a new 114-acre Health Village. Instead, the health system sold the land to a local developer who agreed to give Florida Hospital employees a three-month preferred leasing option before the apartments are made available to the general public. When all apartments are rented, hospital employees will be bumped to the top of a waiting list while the hospital contemplates building more apartments.
Jody Barry, administrative director, strategic property development at Florida Hospital, says the project, which breaks ground in July, could serve as a valuable recruiting tool. "We're located in a fairly urban environment. We do have a hard time recruiting nurses and various specialties as well. Our thought was how can we create a competitive advantage in recruiting?" Barry tells HealthLeaders Media.
The availability of safe, convenient, and affordable housing in a major urban area would be a prized asset for any hospital, especially when recruiting from out of state.
"When we are talking to nurses, say in the Midwest, we can say: 'Move to Orlando, work for Florida Hospital and while you are here you can live in an apartment complex that is right near the hospital. You can walk to work, and there is a daycare next door. You can stay in the apartment as long as you want to, or you can move somewhere else once you're settled,'" Barry says.
Florida Hospital's request for proposal in the bidding process specified that 80% of the apartments would be affordable for families earning between $40,000 and $70,000. The remaining 20% of the units would target households with incomes above $70,000. While hospital employees will be given priority in leasing, they won't get cheaper rents and the hospital won't subsidize the cost. "That triggers IRS issues," Barry says.
The idea for an apartment building near the hospital germinated in 2005 in the midst of a housing boom when affordable housing in Orlando was difficult to find.
"When we first started discussing this, the housing market was on fire and the housing costs for Orlando were becoming outrageous," Barry says. "At a hospital you are paid a fair market value based on skill. So, employees had to live far out in the suburbs. This project was a solution to put affordable housing in proximity to alleviate this."
Since then, of course, the housing market in Florida and the rest of the country has cratered. While sky-high housing costs are no longer a concern, Florida is notorious for its boom-and-bust housing cycles. Barry says there is no telling what the city's housing market might look like in a couple of years.
For now, he believes, simple convenience could be the main draw to the new building which will be called The Ivy – Residences at Health Village. Employees who now spend 45 minutes in Orlando's notorious traffic both to and from work each day might find a five-minute walking commute more appealing.
"The economics work out," Barry says. "You can live closer for the same or lower price than you pay in the suburbs, plus you save gas and wear-and-tear on your car, and you get all that time back in your day."
In addition, the residences are a key component of the Orlando campus's Health Village concept, which will include shops, restaurants, a swimming pool, a fitness facility, garage parking, and even electric cars that can be rented by the hour for quick neighborhood jaunts. A SunRail commuter rail station will be built near the hospital for easy access to downtown Orlando.
"We are creating a medical live-work-play community and having multifamily apartments in close proximity to the hospital adds vitality. We want to create a vital community, like a small downtown type atmosphere," Barry says. "Someone could live here without owning a car."
It's not clear when The Ivy will begin writing leases, but Barry says there is already a buzz in the halls of Florida Hospital. "We hold town meetings for our employees and this project is always the most discussed topic," he says.
Tim McKnight, MD, a family physician from Dennison, OH, believes government has a role in healthcare delivery, but not necessarily a big role.
"I think the less government is involved the better off we are," says McKnight, who is not a supporter of the Affordable Care Act.
So when McKnight and three dozen other healthcare providers were invited to meet with cabinet-level members of the White House Rural Council this month, he was skeptical, but he accepted.
"I thought they would be more about promoting their policies and give us very little if any time to express our concerns," McKnight says of the May 1 meeting in Washington, DC, which was hosted by Health and Human Services Secretary Kathleen Sebelius, and Agriculture Secretary Tom Vilsack.
"Two-thirds of the meeting was about them listening to us and I was impressed with that. I felt like they were listening intently. A lot of topics were discussed," he says. "They said they were going to take this back, discuss it, and rehash it, and come together and decide their next step. Let's see what happens."
To be clear, McKnight is not anti-government. He just doesn't believe that all of the problems that plague healthcare delivery in this country can be solved with a government fiat.
In fact, McKnight says he is the product of successful federal healthcare policy. He had no plans to practice in a rural area when he graduated from medical school in 1997 until he tapped federal government debt forgiveness and scholarship programs that situated him in this eastern Ohio town of 2,650 or so souls.
"Traditionally, the problem has been the new docs go to the rural site, you do your time, and you move back to the suburbs or where your ideal practice is. They weren't able to retain them," he says.
Rather than plot an escape, McKnight, his wife, and their three children have made Dennison their home.
"I did thank the council for the scholarship and the loan repayment. I told them I felt like this was a successful placement because in my case, I fell in love with the area and I am committed to [it] and to my patients," he says.
And that commitment to his patients prompted McKnight, a PhD in nutrition, to establish a federally funded 12-week "Fit-For-Life" wellness initiative in Dennison that has improved the health of more than 1,200 people over the last six years through exercise, better nutrition, and knowledge.
McKnight says he was driven to build the program because "I was very dissatisfied with the way we delivered healthcare. In primary care, the way you survive is on volume. You see a lot of patients and that does not allow you to educate them on healthy lifestyles."
He concedes that Fit For Life would not exist without the more than $750,000 in federal grants it has received over the past six years, along with a new $375,000 Rural Health Care Services grant this year to expand the program.
Rather than railing against government, or being overly dependent upon a subsidy, McKnight wants to strike that balance.
"The message I had for Washington was number one, thank you for the support. Number two was that while legislation and policy have a role in delivering healthcare, we have to empower people individually. We have to instill in them hope and give them information and model for them what good health looks like," McKnight says.
The family practitioner told the Rural Council that the nation suffers from a "poverty of hope, belief, and empowerment. I told them we needed to at the local level help empower people and motivate them and show them what they need to do to take control of their health," McKnight says.
"The allopathic approach is failing miserably. It's not healthcare. It's disease management. What is really frightening is if you look at the obesity and diabetes maps, the healthcare crisis we are anticipating in the next five or 10 years is going to be mind boggling. It will break us economically if we don't do something different," he says.
Prevention is the best and most cost-effective weapon against this epidemic, and McKnight says the 1,300 graduates of his Fit For Life program are sending the message that people want to be empowered.
"They are tired being told there is a pill for every problem, but they're not given alternatives," he says. "The primary care docs don't really know better. They're saying 'no, you can't reverse this. This is the way it is going to be.' So people are taking pills. They're suffering through side effects. They are spending a lot of money, but they are still having heart attacks and they're feeling disempowered."
McKnight says improving health outcomes for patients means that primary care physicians have to understand their patients' belief systems, emotional state, and family dynamics at a granular level. That's a task he feels is ill-suited for policy wonks, however well intentioned.
"Washington has the ability to do some things, but this change needs to be at the grass roots where we address the whole person," he says. "It's the message of hope and empowerment that has made this program successful."
