Wednesday, December 26, 2018

A Battle Royal Over Naples Hospitals

There hasn't been this much collective passion in Naples since ... well, for a long time. I'm talking about the brouhaha over the new proposal for admitting and treating patients in NCH hospitals.

Everyone, it seems, is up in arms. Thousands are signing petitions opposing it. Yard signs are popping up everywhere. The Collier County Medical Society and the Florida Medical Association are against the plan. Wealthy donors are threatening to withhold money. Letters, editorials and guest commentaries have taken over the Naples Daily News editorial pages, running 5:1 against the policy. A lawsuit has been threatened.

What could possibly cause this kind of uproar? The answer is change, and not necessarily change for the better.

NCH Healthcare CEO Allen Weiss lit the fuse by piloting a study where personal-care physicians were stripped of their admitting, treating and discharging authority. NCH-employed "hospitalists" took over those duties, leading teams 24/7 to treat hospitalized patients.

In this paradigm, your personal doctor can provide records, make recommendations and even visit you in the hospital. But he has no authority. He's more like a consultant; he can only recommend. (Note that this does not apply to specialists, who still call the shots at NCH. Only PC docs are knee-capped.)

Why do this? Why turn things upside down and invite community outrage? Weiss claims it leads to better patient care, citing a 25% reduction in hospital stay and a lower 30-day readmission rate. According to Weiss, the patients who participated in the pilots loved the experience, and it saved money to boot.

It should be pointed out that this model is not new. Weiss didn't invent it. There are over 50,000 hospitalists now employed in the U.S., working in 80-plus percent of hospitals with over 200 beds. The question is whether the model right for Naples.

Evaluations in the medical literature are mixed. All agree the arrangement results in shorter hospital stays and lower readmission rates. And all agree healthcare costs are reduced. Most agree around-the-clock physician availability improves access to specialists, therapists and pharmacists.

But downsides are also cited. One piece reports, "Hospitalists disturb the relationship between the patient and his primary-care physician, increasing the chances of failure due to three-way communication." Another says, "Hospitalists function as little more than 'shift workers,' 7-days on/7 days off." When "off," patient involvement disappears. Still another piece decries "chances for miscommunication between the PC doctor and hospitalist, particularly at admission and discharge, resulting in failure to follow up on test results and treatment recommendations."

A bottom-line concern: "From the patient's point of view, it can be highly disconcerting to discover that the physician who knows you best will not see you at your moment of greatest need ... when you are in the hospital from serious illness or injury."

Local letters and op-ed pieces have attacked Weiss's plan on a number of fronts.

  • NCH is more concerned about the bottom line than about patient care.
  • NCH's open hostility to physicians is driving away good doctors and hurting efforts to attract new ones.
  • Many NCH hospitalists are foreign-trained in second-rate medical schools and speak English as their second language.
  • Botched treatments, some with near-fatal consequences, have occurred at the hands of hospitalists who failed to access records or consult with personal physicians.
Confronted with this pushback, Weiss and his Board of Trustees have doubled down, planning two more pilots with the intent of eventually converting all NCH hospitals to the new model. 

And so the battle rages on, with neither side showing signs of backing down. At this point the only thing that's certain is a long, acrimonious fight.

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