It has taken years for America to reach this place in healthcare, a Tucson hospital chief executive officer told a gathering of business people Friday in Oro Valley.
It will take years to correct, according to Larry Aldrich, president and chief executive officer of University Physicians Healthcare.
"We are in this circumstance – good, bad or indifferent – through decades of results, and it will take us decades to get out," Aldrich told a large audience at an event hosted by the publication Biz Tucson.
Emergence can occur, he believes, if decision-makers exercise "good judgment," invite dialogue and "don't go for the political gain.
"Pay attention to the false debates," Aldrich said. "Is healthcare a right or a privilege? It doesn't matter, we have to fix it." He also warns that the "constant vilification of other groups … can really take our eye off the ball of what we're trying to do. We have a serious problem, care and coverage. Can we solve that problem?" There is a notion that "we can have it all, and we don't have to pay for it."
Officials from seven hospitals – UPH, Carondelet, Sierra Vista Regional Health Center, Northwest Medical Center, University Medical Center, Tucson Medical Center and Oro Valley Hospital – tried to identify the biggest challenges facing their institutions, and their industry.
Paul Kappelman, chief executive officer of Northwest Medical Center, asked "how many baby boomers are in the audience?" Many hands were raised. The challenge, he said, is to provide those people affordable, accessible care that meets expectations at a manageable cost.
"How do we balance the increased bad debt of patients who are uninsured and underinsured?" asked Winnie Fritz, chief executive officer of the faith-based Carondelet system. "We are moving costs around, and not really redesigning the system."
"There are a handful of issues all of us here would agree" are crucial to hospitals, said Margaret Hepburn, president and chief executive officer of Sierra Vista Regional Medical Center. Among those are paying for the care given the uninsured, and reimbursements from government-administered programs such as federal Medicare and state-administered Medicaid. She adds patient safety to the mix.
"Hospitals are incredibly complex places," Hepburn said. "There are more opportunities for unanticipated outcomes." It's not uncommon for five, six or seven doctors to care for one patient." Where once physicians worked with a handful of drugs, there are hundreds now, "with thousands of opportunities for misadventure to occur."
Carondelet's Fritz said the public must answer the question of "100 percent access … to what? Is that misleading, to say we're going to be able to pay for everything for everybody? Should everyone be able to get a transplant?"
University Medical Center CEO Greg Pivorotto said there is some sense in the public that "we're a bunch of crooks." It's not true, Pivorotto said. "Doctors and hospitals really are trying to provide the highest level of care."
Providing greater access to healthcare while saving money "is a real issue, a real challenge," said Shawn Strash, chief executive officer of Oro Valley Hospital. "We don't try to be what we can't be," Strash said. "Our goal is to be what the community wants, and not try to get ahead of ourselves."
Each of the facilities is in the midst of, or is planning, investment in facilities and technology. Oro Valley Hospital hopes to begin constructing office space for professional staff next summer. Tucson Medical Center plans $120 million in renovations over the next five years. University Medical Center is filling its new, multi-story, 116-bed Diamond Children's Center. Sierra Vista Regional Health Centre is in the midst of a $10 million improvement of its computer technology. Several plan expansions of urgent care facilities to reduce more expensive emergency room visits.
"We are challenged by the need to increase capacity," said Judy Rich, president and chief executive officer of Tucson Medical Center. "That is not unique to us."
"We are trying for the 6 or 12 percent bottom lines" that allow acquisition of capital equipment, the recruitment of new talent, and the maintenance of existing facilities, said Carondelet's Fritz.
Rich said TMC is in a two-year conversion toward 100 percent electronic medical records. It's painful, she allowed, complex and expensive. TMC's program goes live in June. "It's safer, and more efficient, but a real gut-wrenching commitment" requiring "perseverance."
"Think about an organization our size, or Judy's size, going through that transition," UMC's Pivorotto said. "It's not easy."
Sierra Vista's Hepburn urged business people to be aware of the value of wellness and preventive measures.
"There are incredibly costly chronic diseases in our society," Hepburn said. "They are largely preventable, and certainly treatable in the early stage."
Regional hospitals collaborate on a number of programs, Sierra Vista's Hepburn said, among them the sharing of patient information through electronic records, nurse and physician training and work force development. "We do compete, and we compete every day, but we collaborate all the time," she said.
Several years ago, "We asked the Legislature to allow us to collaborate further, and that got shut down," UPH's Aldrich recalled. "We're not talking about collusion. There are things we can do." Yet, "when we meet, there's always an attorney in the room."
University Medical Center is the only university-based hospital in Arizona.
"Our mission is really quite different," said Greg Pivorotto, president and chief executive officer. In serving the entire Southwest, UMC "brings specialties that would otherwise not be here." Thirty percent of its cancer patients come from outside Tucson. Fifty percent of the people who train at the hospital remain in the community. "Imagine our medical practitioner base without it," Pivorotto said.
The Carondelet system covers more square miles than any of the others, chief executive officer Winnie Fritz said. It has four hospitals, among them Tucson Heart Hospital, recognized as a center of excellence for cardiac care and cardiac surgery. Tucson Heart gets heart attack victims into a catheterization laboratory in an average of 68 minutes from the call.
Carondelet is operated by Ascencion, a faith-based ministry in St. Louis.
At 648 beds, Tucson Medical Center is the largest of the region's hospitals. The community, not-for-profit hospital delivers about 6,000 babies a year, and has 85,000 emergency room visits. It is the largest single-story hospital in the country, said Judy Rich, president and chief executive officer.
University Physicians Healthcare is "a small and challenged hospital in terms of the population it serves," said Larry Aldrich, president and chief executive officer. It operates in "a very complicated environment, even when healthcare was at one point less challenged than it is today."
Sierra Vista Regional Health Center is 30 miles from the border with Mexico. It serves the people of Fort Huachuca, which has diminished its services to active duty military personnel, their dependents and retired military individuals, according to Margaret Hepburn, president and chief executive officer.
Oro Valley Hospital faces the complexities posed by snowbird migration, according to chief executive officer Shawn Strash.
The seasonal "fluctuation in volume is difficult for a hospital of our size," he said.
This is "the first time I've experienced a surplus of access" to registered nurses, Strash said. He expects a relatively brief economic downturn, then "seven, eight years of growth. We will be scrambling again for nurses."