NCH administrators face residents angered over admissions policy change
Dr. Allen Weiss, president and chief executive officer of the NCH Healthcare System, discusses results of a pilot study at select units in NCH hospitals at a community forum Wednesday, Dec. 19, 2018. Naples Daily News
Several dozen residents skeptical of an NCH pilot study underway didn’t get assurances Wednesday that the medical staff will remain open or that their independent physicians will be the final authorities for their care while hospitalized.
“We cannot predict the future,” said Dr. Allen Weiss, president and CEO of NCH Healthcare System.
He was declining to guarantee that the medical staff will remain open at NCH’s two hospitals in Collier County.
“Let’s everybody keep an open mind as we go forward," Weiss urged.
Barbara Lafer, a resident, responded: “You haven’t kept an open mind.”
The first of two community forums Wednesday where Weiss and other administrators spoke about a pilot project drew about 40 people to North Naples Hospital and about 20 hospital employees.
Residents peppered the administrators with questions about the future of their independent physicians’ opportunities to admit and direct their care.
Under the pilot project, NCH-employed hospitalists handle admissions on select units. Residents said they are concerned about how far the project will expand and how their relationships with their longstanding doctors might change.
NCH also held a noon telephone conference call for the public, and an evening forum was scheduled at South Regional Library in East Naples.
The pilot project started in June, the medical staff voted unanimously against it in October, and the Collier County Medical Staff launched a campaign to educate its physicians and their patients. Opponents paid for yard signs that now dot lawns in Naples, saying NCH is denying patients their choice of physicians.
NCH has responded to the backlash that patients still can be admitted to nonpilot units by their independent doctors.
Weiss opened the one-hour session Wednesday morning by saying the hospitals were hard-pressed to improve patient satisfaction scores despite efforts. He explained how the pilot project began in one unit at each hospital with employed physicians embedded to handle admissions and direct patient care.
Many of the admissions come from the emergency rooms, where patients often are uninsured, he said. The use of hospitalists is not new in hospitals, he said.
At present, the pilot project involves 92 rooms in two units at NCH Downtown Baker Hospital and 45 rooms on one unit at NCH North. The embedded hospitalists conduct patient rounds twice a day with a support team from pharmacy, rehabilitation and other fields, said Sarah Frye, director of operations.
“We try to see all the patients on the floor by 11 a.m.,” she said. “We want to make sure patients and families know what is going on today.”
Since the project began, 3,200 patients have been cared for through the pilot program, and there have been 50 percent drops in the 30-day readmission rate and in patients developing adverse events, she said.
Jonathan Kling, chief nursing officer, shared a story of how the wife of a cardiac patient said her husband’s care and attention was greatly improved on the pilot unit compared to an earlier hospitalization.
Kling said he gets asked by floor nurses not in the pilot program when they will be added because of improved coordination and availability of the hospitalists on the unit.
After the 20-minute presentation, many people in the audience were not sold on the program, and several said they didn’t like the answers they got.
Tim Norbeck, of Bonita Springs, wanted to know whether his independent primary-care physician will be reimbursed for seeing him on a pilot unit and who will be in charge.
Dr. Bryan Murphey, an NCH internist, responded that the hospital wants to honor patients’ wishes, and he said the hospitalist is not going to be the final arbitrator on a patient’s care.
To the reimbursement question, Frye, the operations director, said the primary-care physician will not be directly reimbursed for the patient’s care in the hospital.
As to whether NCH is planning to close its medical staff and allow only employed physicians, Weiss said: “We are not heading to a closed system.”
Joe Trachtenberg, a member of the Aqualane Shores Homeowners Association board, questioned the legitimacy of the pilot study findings and asked why NCH is compelled to make changes when the current admitting structure has been working for years.
“I don’t understand why you are not listening to the public,” Trachtenberg said. “I think it is wrong-minded and I think it is inappropriate.”
Frye said there are still nine hospital units not involved in the pilot study, and she said an independent body will review the data findings.
“We will see where this goes,” she said.
Of 200 primary-care physicians in the community, Weiss said, 38 admit patients, and they average admitting fewer than three patients a month.
Dr. David Kramer, who was a Pennsylvania emergency room physician who served on the American Board of Emergency Medicine before retiring, said patients already enjoy a 100 percent satisfaction rate with their primary-care physicians.
“You are already taking out a very important group,” Kramer said, adding that NCH’s quality rating with the independent Leapfrog Group was an “A” a few years ago and today is a “C.”
He said NCH’s study of only its employed hospitalists with improved outcomes was tremendously biased.
“You clearly are not hearing what the public wants, and that is very sad,” Kramer said. “We are very concerned we are losing the choice of who takes care of us.”
Weiss said NCH is concerned about the Leapfrog grade and that the goal is to give patients a better experience.
“This is an ongoing study, and we are looking at things,” he said. “Across the nation, more hospitals are using hospitalists.”
After the forum, Weiss said one goal is to retain in the near future a nationally recognized and independent group to review all the pilot study results.