Cook: A tale of two hospitals

Cook: A tale of two hospitals

December 26th, 2011 by David Cook in Opinion Columns

In the mid-1990s, R.E. Thomason Hospital in El Paso, Texas, was going broke.

The area's only public hospital, it handled the lion's share of indigent care in the area. When things got really bad, the hospital was losing more than $1 million a month, or $15 million a year.

Sound familiar?

In 2004, the same year Jim Brexler was hired as Erlanger CEO, the folks in El Paso hired as their CEO a man named James Valenti, who's like a surgeon for hospitals.

According to The Wall Street Journal, Valenti didn't slash and burn with budget cuts, but instituted a clear, businesslike focus on common-sense efficiency while changing the culture of the hospital from dysfunction to health.

Big things changed: He built relationships with physicians, and spoke daily to local groups, winning over public opinion while also winning fairer contracts with insurance companies.

Small things changed, too: The hospital, for example, used to stock 10 choices of prosthetic knees.

"Now the hospital carries just one model, which it buys at a negotiated discount,'' wrote Dr. Abraham Verghese in the Aug. 7, 2009, Wall Street Journal.

Three years after Valenti arrived, Thomason posted $26 million in annual earnings and 28 straight months debt-free.

"Sick public hospitals -- and so many of them are sick -- do not always need infusions of money to be fixed," wrote Verghese, a former doctor at the hospital, since renamed University Medical Center.

"Instead they need discipline, accountability and progressive politicians and hospital boards whose actions are made very public and who are held accountable."

Erlanger is sick. Not terminally, but with a lingering flu. In need of a joint replacement. Or transfusion and juice cleanse, maybe.

It lost $6 million since July, half of that in November alone.

Hospital officials say more people come for medical visits than surgeries, which generally pay more. Erlanger says

it also spends $80 million a year on uncompensated care, which is vital for our city's health and conscience.

Erlanger, which sees 27,000 patients a year, is struggling to make up for the loss of half its annual $3 million county subsidy that was slashed after the city-county sales tax agreement lapsed.

Yet last year, the hospital awarded nearly $2 million in executive bonuses. You get the sense this would never happen in El Paso.

In 2011, Valenti's base salary, according to industry reports, was around $424,000. At the time his resignation was announced, Brexler was earning $550,000 in base salary.

If it can adopt a Valenti-like approach, then I believe Erlanger will heal. Yet the hospital's problems are also symptomatic, reflecting, like a fever, something amiss in the world outside hospital doors.

Why are so many of us sick?

What if, in 2012, we made a goal: more healthy people in Chattanooga and fewer sick ones?

Fewer trips to the hospital in 2012. Fewer car crashes. Fewer addicts looking for prescriptions. Fewer heart attacks. Fewer folks with heart disease and cancer.

Let's pretend the city took $1.5 million and applied it to keeping people well. A third of it to the Chattanooga Food Bank to supplement its organic garden so that the thousands of people who need help paying for groceries (and probably health insurance) can eat healthy, fresh vegetables and fruit.

Put $100,000 into a stress reduction clinic, where measurable and scientific practices can be applied that quantifiably help reduce stress in people that often manifests in addictions (smoking, alcohol, drugs), violence (domestic) and poor behavior choices.

What if, for one year, the city partnered with the Chattanooga Track Club and promised to pay $100 to anyone who completed a road race in 2012?

Or began subsidizing local farmers markets, in order to both publicize and prop up the food and farmers whose work can prevent illness more than any other sector of professionals in Chattanooga?

Sick hospitals can get better. But never while hoping for more patients.

David Cook can be reached at davidcook@ blumail.org.