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Taking the temperature of health care part 1: The doctor-patient relationship

Editor’s note: This is the first article in a five-part series on the cost of health care in western Wisconsin

Put your fingers in your ears and slowly close your eyes. What do you hear? Listen closely and you might hear your own heartbeat. Without that rhythmic miracle, nothing else matters. For most of us, the maddening din of daily existence only comes to a halt when something goes wrong. A bloody nose, a broken bone, a heart attack, or something worse and we are yanked off the speeding train of life and into the often bewildering world of health care.

This is no longer your parents' health care, a life-long family doctor, insurance that worked everywhere, care that could be expensive, but not ruinous. Health care has become complicated, intimidating, expensive and increasingly more uncertain.

Whether you are purchasing health insurance for your employees, buying your own insurance privately or on the government marketplace, participating in a healthcare sharing ministry, or opting not to purchase health insurance, it has become a frustrating, stress-inducing experience.

The blatant politicization of the health care system holds consumers hostage leading to anxiety and uncertainty. Even with insurance, practically every health care decision today has also become a financial decision and that makes people more than a little uncomfortable.

Patients can pay thousands of dollars for care and barely benefit from their insurance. Are we approaching a point where the cure is becoming worse than the disease?

To find out, RiverTown Multimedia asked the CEO's of four local hospitals to answer five questions about the state of health care in our backyard. Here is Part One of the discussion.

Steven Massey, President and Chief Executive Officer, Westfields Hospital & Clinic.Steve Massey

Steve Massey joined Westfields Hospital & Clinic as President and Chief Executive Officer in August 2011. He has led the hospital through a number of strategic initiatives including the joining of Westfields Hospital and New Richmond Clinic to form Westfields Hospital & Clinic in 2013. Before taking on his current role, Massey served as Chief Financial Officer at Osceola (Wis.) Medical Center. He also held prior leadership positions at Allina Health and Fairview Health Services. He received his undergraduate degree from Missouri State University, Springfield. He has a Master's in Healthcare Administration from University of Minnesota, Minneapolis. Massey and his wife, Nicole, and their three boys live in New Richmond.

Alison Page, Chief Executive Officer, Western Wisconsin HealthAlison Page

CEO Alison Page joined Western Wisconsin Health in 2009. Before joining WWH she was the chief safety officer for Fairview Health Services (now M Health), a large, integrated health care delivery system in Minnesota. Page received a Master of Science degree and a Master of Healthcare Administration degree from the University of Minnesota. She also holds a Bachelor of Science degree in Nursing from Marquette University. A western Wisconsin native, Page grew up in River Falls where she still lives with her spouse, David, a local dentist. They have five adult children and seven grandchildren.

David Miller, President, River Falls Area Hospital, Allina HealthDavid Miller

Prior to joining River Falls Area Hospital, President David Miller served for ten years as the vice president, operations, for United Hospital in St. Paul, Minn., where he led the development of the John Nasseff Neuroscience Institute, the St. Paul Cancer Center and the Peter J. King Emergency Center, along with overseeing multiple patient care departments, support services departments and strategic initiatives. Miller is also a former nationally registered paramedic and served as the president of Allina Health Emergency Medical Services and Allina Health Urgent Care Clinics. Miller earned an MBA from the University of St. Thomas.

Thomas Borowski, President Hudson Hospital & ClinicThomas Borowski

President Thomas Borowski came to Hudson Hospital & Clinic from the Mayo Clinic Health System last October. Since 2005, he had been a part of the Mayo Clinic Health System Southwest Minnesota Region, a fully integrated health care delivery network that is comprised of six hospitals, 23 clinics, 300+ providers and nearly 4,000 employees. Since 2014, Borowski had served as CEO of the Waseca and New Prague Medical Centers, and prior to this role, he was the Chief Compliance Officer (2012 to 2014); Chief Knowledge Management Officer (2009 to 2012); and Chief Information Officer (2005 to 2009) for Mayo's Southwest Minnesota Region. Borowski's 20+ years of healthcare leadership experience includes physician collaboration, building high performing teams, executing strategies, organizational development, and community engagement.

Question #1

The traditional doctor-patient relationship that used to see patients develop life-long relationships with their physicians is nearly impossible to find today. Gone is the age of "independent practitioners." For many people who cannot afford healthcare insurance, the emergency room has replaced the primary care physician. Our care is now centrally located in hospitals with related services tethered contractually through clinics and specialty groups and all of it is managed financially through insurance companies. What impact has this integration had on the doctor patient relationship and how has it impacted the delivery of healthcare?

DM: I would say that the trend has actually been to deliver more and more care in outpatient settings rather than in the hospital. Many services that used to require a several day hospital stay are now done routinely outside of the hospital and that is a good thing for the cost of care and for patients and families. Yes, the model of how we organize and deliver care has changed significantly over the years. For some people there is a real sense of loss around the decline of the sole or independent practitioner model. Today there are so many subspecialty groups that the primary care doctor cares for you in a primary care aea. Then they ship you in to a specialty environment. Then it's often the hospital that starts to quarterback your care.

If you're in an intensive care unit in a hospital, you're managed by intensivists. These are doctors that deal with very complex medical cases, very complex drugs. If you're in a trauma center today, you are managed by traumatologists. They deal with the nature of the body in trauma. That's how it works.

That being said, I strongly believe that there are many more important benefits of integrated care models. For example, the rise of the multidisciplinary care team (or several care providers working together seamlessly) allows patients with complex needs to have their care coordinated among many providers in a more efficient and effective way. One needs to look no further than how we manage diabetes today versus several decades ago. Our rates of optimal diabetes care are much higher now because we surround a patient with multiple resources that would be difficult to coordinate outside of an integrated system such as dietitians, physical therapists, physicians, patient educators, pharmacists and so on. This is higher quality care that keeps the patient healthier and reduces overall health care costs.

AP: I think you assume that things are being generated here at the hospital. We're trying not to do that. We're trying to make sure people are building relationships starting in the clinic. And there is a distinction. If you've got a sore throat and you need some antibiotics, you might not care who you see. Longer term, we're trying to partner with you in your health and wellness to help you lead a healthier life overall. We offer different kinds of providers in the clinic like a health coach, dietitian, psychiatrist, psychologist and counselors. We also want to be the first stop and best partner for acute care services when you're really sick, but we want there to be continuity in that care. Our goal is for patients to have a provider or couple of providers that they are comfortable with and they see over a period of time. Right now, our behavior health services just opened up clinics in schools in this area. It's a lot easier for parents if their child is struggling to have them get those services right during the school day , instead of having to figure out how to get down here after school. It's one of the ways we are trying to take our services out into the community.

SM: Health Partners started out as kind of a group health insurance plan back in the 1950's. Some employers got together to try to create a kind of prepaid medical plan to help stave off the risk of their employees going into bankruptcy because of medical care. It then evolved to, lets partner with some medical groups to have kind of a closed network, an HMO feel, and then that evolved into lets get into specialities. Ramsey County Medical Center, known as the safety net hospital back then, now Regions, joined then Holy Family in New Richmond joined about 10 yrs ago and then Hudson a couple years before that. We've had a couple family docs retire in the last couple years in New Richmond. General surgeon and family medicine doctor, Dr. Melby, practiced 46 years. Family doc, Dr. Olson, did OB 35 years, delivered over 1,500 babies. PA Joe Beuning practiced almost 40 years. Joe told me when he retired, it was like he was leaving his friends because so much of the doctor visit was more of a social get together because they were life-long relationships. I think there are still connections like that at least in this market. When I think about the physician groups and clinics that are out here, there are doctors that still have long-standing relationships with patients. A lot of that is because that is what the patient is looking for. But the reality is, there are some people that aren't looking for a connection with a family physician long term. It's more about what fits them, what they want, when they want it. They're fine getting on the internet, logging on and getting healthcare through a service like, where there's not even a face-to-face connection because that's what they want. Consumers are dictating the kind of relationship they are looking for. Some of it is age-related, the generational thing. We have the clinic at Walmart. You talk to a good number of the patients that go there and they'll tell you that that's their primary care. They are generally healthy, but when they get sick, or have a child with an ear infection, or they get a UTI or whatever, they're fine just going to the clinic at Walmart and seeing whoever is there. Doesn't matter, they just want to get a prescription and they want to be seen, quick experience, low cost, pharmacy right there and that's all that they want.

TB: Look at the mission statement for Health Partners; Health as it could be, affordability as it must be, through relationships built on trust. Paraphrasing, our philosophy would be, we want to make sure we can provide the right level of care at the right location at the right time with the right level of credentials at the right price. We want to make sure we can provide all of the options to meet the unique needs of the patient. We try to cover the complete spectrum of what different patients need depending on their diagnosis and treatment. It's trying to be everything for everyone. That's a tall order.