Barton on course to be trauma center; severs ties with 4 docs
By Kathryn Reed
While Barton Health officials say money is not the overriding reason to become a trauma center, it is the primary reason they say four doctors as of Jan. 1 will no longer be affiliated with the South Lake Tahoe healthcare system.
Clint Purvance, chief medical officer for Barton Memorial Hospital, said it is hoped the Level 3 trauma designation will be acquired in the first quarter of 2013.
There are four levels of trauma centers, with Level 1 usually reserved for teaching hospitals that are research based. Level 3 requires an emergency room, general surgery, orthopedic and anesthesia be available 24 hours.
“We are not changing the level of care, we are changing the system,” Purvance said. “The delivery of health care is fragmented at best.”
Purvance, with CEO John Williams, spoke with Lake Tahoe News about the changes that are about to occur.
It is the medical practices of Emerald Bay Center for Women’s Health and Tahoe Women’s Care that will not be contractually renewed at the end of the year.
“Even though we did not come to terms with the ob-gyns, they can still practice at Barton. They can use the da Vinci. They can run their own practice,” Williams said. “We just won’t be managing and underwriting their practices.”
Trauma center
It’s not known how many more patients would be able to be cared for locally instead of being flown to Renown Medical Center in Reno (a Level 2 facility) or UC Davis Medical Center in Sacramento (Level 1) if Barton receives the trauma center designation. Officials aren’t releasing projected income from the change either. Nor has it been released if the cost to patients will go up if Barton becomes a trauma center.
For the past year as Barton has worked on its trauma center status, additional equipment has been purchased, employees hired and others trained to meet the demands of the American College of Surgeons. El Dorado County also has criteria for Barton to meet in order to become a trauma center.
“It raises the bar and awareness,” Williams said of being a trauma center. “It’s good for the community image.”
Purvance said the center would create a coordinated care system for patients from the moment they are injured.
As it is now, someone could arrive by ambulance and no one in the ER will know ahead of time what type of care would be required or even that a patient was coming. That would change per trauma center protocol. Barton is talking to its health care partners to put the coordinated system in place.
Even though Barton will be 50 years old next year and has lived without being a trauma center, the health care administrators say the world is changing and things need to change locally.
Even if Obamacare is altered, there is still the California Health Benefit Exchange that providers in the Golden State must adhere to.
Williams said starting in 2014 it will be “value vs. volume when health care reform hits.” Reimbursements are expected to be less, but the number of people with insurance is likely to increase.
Keeping more people at Barton is obviously a moneymaker. But that does not mean patients won’t be flown out even if the hospital is a trauma center.
Neurological trauma with bleeding inside the head, spinal cord injuries, major amputations, burns, and pediatric trauma patients will continue to be airlifted to Reno or Sac.
While trauma centers were in the decline in the 1990s and early 2000s, the reverse has been true the last few years. According to Kaiser Health News, this is in large part because money can be made from being a trauma center.
A Kaiser study show that since 2009 more than 200 trauma center have opened in more than 20 states, with 75 more hospitals seeking approval.
“Trauma centers make money. If a hospital is not making money on trauma, then it’s not structured the right way,” Mike Williams, president of the consulting firm Abaris Group in Martinez told USA Today. “Trauma centers can basically charge whatever they want.”
Women’s care
With Barton being a private hospital, negotiations with individual doctors or groups it contracts with are confidential. Without either side releasing the numbers, it is not known how far apart the hospital administration and the offices of Tahoe Women’s Care and Emerald Bay Center for Women’s Health were.
“Substantial” is how Williams described the difference.
Kelly Shanahan with Emerald Bay Center said, “We basically asked for a continuation of what we have now. The only thing additional was paying our malpractice premium.”
Doctors Gary Willen, Kris Kobalter and Caroline Habaradas with Tahoe Women’s Care did not return a phone call.
This was the administration’s decision, not the board’s.
“I don’t think the board had much of a choice. The administration tried to negotiate in good faith,” Barton board President Guy Lease told Lake Tahoe News.
Shanahan also believes the decision by the administration was personal.
“He doesn’t like us,” Shanahan said of Williams. “I really think it’s about the personalities.”
Obstetrics is not a moneymaker. And with there being a 21 percent decline in births at Barton from 2010 to 2011, the income is on the decline.
While these four docs were costing Barton Health money on the obstetrics side, Shanahan does not believe the g-y-n part of her practice was taken into consideration.
Barton know it needs ob-gyns. Two doctors have been interviewed to replace the four they let go. How many will be hired is an unknown.
Shanahan said the two ob-gyn offices agreed to merge to save money, but that and other concessions were not good enough for Barton.
Barton owns the building Tahoe Women’s Care is in, while Shanahan also owns her. It’s still possible they could consolidate so they can continue to practice medicine locally.
Shanahan foresees having a strictly gynecological practice.
“I kept my office through breast cancer and chemo. I will be damned if this hospital administration makes me shut my doors,” Shanahan told Lake Tahoe News. “I don’t think it is a community hospital. I think it’s corporate.”
Obstetrics is a “gateway” service. Women are typically the ones who decide where and whom their family members see in the healthcare system, and having a child in your hospital is often times their first introduction to your hospital, and can devote them to your facility for life.
What is Barton’s mission? because I feel a very mixed message with some of the decisions they have been making. I thought they are a non profit for the community needs hospital, they come off as a private for profit entity.
I’ve always defended Barton when people talk about the level of care because I’ve always had a good experience there. Had 4 kids born there, a surgery and a few emergency room visits.
This decision of theirs changes my feelings completely. Choosing one’s ob-gyn is a big decision, trust is built and commitment to one doctor/group is the result. The population of SLT is almost half women so Barton’s decision is affecting almost half of our population!
If Barton is a non-profit I would assume the board of directors has ultimate power over decisions of their executives. The would have to back their executives but if what they feel is the wrong decision, I’m sure they could repeal it.
Wrong move Barton. I hope the 4 doctors you’ve severed ties with end up someone with a thriving practice as I’ll follow. And I’m sure I won’t be the only one. Remember….almost half of the town is who you’ve affected.
To bad Barton has been going down hill for a long time, just one more move in the wrong direction. Their real goal is to be able to sell to Renown, keep watching.
Forcing a pregnant woman to have to drive or ride to Carson Valley in the winter to deliver a child has got to be one of the most absurd “improvements” that one could imagine. I agree with 30 yr local. Both my kids were born at Barton over 30 years ago. I have always defended Barton despite their proclivity for waste. I don’t know how I can anymore. This is nonsense.
Barton Health is now a private corporation. That makes their #1 priority and driving force behind all executive decisions overwhelmingly influenced by one thing…profit. This is the GOP corporatist free market at work. Community health and well-being be damned. I’m sure all the good and caring people that work there have horror stories about the changes in patient care that come with these new policies. The profiteers will threaten everyone with impending closure if they can’t make more money, they did the same routine in the casinos after the Harrah and Gross families sold out. A race to the bottom on wages and benefits and cut customer services to the bone to enhance those quarterly profits, that’s the greedheads short-sighted mantra.
Not weighing in either way but did I miss something here? I read that they will still be able to practice there, just won’t have there malpractice insurance underwritten and that they couldn’t come to agreement on fees. Also see that they are hiring docs to replace them.
I suspect that OB-GYN malpractice insurance they asked for to be paid by Barton was the killer, of course I do not know that.
That type of insurance is SUPER EXPENSIVE.
My questions are:
1. weren’t these doctors at one time contractors to barton?
2. they at some point joined the barton rolls as employees?
3. they are now being let go, but can use the facilities as private contractors again?
4. as “outside” doctors are they limited in their use of the facility in any way?
5. are there not other doctors in this town that are not on barton’s rolls today who run their own practice?
6. if so, then what is the disadvantage to not remaining on Barton’s list of doctors?
anyone?
Criticalthinker55, thank you for your inquiry. As the Community Outreach Coordinator for Barton Health, here are the answers to your questions.
1. The physicians at Tahoe Women’s Care have been contracted with Barton for the past 5 years; Emerald Bay Center for Women’s Health has been contracted with Barton the past 2.5 years (Barton cannot legally employ physicians, so we contract with them though a physician group). Prior to being contracted with Barton, each office was in private practice, and had privileges at the hospital. So yes, both offices were in private practice prior to being managed by Barton.
2. See the answer above.
3. Rather than being let go, the contracts between the physician offices and Barton are expiring, and the two groups could not reach an agreement on the terms of a new contract. So, yes – they can go back into private practice and continue their privileges at the hospital. Essentially that means they can deliver babies and conduct surgeries at Barton Memorial – but they run their own day-to-day operations of their private practice.
4.No – they are not limited in their use of the hospital if they have privileges there. All doctors in these contracts would continue to have priveleges at Barton Memorial Hospital.
5. Many local private practices work under this type of arrangement (examples are Tahoe Fracture, Alpine Family Practice and Lake Tahoe Pediatrics). This is a very common arrangement across the nation – and was the same model these practices worked under 5 years ago and 2.5 years ago respectively.
6. The advantages of working with Barton is that practitioners don’t need to worry about the day to day business operations of their medical practice such as appointment scheduling, billing, marketing, human resources and other overhead business costs.
Thank you again for your interest.
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“As it is now, someone could arrive by ambulance and no one in the ER will know ahead of time what type of care would be required or even that a patient was coming. That would change per trauma center protocol.”
All incoming ambulances to Barton’s emergency room call in a patient report to an ER RN.
Thank you Leanne!
That helps to offset some of the misinformed comments above.
Ms.Wagoner, It was good of you to respond to the LTN readers. As a spokesperson for Barton Health could you also clear up the question about the hospital’s status business wise? Is it not true that as a private company the main goal is to make money and that trauma centers make it and obstetrics do not? Therefore, women and kids get 86’ed without concern for the community?
Phyllis, that totally makes sense, and probably has been normal protocol for a long time!
Dear TeaTotal,
Barton Health is a private non-profit. In order to provide quality health services, we must be financially sustainable. We plan to continue to provide high quality obstetrics and gynecology services to the South Lake Tahoe area. Our community’s health is number one. Our programs for our women and children in our community are of the upmost importance as shown by our commitment to remodeling our family birthing center, buying the da Vinci robot for women’s health surgeries, and in expanding our community clinic for uninsured and underinsured moms and children. Thank you.
Well at least they still have the Disney Way!