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.”