Letter to Tom Blum

May 10, 2011

Tom,

Based upon a cursory review of that e-mail regarding a cooperative initiative between the Hospital and the private practice sector, the following are my initial thoughts…which you may consider presenting at your option. 

• Such an initiative does not require an intricate new structure, developed by a team of outsiders at much cost.  We have all of the ingredients here already.
• Any such effort must take pains to avoid any problems with the Stark Laws and with the Anti-Trust Laws, since the Federal Government has long targeted the Health Care Professions for special scrutiny…in order to prevent any effective professional efforts to thwart either a Business or Government take-over of that economic market.  To succeed in avoiding that danger, any local cooperative initiative must succeed in defining The Market as the entire catchment area from Norwich and beyond to Westerly and to the Connecticut River.  In that way, our efforts can be shown to represent less than 30% of the area of competition. 
• We already have the excellent Staff, both within and without the Hospital.  We have decades of community good will.  And we can compete both in our area and regarding the tertiary centers of Connecticut and beyond.
• What we have lost in recent years is a perception that we professionals are united and cooperating fully for the benefit of the community.  What a patient does not want is a fractured “team” when he is vulnerable; and that is the perception now. 

What to do?

1. Agree individually that any form of capitation or “bundling” or ACO is unethical, not in keeping with our fiduciary responsibilities to our patients, and a cynical attempt to have physicians ration their patients’ care…a function only appropriate for the public at large.
2. Inform the community of the great education, training and experience of the members of our staff, both Hospital and private.  Believe it or not, the community has only a vague awareness of this. 
3. Demonstrate these capabilities by abundant and regular out-reach programs for the public on all manner of medical / health issues, produced by the staff members themselves…and not just by outside “experts”. 
4. Complete finally the integration of the Hospitalist program with the greater health care community by tight communication with outside physicians: before, during and after a patient’s discharge…a cooperation obvious to the patient lying on his or back in the hospital room. 
5. Declare and demonstrate the new cooperation in tangible ways to the community in order to reverse the current perception of division.  That must involve every physician in the community.  The elements of such cooperation are already available to be applied widely, without triggering an allegation of a “combination or conspiracy”. 
6. Use such cooperation to petition our governments regarding ethical methods for reforming our Health Care System, developed from within and not imposed ham-handedly and ignorantly from without.