A small group of independent physicians challenged a powerful hospital organization, and against all odds, won the day.
Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions expressed here are that of the authors and not UBM / Medical Economics.
In our increasingly corporate healthcare system, physicians are becoming disillusioned with the practice of medicine. Many doctors feel that they have no control; that the battle is already lost, and that there is no use in fighting.
But they are wrong.
Physicians, working together with patients, can be very powerful indeed.
Take for example, the story of a small group of independent physicians who challenged a powerful hospital organization, and against all odds, won the day.
This unlikely miracle occurred not by luck or accident, but from a coordinated, organized effort by community physicians, in response to a threat to their professional livelihood. Working together and utilizing the resources of their county medical society, these physicians galvanized their community, which came out in droves to support their doctors.
The story begins in October of 2018, when NCH Healthcare, a hospital system in Naples, Fla., announced the success of a small pilot project on a unit staffed only by physicians employed by the hospital. Touting improved quality of care, better patient satisfaction, and shortened length-of-stay on this employed hospitalist-only unit, NCH Healthcare CEO Allen Weiss, MD, told the Naples Daily News that the pilot program would soon be expanding to other floors of the hospital.
This announcement alarmed independent physicians, who feared that they would soon lose the right to care for their own patients in the hospital, or to select their own hospitalist team. Arguing that the NCH pilot study was biased-as the project unit was provided with additional resources like extra case managers and support staff-community doctors asked for the study to be repeated using non-NCH-employed doctors. The hospital rejected this proposal, and despite the NCH medical staff unanimously voting against the admissions policy change, the administration continued to move forward with their plans.
Facing the possibility of having their hospital privileges summarily restricted, the independent physicians brought their concerns to the Collier County Medical Society (CCMS), which represents 600 of the county’s 800 practicing physicians. The CCMS board was concerned and appointed a committee to investigate the situation further and formulate a response.
On November 8, the President of the NCH medical staff and CCMS member Paul Jones, MD, wrote a guest editorial to the local newspaper, asking the hospital to consult the community before instituting the new admissions policy. Within days, he was forced to resign as president of the medical staff.
Physicians take action
With this added affront, the CCMS board decided to act immediately. Along with other community leaders, CCMS President Cesar DeLeon, DO, and Executive Director April Donahue met with a marketing agency to plan a public relations campaign to oppose the NCH hospital admissions policy. In just weeks, thousands of dollars were raised by community physicians and concerned citizens, allowing the group to begin a strategic multi-media assault.
The campaign focused heavily on educating the community about the NCH admissions policy and the impact of this decision on patient choice. The message was repeated in television, internet, and newspaper ads, as well as printed brochures available in physician offices.
Physicians added their name to a full-page newspaper ad and wrote individual letters to the editor. DeLeon and Ron Garry, MD, a local concierge physician, appeared on television news to discuss physician concerns.
But most importantly, physicians were able to engage patients and convince influential community members to add their voices. The mayor of Naples, the Collier County Commission, and the Naples City Council wrote letters to the NCH Board of Trustees asking the hospital to reconsider their stance. Yard signs decrying “NCH Denying Patient/Physician Choice” were posted in front of multi-million-dollar homes across Collier County. Large hospital donors pulled funds earmarked to the organization in protest, resulting in the cancellation of a $1 million biannual fundraiser event. Patients made themselves heard by writing letters to the editor and showing up at meetings and rallies, and fifteen thousand signed an online petition in protest of the policy.
The campaign continued throughout the months of November and December, with no call for compromise by NCH. In fact, the hospital doubled down on its original plan, responding with its own public relations campaign, as well as holding two town hallsto explain why the self-contained hospitalist system would be better for patients.
Physicians intensified their complaint by sending a letter on December 7 threatening legal action if the admissions policy continued. And a month later, six interventional radiologists and five cardiologists resigned from NCH amidst the controversy.
On January 18, the NCH medical staff held an emergency meeting to discuss a vote of no-confidence in hospital leadership. According to Garry in a letter to the NCH Board of Directors, the hospital did everything possible to prevent the meeting from taking place, including “removing all fliers from the hospital and calling physicians to tell them not to attend.”
Despite these efforts, attendance was the largest medical staff meeting in 62 years, and the vote was nearly unanimous: 98 percent of the medical staff voted “no confidence” in Weiss and Chief of Staff Kevin Cooper and recommended that the NCH Board of Trustees remove them immediately from hospital leadership.
Despite the medical staff vote, the NCH Board issued a statement granting Weiss and Cooper their full support.
Pressure continued. On January 21, a rally in downtown Naples was held to support community physicians. A competing rally was held on NCH grounds supporting NCH administration.
On January 23, in a move that came as a complete surprise considering their recent statement of support, the NCH Board of Trustees asked for, and received, the resignation of Weiss and Cooper. Community physicians, thanks to widespread support from patients, had won.
Answering the critics
Not everyone sees this game-changing result as the victory that it truly is. David Johnson, an investment banker-turned-healthcare adviser accused “embittered physicians” of executing a coup against NCH’s “shining legacy,” noting that doctors fought “viciously to keep a corrupt status quo intact.”
Yet Johnson neglects to mention NCH’s darker side-like the lawsuit it filed to block physician Beau Braden, DO, from opening a micro-hospital in a rural, underserved area of Collier County, despite a Certificate of Need being approved by the state.
And what about the hospital’s decision to stop supporting the Neighborhood Health Clinic, a medical home for employed but uninsured patients established in 1999? NCH administrators told Nancy Lascheid, the clinic co-founder, that the not-for-profit community hospital would not only no longer see patients of the clinic, but also that physicians employed by NCH would not be permitted to volunteer there, even during their own free time.
Thanks to persistent efforts from physicians and patients, the situation is already looking brighter. Within weeks of the turnover in leadership, NCH’s Interim President and CEO Phil Dutcher met with the Neighborhood Health Clinic to repair the relationship between the organizations. Dutcher and the Board also canceled the lawsuit blocking the creation of Collier County’s micro-hospital, and administration announced the creation of a new task force that includes physicians to improve communication and patient care.
Effecting change isn’t easy, and it often feels futile to even try. But as this example shows, when physicians and the community work together towards a common goal-better patient care- we can succeed.
As DeLeon says, "We physicians have been victims for too long of powerful groups interfering in the care we provide to our patients. United, and with the help of our patients, we can keep the care in healthcare and prevent others from exploiting it for financial benefit. "
Rebekah Bernard MD is a family physician and current board member of the Collier County Medical Society, and the author of Physician Wellness: The Rock Star Doctor’s Guide.