Continued from page 11
Beshear: That’s universal in the country. We also learned from the report that came out in ’08 that the average physician age was 55. The average nurse age was 50. Right now (local hospital executives) feel comfortable with where they are with their nurse staffing. But the problem with nursing on a national level is we don’t have enough nurse instructors. The challenge for Montgomery is we don’t have a medical school and a lot of people will train and settle pretty much within the same general area. We do have two residency programs and one of them in particular takes a huge number of foreign medical graduates. MBJ: What’s the impact locally? Beshear: We may need to become accustomed to having our health care delivered by people who might not be what we are traditionally accustomed to. The city has historically given some money to the internal medicine residency program. A lot of these students come here, get their residency training and then go on to fellowship and a specialty. A few will stay in the area or a few will go somewhere else, but remain in family care. The city is going to structure the funding for this program (at UAB Health Center Montgomery) in a slightly different way – in more of an incentive. The mayor said if you train a doctor and he’s willing to stay here, we will support that with X number of dollars. MBJ: Is Envision 2020 going to also play in a role with this program? Beshear: What we’re going to do with our little money, if we can get it, is use it as a catalyst. Our money - $100,000 – would go to a physician reimbursement program, which the state matches. MBJ: I’ve heard that Judge Bill Gordon has played a critical role in this endeavor. Beshear: Drawing on his remarkable expertise and experience as a judge, mediator and arbitrator, he forged unity where there has profound division for a long time. This work would not have been able to move ahead as quickly or as successfully without his brilliant mind, his concern and his passion to see that everyone has access to health care. MBJ: One of the five major areas for health care was research, reporting and education. Would you please elaborate? Beshear: That’s the easy part – changing people’s behavior. That was another big 12
Montgomery Business Journal October 2010
piece that came out of this work. We have to do a whole bunch of education. MBJ: Are you talking about being aware of nutrition, exercising and living a healthy lifestyle? Beshear: Yes. I just heard on the news this morning that 10 percent of all U.S. medical costs are from obesity and $150 billion is spent every year on diabetes, heart disease and cancer. Montgomery was ranked No. 1 for obesity. Part of the education will be reducing the demand – having people take better care of themselves and if they are getting access to primary care in a timely fashion they will be healthier. They won’t have to show up as often or be as sick. This is not brain surgery. You just follow this logically that if people are healthier they need less health care. MBJ: Is the River Region prepared to implement health care reform? Beshear: I wish I had a crystal ball. I believe Montgomery is going to have a leg up on some areas simply because we started earlier addressing it; we have a very collaborative team; and we’re moving proactively. Another impacting factor is an aging population. The boomers start turning 65 by next year. The rolls of Medicare are going to be flooded. Incentives were built into health care reform to hopefully change the behavior of providers and change the behavior of consumers because we are all consumers of health care. This is a very multi-pronged thing. Another thing we’re doing because we don’t know everything now and we don’t know what is going to come up next year or the next 10 years, we are in the process of creating the River Region Healthcare Council. MBJ: What is the River Region Healthcare Council? Beshear: One of the recommended strategies was to establish a consortium of health care providers, government agencies and citizens to assess met and unmeet health care needs of the five-county region, to identify available resources and to develop immediate and long-range plans. MBJ: What is the ultimate goal of the River Region Healthcare Council? Beshear: A medical home for every resident of the River Region.
MBJ: What is the mission? Beshear: To maintain the permanent relationship structure to ensure a financially sustainable, accessible, affordable and comprehensive health care system for every citizen in the River Region. The national problems with health care are also regional problems, but we are coming together as a region to collaboratively solve them. Another important thing to note is that not only are we (dealing) with a decreasing number of physicians generally and primary care specifically – everybody coming out of training now has about 100 job choices. Why would you come to the River Region? MBJ: How do you compete for those physicians? Beshear: We need to do a bang-up job of marketing and we are pulling together a big initiative around that. There are two answers to this issue: You grow your own work force. We want to create a system for staying in touch (with local high school students), supporting them, mentoring them – whatever it takes to get them to get back if they leave the area. That’s the long-term solution. The short-term solution is we need to put together the very same type of collaborative teamwork when we recruit a Hyundai and we need to sell the River Region. Our hospital administrators tell us if we can just get them (physicians) to come here they are overwhelmed by what’s here. The issue is getting them here in the first place. MBJ: What is going on with information technology in health care? Beshear: We’re creating what is called an HIO (Health Information Organization) and it will collaborate by sharing information through electronic medical records. There are a lot moving places on all of this that have to be moving at the same time and that’s what we try to do. Our issues reflect what is going on at the national level. But the River Region is being recognized by Medicaid (and others) as being a model for moving proactively and collaboratively with a unique set of players. •