The biggest issue currently facing Columbia-area hospitals is the Affordable Care Act and the uncertain future it creates for doctors and services. The act, labeled Obamacare by both detractors and supporters, requires all U.S. residents to have health insurance or pay a tax.
“To me the looming elephant in the room is not knowing how health care is going to evolve over the next five, or even 10 years,” says Dr. Glen Strickland, chief of staff at Lexington Medical Center. “If you’re not sure what you’re going to get paid for a service, it makes it very difficult to have long-range planning.”
While the chiefs of staff at the five Columbia hospitals say they are uncertain of the eventual impact of the law, which is still rolling out, hospitals already are cutting back on unneeded staff, equipment and procedures to prepare.
“It’s hard to know what’s coming,” says Dr. Carey Hite, chief of staff at the newest hospital in the Midlands, Palmetto Health Baptist Parkridge. “We cannot expect to have our funding increase. So in the era of decreased funding, we’re going to have to become more efficient and provide higher quality service. So that is quite a challenge.”
Lexington Medical Center
Dr. Glen Strickland was born in Columbia, but grew up in Little Rock, Ark. He earned a degree in biology with a minor in mathematics from Vanderbilt University in Nashville, Tenn., graduating magna cum laude in 1980.
Dr. Strickland went to the University of Arkansas for medical school and did his general surgery training at the University of South Carolina School of Medicine in Columbia. He has been at Lexington Medical Center since 1993 and says his longevity is likely the reason he is chief of staff.
“I was interested in doing it because it’s sort of like team sports,” Dr. Strickland says. “You get to know the people, and you want to help the team. It’s kind of like giving back.”
Dr. Strickland points out that he and all the area chiefs of staff are volunteers. That is, they are not paid for being chief. Meetings are held before or after the typical workday, which can extend from 6 or 7 in the morning until 10 at night.
Dr. Strickland is a general surgeon but also is director of weight-loss surgery at Lexington, a specialty he picked up during his residency at USC.
“We have lots of folks who’ve changed their lives,” he says of his patients. “It was that aspect of it that I liked. I don’t think that we’ll ever make a dent in the number of people who are morbidly obese, but for the people we’ve been able to help, it really changes their lives.”
Dr. Strickland’s top priority for Lexington is to help develop the cancer treatment program. To that end, the hospital has teamed up with Duke Medicine, which helps select oncologists who apply for positions at the hospital.
“It makes it more of an academic program where we can have clinical studies and Duke’s guidance with that sort of work,” Dr. Strickland says, adding that the hospital has hired a number of medical oncologists and a surgical oncologist. “Some of the cases we had been sending down to MUSC (the Medical University of South Carolina in Charleston) because we didn’t have the expertise.”
The second priority for his two-year term as chief is to continue to support Lexington’s heart program and help it continue to grow. Lexington opened in 1971 as a fairly small hospital — its newest community medical center opened in Lexington in 2001 and is larger than the original hospital. Lexington now has more than 400 beds and 600 physicians.
“I’m very proud of our hospital; it really is growing to be a big place,” Dr. Strickland says. “The one thing I am most proud of is they’ve kept a small hospital, small-town type attitude.”
Palmetto Health Richland
The largest hospital in the Columbia area is Palmetto Health Richland with 649 beds, and it is the region’s only Level 1 Trauma Center — one of only four such centers in the state. That means the hospital takes patients with injuries and issues that cannot be handled by other local hospitals. The services are considered vital to the community, but often provide the least payback to the hospital.
Richland’s chief of staff is Dr. Rick Dreyer, a graduate of Dartmouth College who went to medical school at the University of Miami, where he saw a large-scale trauma center up close. It was here that he decided to follow one of his mentors into the field of interventional radiology. This includes testing and reading film but also treatment services such as clearing blockages in arteries outside the heart and in other organs.
Dr. Dreyer’s goals for his medical team during his year as chief revolve around missions already started, namely having everyone who practices at Richland use electronic records and providing orders electronically.
“We live in a hybrid world right now where some physicians are working on computers and others are in the written chart,” he says. “The conversion is for everyone’s benefit. You can’t have a nurse looking on a computer, then wondering if there’s a written note coming in.”
His second priority is doing what most hospitals around the country are doing: more with less. “We are treating more sick people with less things. What I mean by things is staffing and equipment,” he says. “We have to take care of more sick people with less tools. And that’s not easy.”
While Lexington has the newest heart specialty center, Providence Hospital has the oldest heart center in the Midlands. This was the catalyst that drew Providence’s Chief of Staff Dr. Andy Weisinger to Columbia.
“At Providence, we were annually doing 1,100 hearts or so back in 1998,” says Dr. Weisinger, a cardiac anesthesiologist. “There aren’t a lot of jobs where there’s enough volume of heart surgery to justify having a designated anesthesiologist that does cardiac anesthesia.”
Dr. Weisinger attended Duke and wanted to stay in the South. He and his practice partner alternate days on call. “With our practice, there’s just two of us, so we’re on call every other night,” Dr. Weisinger says. “We have a very intense practice. I’m either home or I’m here at the hospital.”
The added duties of chief of staff are possible only because his partner helps pick up the slack when he has to go to meetings, Dr. Weisinger says. But both of them think that sort of involvement is important to the practice of medicine and to its future.
“One of the things we’ve seen in the past 15 years that I’ve been here is a huge change in physician involvement,” he says. “When I got here, there was a sort of them-against-us mentality. Physicians have really come to understand that they are aligned with the hospital and that hospitals have the patient’s interest at heart.”
As Providence has seen its volume of procedures fall off due to an increased number of heart centers in the area, it has branched out to add other surgical specialties, such as orthopedics, which are concentrated at the hospital’s Northeast Richland County branch.
Dr. Weisinger says that Providence is hoping to achieve some efficiency by concentrating its specialties at different locations instead of trying to staff both of its facilities with doctors for each specialty. “I think that what we’ve learned at Providence is you can do different things,” he says. “You just have to make sure you’re efficient when you do them.”
One step is making sure doctors understand new reimbursement rules so that patients are properly scheduled for outpatient procedures, whereas just a few years earlier their operations would have been considered and reimbursed as inpatient.
Providence is also trying to place its patients physically in the hospital according to the level of care they need. Sicker patients are on floors with lower patient-to-nurse ratios.
“In the end, we do a better job of taking care of patients because we have the sickest patients aligned with the best one-on-one care with the nursing staff,” he says.
Palmetto Health Baptist
At another downtown hospital, an anesthesiologist leads the doctors as chief of staff. Dr. Greg Malcolm is a native of Greenville, a graduate of Clemson University and has 24 years of experience on the medical staff at Palmetto Health Baptist. That experience makes being chief a little easier, he says.
“You get a better handle on how to deal with issues when they come up because you’ve been in the trenches,” he says.
Founded in 1914 and celebrating its centennial year, Palmetto Health Baptist has 413 beds and 700 physicians. The hospital offers a wide range of services, from general surgery and oncology to behavioral services, but it has a growing specialty in women’s health through its Breast Center and The Birthplace, which delivers thousands of babies every year.
“Baptist is a center of excellence for women’s care. We do a lot of general surgery and most of the urology for the Palmetto Health system,” Dr. Malcolm says. His hospital’s primary goal for his yearlong tenure as chief is to play its role in making the entire Palmetto Health system the go-to place for health care in the Midlands. He also has a personal goal.
“What I personally want to get out of this year is to better understand what makes a hospital work and to create better relationships with all the people involved with making it successful,” he says.
One of the keys to understanding a hospital’s operations is grasping government regulations. “The general public has no idea what the hospital goes through to try to comply with all of those regulations and comply with them in a way that maintains the quality of care,” Dr. Malcolm says. “We want to do what’s required, but we also want to do what’s right for our patients.”
To that end, Dr. Malcolm says, Baptist and all the Palmetto Health systems created a collaborative medical staff at all three hospitals to improve quality. “We try to focus their energies on setting quality goals for different departments, trying to meet those goals and improve care,” he says.
Palmetto Health Baptist Parkridge
The newest addition to the Columbia hospital scene is Palmetto Health Baptist Parkridge. With its opening, the Palmetto Health system now has three medical staffs, and some physicians have privileges on multiple campuses. “The 76-bed facility fills a need for a hospital on a peninsula of land between two rivers and the lake,” Chief of Staff Dr. Carey Hite says.
“Geographically, because we have those rivers separating us and we have to cross those bridges to get places, we’re isolated here. So it made a lot of sense to put a medical facility here,” says Dr. Hite, who previously served as chief of staff at Baptist and is a graduate of MUSC.
While Parkridge was being built, it was one of only a handful of new hospitals going up in the country. “One of our goals was to spread the word quickly and fill that hospital up,” he says. “Then our goal is to establish this hospital as the top-quality hospital in this area and hopefully in the state.”
On the personal side, Dr. Hite says, he wants to implement a better system of handing off patients from the hospital back to primary care doctors. Dr. Hite calls it transitional services.
“You get discharged from a hospital then there is a period of time before you’ll go back and be seen by your doctor, that is, your primary care doctor out in the community,” Dr. Hite says. “That’s a really high-risk time for people who have been pretty sick, and it needs to be transitioned smoothly. A lot of information needs to be shared quickly, smoothly and correctly between the hospital and the next doctor who will care for you.”
Some things patients might see is a phone call from the hospital after they get home and personal contact between their hospital physician and their primary care doctor. “I don’t think that is done well,” Dr. Hite says. “And that’s a challenge I’ve given to our doctors.”
An internist, Dr. Hite says he hopes to bring a new mindset to his new hospital.
“A traditional hospital mindset is an institutional mindset; in other words anything that goes on there needs to fit a schedule, fit that institution’s timeframe,” he says. “Our mindset out here is different. The institution is here to serve people, and we want our mindset to be a service mindset, where the patient’s priority is first.