Tuesday, March 13, 2018

National Walkout Day, March 14... These Boots are Made for Walking.

A National School Walkout Day is planned for March 14, 2018 at 10 a.m. and will last 17 minutes in honor of the 17 students and staff members killed at Marjory Stoneman Douglas High School in Parkland, Florida, on Valentine’s Day.  The heart of the nation has seemed to shift overnight regarding the debate on guns, but this change has been almost two decades in the making.  United and Delta Airlines pulled their support for the NRA, Dicks’ Sporting Goods will not sell assault-style weapons, and Walmart plans to raise the minimum age to purchase a gun to 21 years old. 

I am a pediatrician.  I have sat on the sidelines for far too long --  I watched from a front row seat as frightened, grieving children who survived the shooting at Columbine High School on April 20, 1999 struggled to put their lives back together.  My pediatric internship began June 23, 1999, at the Children’s Hospital in Denver, Colorado, approximately 20 miles north of Columbine High School.  Up until that time, a mass shooting inside the walls of a high school had been almost unimaginable.  Many students who had survived by hiding under a desk in the library that tragic day crossed my path over the next three years.  In reality, every student and teacher inside Columbine High School was irreparably damaged forever; they lost a huge part of themselves on that solemn, heartbreaking day. 

Why has so little changed in almost 20 years since Columbine? I don’t know.  Why has so little changed since the mass shooting at Sandy Hook where 20 children and 6 adults were gunned down in cold blood?  I cannot understand.  Why has the mass shooting in Parkland, Florida galvanized the nation?  Because now, it is our innocent children leading the fight for meaningful change. 

“Silence in the face of evil is itself evil.  Not to speak is to speak.  Not to act is to act.”  These are the immortal words of Dietrich Bonhoeffer, a German pastor and theologian, who was executed for his anti-Nazi beliefs in 1945.  Unspeakable damage is being done to our children and it is time we, as parents, teachers, administrators, and community members stand with them. 

Now is the time to speak and the time to act, before more children die.  At Columbine High School, it took only six minutes to kill 10 and wound 12.  At Sandy Hook Elementary, it took a mere five minutes to kill 26 and wound 2.  At Marjorie Stoneman Douglas High School, it took just 7 minutes to kill 17 and wound 14.  These statistics are sobering. 

As a pediatrician, I have spent over two decades acquiring knowledge on adolescent growth and development. Teenagers acquire higher-level thinking in the form of cognitive competence, which includes the ability to reason effectively, problem solve, reflect, think abstractly, and make plans for the future.  Linear, black-and-white develops into a broader understanding of the shades of gray.   These new capacities allow them to engage in mature decision-making with a depth they did not previously possess. 

Society is not giving them enough credit.  Teenagers are capable of a great deal more than we recognize.  This is the moment where we should stop talking, give these young people the floor, and listen to their words.  Their opinions matter.  Their continued growth and development matters.  Their mental health and safety matters.  Their contributions matter.  Their future should matter to all of us.  

While there are no easy solutions, I support the efforts of every student participating in National Walkout Day as they endeavor to bring much-needed attention to gun violence inside our schools.  Our children are actively engaging in a form of civil disobedience for likely the first time in their lives about a critical safety issue they face every day.  Young people are depending on the courage of the nation and our lawmakers to do what is right, which includes enacting bipartisan common-sense gun safety regulations that could literally save their lives.    Please join this generation of motivated students from Parkland, Columbine, Sandy Hook, and many other schools across the country to support their efforts, on March 14, National School Walkout Day.  While I may not agree with every idea or proposal of these young people, I respect them, I salute them and I validate their strong stand against what they see as injustice. 

Tuesday, March 6, 2018

The Peril of Online Physician Reviews

You may have heard that before you pick a doctor you are supposed to look them up online and see what other people have to say about them before you set up an appointment.
In the Age of Amazon this makes sense. Why wouldn’t you?
Allow me to give you a little insider information.  While they may well be a good idea in theory, Yelp.com and other online physician review sites have evolved in recent years to become the bane of my and fellow doctors existence. 
This past summer, Physicians Working Together, a non-partisan physician organization, started a petition on Change.org requesting Yelp remove online reviews of doctors.  To date, more than 30,000 physicians have signed it but I doubt Yelp will pay much attention.
Recently, the highest-level court in Germany ruled Jameda, an online physician rating site, must remove the name of a disgruntled physician.   A dermatologist from Cologne filed the case in the Federal Justice Court demanding Jameda remove her name due to the fact the anonymous nature of the rating site inspires the public to leave spiteful, vindictive comments.  Interestingly enough, in 2014, a gynecologist asked to be removed from Jameda, however the Court ruled the right of patients to be “well informed” about their doctor took precedence over freedoms of the physician.
What is the value of rating physicians online?  Are consumers becoming “well-informed?”
Patient advocates would argue rating sites for physicians improve transparency for consumers.   Physicians would counter with the argument that a medical clinic is not like a restaurant, hair salon, or shopping mall.  We engage in a highly personal way with the public that is quite different from sitting down for a meal.  The larger concern is whether or not Yelp.com patrons are actually “well-informed” by reading online physician reviews. 
After a little research, it appears the answer is no.  I used a local medical community as an example.  The reviews overall are not very good; on average the medical clinics are 3.0/5.0 stars.  Some reviews extol on physical appearance of the physician, be they female or male.  One reviewer discusses being offended by seeing a transgender physician, an element which has little to do with the provision of medical services.  At first glance, one might believe moving to Kitsap County, WA is akin to choosing between life and death.  Rest assured, most of the populace is alive and well. 
Online reviews are not a reflection of medical care quality.  Patients do not like receiving medical bills and do not like rude clinic staff.  They are unhappy if the physician disagrees with them, they abhor long wait times, and they detest prior authorizations, (news flash, so do physicians!) Yet these criticisms are not a reflection of the healthcare quality provided by the physician.  It is doubtful these grievances even have an impact on the mortality rate. 
According to “well informed” consumers, which qualities make a physician “good”?
Actually, the answer is amusing.  It is best if a physician is in fact, not a medical doctor at all.  It turns out EVERY naturopathic doctor, homeopathic doctor, chiropractor, and acupuncturist in my community is providing five-star-rated care.  One patron gave a few alternative practitioners only one star, but those reviews were more than nine years old; alternative medical practitioners were not as “well-accepted” by a “well-informed” public at that time.  As with other service businesses, the internet is unlikely to replace good, old fashioned “word-of-mouth” referrals. 
While internet ratings are not an accurate way to measure medical care quality, they are a way for angry individuals to air grievances, whether those are truth, lies, fiction, or somewhere in between.  For example, a one-star rating was left by a woman who did not like the way a staff member answered the phone at one clinic; she went on to give 5 one-star ratings to other physicians nearby at other clinics.  Interestingly enough, googling her name brings up a Yelp.com review describing her as having borderline personality disorder. 
What is the public being informed of exactly?  Not much.  Physicians may have difficulty responding to patient reviews without compromising protected health information, ultimately rendering them defenseless.  If the goal is to keep everyone accountable, where is the balance between physicians and consumers?  Should physicians have a database to rate patients?  Accountability is where the rubber meets the road and it cannot be found in online reviews of physicians.  Ironically, the lawyers in my community have very solid 5.0-star ratings, that is, unless they delivered a summons, then they were given a 1.0-star rating. 
Yelp and other physician rating sites should remove the physician reviews entirely because these entities are selling something they cannot deliver.  Until a physician wins a case against Yelp, Google, or another physician rating site, it seems wise to give every patient exactly what they ask for, never argue or tell them the truth, hire staff members who are like Mary Poppins and “practically perfect in every way”, and prioritize timely visits no matter if a patient is dying in the next room.   
Is it any wonder the U.S. mortality rate continues to fall?

Tuesday, February 27, 2018

Sandy Hook Promise: The "Human" Side of the Gun Debate

Last week, another school shooting took place in Parkland, Florida, and cut short the lives of 17 high-school students.  The epidemic of school violence is a public health issue and warrants development and implementation of evidence-based prevention strategies.  Each school shooting begins long before the fatal shots are fired; studies show most have been planned up to 6 months beforehand.  The answer to gun violence cannot be found in the halls of Congress; the responsibility to protect our children lies with every parent, teacher, politician, student, and community member in America.  It is time to direct our efforts toward preventing violence BEFORE it happens by recognizing the warning signs of a child at risk and intervening. We must change the conversation about gun violence to alter the course of the future for our children.

On December 14, 2012, 20 children and six adults were gunned down inside Sandy Hook elementary school in Newtown, Connecticut.  A core group of parents who lost children that tragic day saw past their grief and created Sandy Hook Promise (SHP), a non-partisan national nonprofit organization focused on preventing gun violence BEFORE it occurs. SHP has trained 2 million adults across 50 states.  Since inception, their programs have helped stop multiple school shootings and suicides, reduced bullying and victimization, and ensured hundreds of youth receive mental health and wellness assistance.

Their three-part program is extraordinarily simple and effective. 

1.      Know the Signs to identify when a child is feeling alienated and connect with them by “starting with hello” and “saying something” to a trusted adult.

2.      Educate parents, teachers, and community members using evidence-based violence prevention strategies. 

3.      Focus on the “human” side of gun violence and be “above the politics.” 

“Start with Hello” is a program which encourages social inclusion and community connection. Our children can be taught to recognize isolation, marginalization, and rejection in their peers.  Parents and teachers can create a more inclusive school culture by training children to reach out to those who seem lonely and support growth of their coping skills.  Adverse childhood experiences can devastate even the most resilient among us.  The value of connectedness between children cannot be overstated.

 “Say Something” is designed for middle and high school-aged children to better recognize the warning signs of escalating behavior on social media in particular.   When adolescents are struggling, they tend to confide in their peers, many of whom are not equipped to intervene.  The second part of this program teaches young people to notify a trusted adult with their concerns.  By looking out for one another, and taking all threats seriously, whether written, spoken, in photo or video form, our schools and communities will be made safer. 

Safety Assessment and Intervention (SAI) is a cornerstone of the Sandy Hook Promise program that was developed by Dr. Cornell at the University of Virginia and has been rigorously evaluated for more than a decade.  SAI trains multidisciplinary teams within schools and communities to identify, assess, and respond to threats of violence while paying special attention to address the underlying conflict which led to concerning behavior in the first place.  Scientific studies show SAI-trained teams are capable of evaluating threats, distinguishing when they are serious, and intervening to prevent violent acts.

Hilary Clinton once said, “there’s no such thing as other people’s children.”   Every child is mine.  Every child is yours.  Every child adds value to the world.  By preventing just one child from bringing a gun to school, we could transform the life of not only that child, but also every student in attendance that day, plus every teacher, administrator, parent, grandparent, and community member working to support vulnerable young people.  

Laws will not change the mindset of a school shooter; we can only make an impact by altering the outlook of the school shooter.  It is time for meaningful action where we can find consensus.  It is too late to go back and save the children who were already gunned down at their schools, however we should honor their lives by supporting programs like Knowing the Signs, focusing on the delivery of mental health services to children and adolescents, and protecting at-risk individuals from firearm access and ownership.  We must talk with each other and our children about gun violence before more children die.

You can learn more about the Sandy Hook promise at www.sandyhookpromise.org. Additionally, I urge Gov. Jay Inslee and Washington State Superintendent of Public Instruction Chris Reykdahl to review the Sandy Hook Promise program and consider sharing the materials with every school district in Washington State.   

Tuesday, February 20, 2018

CMS Quietly Launches an Offensive Against Direct Primary Care

CMS could be a wolf in sheep's clothing 

Our healthcare system is self-destructing, a fact made more obvious every single day.  A few years ago, a number of brave physicians who were fed up with administrative burden, burnout, and obstacles to providing care for patients started a movement –known as Direct Primary Care (DPC.)  This is an innovative practice model where the payment arrangement is directly between a patient and their physician, leaving third parties, such as insurance or government agencies, completely out of the equation. 

The rapidly growing number of DPC physicians have organized into a group called the DPC Coalition (DPCC); suddenly, the Centers for Medicare and Medicaid (CMS) is paying attention.  As of February 2018, there are 770 DPC practices across the United States with new clinics opening each week as brave physicians leave the “system” behind, never looking back. Breaking free from the chains of insurance and government, this group is restoring the practice of medicine to its core, a relationship between a physician and their patient.   

CMS understands there is a problem with the way Medicare services are being delivered to tax payers; it turns out their idyllic version of “high quality” care is not as affordable as they predicted.  All evidence indicates the DPC model is not only capable of generating significant cost reduction, but also saving the federal government billions if administered on a large-enough scale.  As fewer physicians accept Medicare and convert to DPC practices, CMS wants a piece of the pie. 

CMS has chosen to hold focus groups in four cities, two meetings occurred in Boston and Dallas this past week; two more will be held in Denver on February 19th and 20th, and in Seattle on February 21st and 22nd.  One day is for independent FFS physicians and the other is for DPC physicians.  Last week, questions for the groups were reportedly: “what do you think is wrong with Medicare,” “what needs to change,” and “what will make it better?”  I find this approach patronizing as the majority of DPC docs (and many FFS) have OPTED OUT of Medicare entirely.

Two physician organizations supporting the DPC model are the American Academy of Family Physicians (AAFP) and the Direct Primary Care Coalition (DPCC.)  Representatives from both organizations were secretly present at the “listening sessions” last week, however neither organization openly disclosed the CMS meeting to their general membership.  These organizations should work to preserve and protect physician autonomy rather than invite the government to the table and conceal that fact from their membership.  DPC physicians already opted out of government control.  Why on earth would DPCC and AAFP entertain inviting a third party back into the fold? While some members of AAFP or DPCC might be interested in a Medicare program that incorporates DPC, the vast majority of the small independents are vehemently opposed to this approach. 

Sun Tzu once said all war is based on deception.  Wise commanders take measures to force opponents to react only to the wrong circumstances. Diversionary attacks, feints, and decoys are effective tactics.  CMS has incorporated a new one, raising the false flag -- an ancient ploy where ships were permitted to fly the enemy flag, so long as they raised one with their true colors just prior to attacking their foe.

One year ago, CMS introduced their “value-based” care model at the listening session I attended.  Now, CMS insinuated themselves into the leadership at the AAFP and the DPCC before unveiling their Direct Primary Care Prototype pilot program.  DPC physicians are satisfied with their practice model, who asked for a pilot program?  CMS has realized they need one.  They have designed a prototype which requires that physicians re-enroll in Medicare (capture), accept pre-determined payments of $90-120/monthly based on patient age and complexity (control), and entails submission of patient data for payment (capitulation.)   What appears on the surface to be a DPC-friendly endeavor will destroy the system from the inside. 

The DPC movement offers the first successful and innovative alternative health care approach to emerge in years.  CMS is focusing on physician capture, control, and capitulation, yet should not underestimate the fortitude of independent physicians.  We are steadfast, experienced in trench warfare, and refuse to succumb to their demands.  We will continue to fight relentlessly against mounting administrative burdens which interfere with the provision of patient care.   CMS will raise the flag with their true colors before long.  If you own a DPC or micro-practice, do not be fooled by this wolf in sheep’s clothing.  Stand strong and remain resolute.  Government, insurers, and hospitals will try to silence us, but physicians are absolutely essential to the delivery of proper healthcare.  Make no mistake, CMS is the enemy of independent physicians everywhere and our best defense is to have a good offense – leading with transparency to our patients and the public. 

If you are a physician who has been invited to these clandestine CMS listening sessions, have information to share, or wish to anonymously assist Denver or Seattle physicians who have not been invited to attend, please reach out on Twitter to me @silverdalepeds, or contact @IndDrs (Association for Independent Doctors), @IP4PI (independent physicians for patient independence), or @PPA_USA (Practicing Physicians of America.) 

This post was authored in collaboration with independent physicians who wish to remain anonymous.  May the force be with you all in the challenging days ahead.

Tuesday, February 13, 2018

MD + DNP = Dr.² (Doctor Squared): The Alternative to MOC Burden

The 4th amendment of the U.S. Constitution shields an individual (or business) from unreasonable government intrusion. It is inferred this right extends to ALL people, regardless of profession.  Advanced nurse practitioners are independently practicing medicine in 23 states yet are not subject to onerous Maintenance of Certification (MOC) requirements-- physicians are not equally protected under the law.  Physicians must fight, as one group, against the burden of MOC.  We have two choices:  become a Doctor Squared (Dr. ²) or join an alternative certification organization such as the National Board of Physicians and Surgeons (NBPAS.)

A Doctor Squared (Dr. ²) denotes one who obtains both an MD and a DNP (Doctor of Nurse Practitioner) degree.  This allows independent practice and eliminates the power of MOC.  Reviewing a list of affordable DNP programs in the country shows a degree from the University of Massachusetts – Boston DNP program only costs $10,180.  Coursework is online, and will take only 3 years if attending part-time.  Renewal of an MD license in Washington State costs $697 biannually while DNP license costs $125, putting more money in my pocket.  Additionally, the continuing education requirement is different; advanced practice nurses must complete 15 hours annually while physicians need 50 hours annually even though both professions are independently practicing medicine.  According to Medscape, malpractice insurance rates are $12,000 yearly (2012) for a family physician, while a family nurse practitioner pays $1200, one-tenth as high.  Remember, the cost of MOC for internal medicine is $23,600 every 10 years. 

While the American Board of Medical Specialties (ABMS) argues MOC participation makes for better doctors, no credible proof supports this assertion; only initial board certification has been scientifically validated.  Seven states already eliminated MOC compliance to maintain licensure, physician hospital employment, or insurance contracting, however this same freedom must be extended to the other 43.

Until then, an alternative certification pathway through the National Board of Physicians and Surgeons exists.  In 2015, the Washington State Medical Association resolved to allow alternative certification, yet MOC remains a requirement for licensure, hospital employment, and insurance contracting.  Recently, HB 2257 was introduced, precluding MOC as a condition for state licensure, though overlooks the fact hospitals and insurance companies require physicians, but not nurse practitioners, to comply with MOC.

Why are hospitals and insurance companies enforcing MOC compliance?  Conflict of interest (COI) is defined as a person or organization experiencing multiple benefits, financial or otherwise, which can corrupt motivation or decision-making.  ABMS appears full of corruption.  If there is a risk one decision could be unduly influenced by a secondary interest, a COI is present.  Margaret O’Kane serves on the Board of Directors at ABMS, and her secondary interest is her role as Founder and President of the National Committee for Quality Assurance (NCQA), the organization certifying insurance companies.  She has each hand in a different MOC cookie jar. 

NCQA requires that insurers credential only physicians who comply with MOC programs.  It appears Ms. O’Kane is profiting from the NCQA requirement on one hand while forcing physicians to spend millions completing MOC on the other.  While the average internist earns $150,000 annually, Ms. O’Kane appears to be handsomely profiting from this “arrangement.”  Wikipedia defines collusion as “an agreement between two or more parties, sometimes illegal–but always secretive--to limit open competition by deceiving, misleading, or defrauding others” to gain leverage. It is an agreement between individuals or corporations to divide a market or limit choice and opportunity.  Through Ms. O’Kane, ABMS and NCQA have a connection while misrepresenting themselves as being independent. 

ABMS assumed physicians would never contest corruption, however numerous brave physicians are fighting:  Dr. Wes Fisher, Dr. Ron Benbassett, Dr. Meg Edison,  and Dr. Paul Tierstein, who created the National Board of Physicians and Surgeons, (NBPAS).  While NBPAS has made headway with hospitals, not one insurance company will credential physicians who refuse MOC.  Should insurance companies be in charge of our healthcare system?   

The Maintenance of Certification (MOC) program was initially voluntary; however when billions in potential revenue were realized, participation became mandatory.  My brave friend and colleague, Meg Edison, MD refused to re-certify for the third time, yet was forced to bend to the insurer demands.  We have two choices:  1) Become a Dr² –having all the knowledge and experience of a medical doctor without the regulatory capture or 2) Credential with NBPAS and leave ABMS and NCQA in the dust.  Regulations will not disappear until physicians realize there is no healthcare without our blood, sweat, and tears.  May we all find our way once more. 

If you are struggling under the weight of MOC requirements, please consider taking this survey developed by a Dr. Wes Fisher, who is leading a crusade against forced MOC compliance.  Choice.  Transparency.  Autonomy.  https://www.surveymonkey.com/r/PPA_MOCSurvey.

Saturday, February 3, 2018

National Women Physicians Day: We Stand on the Shoulders of Titans #NWPD

Februrary 3rd is officially recognized as National Women Physicians Day (NWPD), commemorating the birthday of Elizabeth Blackwell, the first woman in the U.S. to earn a Medical Degree.  Allegedly admitted to medical school as a practical joke, she completed her studies despite vocal critics who viewed her gender as inferior. From my perspective, this holiday honors many brave women who trailblazed the path toward gender equality – one we continue to negotiate today. 

A hugely instrumental figure in the movement was born and raised here in Kitsap County, Dr. Esther Clayson Pohl Lovejoy.  She was a pioneering medical doctor, a suffragist, a health policy advocate, and later, a congressional candidate.  Born in Seabeck, Washington Territory in 1869, she spent her formative years in Kitsap County, where she attended primary school, attaining high marks. 

She had a working-class upbringing, spending her youth employed at the Bay View Hotel, which her family operated.  As a result of her conscripted childhood, she vowed to find a career she loved which had a meaningful impact.  After her family moved to Portland, Esther met Dr. Callie Brown Charlton, who became both a friend and mentor.  Despite being widowed with a young daughter, Dr. Charlton made her way in medicine against social and financial obstacles.  When asked for career advice, Charlton told her medicine “was the best vocation possible for a woman.”  Dr. Charlton was right.

Medical education for women in the United States in the nineteenth and early twentieth centuries was shaped by region.  Attitudes in the West were more favorable to women doctors, affording some advantages. Esther Lovejoy began coursework at the University of Oregon Medical Department (UOMD) in the fall of 1890, earning tuition money by working as a department store clerk.  Despite earning a medical degree with honors, professors rejected her application for an internship, and male physicians refused to work with her.  Even with these impediments, she opened a medical practice in Portland with her husband, a surgeon. Her notoriety grew, and her practice flourished. 

Dr. Lovejoy was appointed as the Health Officer for Portland, and in that role, was a staunch public health advocate, believing healthy communities were the responsibility of citizens and their government.  At the same time educational and vocational opportunities expanded for women, the suffragist movement gained momentum.  Dr. Lovejoy thought voting rights for women were pivotal to keep homes and cities healthy.  She had a hand in women being granted the right to vote in Oregon, which was achieved in 1912.   She continued working with the National American Woman Suffrage Association (NAWSA) to pass the Nineteenth Amendment, a feat considered the single greatest achievement for women in the last century. 

Today, female physicians are standing on the shoulders of titans.  These women not only left the medical profession better than they found it, but also the nation.  In the mid-1890’s, women were only 7% of medical students across all institutions.  Today, one-third of all physicians and almost half of matriculating medical school students are female. Now it is our turn to collaborate, mentor, and inspire the next generation. 

National Women Physicians Day represents all that is possible for men, women, and children.   Despite facing ridicule for breaking down barriers, Drs. Blackwell, Lovejoy, and countless others refused to accept the status quo.  While occupational disparities remain more than a century later for women and minorities, it is through honoring the trailblazers who went before us that their mission endures.   Our culture needs to change so women feel valued and respected, comfortable and safe in the workplace, and are provided ample opportunities for leadership and growth.

Recently, a little boy and girl came into my office for check-ups.  The boy shared his dream of becoming a doctor.  His older sister incredulously said, “boys can’t be doctors, only girls are allowed to be doctors.”  Amused, I informed her the field of medicine welcomes all individuals regardless of gender, race, religion, ethnicity, or disability. We must only bring a heartfelt pledge to heal the sick and comfort the suffering with us to embark on a medical education.  There is no other endeavor in the world more rewarding than saving a life using your hands and your hard-earned knowledge.

On National Women Physicians Day, we should honor the courageous women who lighted the way and be mindful of the awesome responsibility of passing the torch to the next generation.   The onus is on the medical profession as a whole to foster an environment of encouragement, collaboration, and mutual respect.    Looking to the future, it is important to understand our past.  Thank you Dr. Blackwell, Dr. Lovejoy, and every medical doctor who continues fighting for equality.

Tuesday, January 23, 2018

Mayo Clinic Health System: Truth, Falsehood, and Ice Cream

The Mayo Clinic in Rochester has held the top spot on the U.S. News and World Report hospital rankings for the past two years, despite the closure of community hospitals that negatively impact rural Minnesota towns. 

Citing staff shortages, reduced inpatient censuses and ongoing financial challenges, Mayo decided to move all inpatient services from the hospital in Albert Lea, Minnesota, including labor and delivery, to a town more than 20 miles away. In response to pleas for reconsideration, Mayo Clinic Vice President Bobby Gastout callously remarked that 23 miles is not ideal — but “people are driving 23 miles to get their favorite ice cream.” 

A grassroots group, Save Our Hospital, galvanized the community by answering “we like our ice cream and inpatient care in Albert Lea.”

So how will our country, from the Midwest to here in Kitsap County, ensure health care access doesn't continue to come second to profits? 

Price transparency must be mandatory at non-profit hospitals if runaway healthcare costs are to be contained. Behemoth institutions are decimating rural areas after a decade-long buying spree. A study in Health Affairs magazine found nearly half of rural counties in the United States are without hospital-based OB services, a change affecting more than 2.4 million women. According to the University of North Carolina's Center for Health Services Research, 83 rural hospitals have closed since 2010. Hospital systems complain they are crumbling under the weight of lower reimbursements, rising bad debt from high-deductible plans, and dwindling admissions.

However, communities are entitled to see the proof in the pudding.

While touting $13 million in losses over two years as the central force behind the closure decision, in reality, Mayo misrepresented their facts and figures according to tax returns posted by ProPublica. Dr. Mark Ciota, CEO of MCHS-Albert Lea, reported the hospital lost $4.6 million in 2015, but the nonprofit's IRS 990 form showed a net income of $2.56 million. In 2016, the Albert Lea hospital projected a loss of $8 million, though residents eagerly awaited release of Mayo's tax returns to separate fact from fiction. Mayo conveniently overhauled its tax reporting process and filed a group return, a format which obscured financial performance of individual campuses, including Albert Lea.  Allen Baumgarten, a Minneapolis-based independent healthcare analyst, utilizes public records to calculate hospital profits and losses — he estimates the Austin-Albert Lea campus generated a net income of $1.2 million in 2016. 

Earlier this year, Dr. John Noseworthy, CEO of Mayo Clinic, feigned financial woes, complaining Mayo had to “prioritize commercially insured patients” over those on Medicaid and Medicare in the interest of long-term survival. Yet they had no reservations investing in the Destination Medical Center Project, a 20-year, $5.6 billion economic development initiative which will position Rochester (actually Mayo) as a global center to provide high-quality medical care to the wealthy across the world. Astonishingly, third quarter earnings show Mayo operating income more than doubled from $86 million to $182 million, with total revenue increasing 9 percent, from $2.72 billion to $2.97 billion.  In 2016, international investment income was $2.7 billion, while close competitors, Cleveland Clinic and Johns Hopkins, produced less than half that amount. 

Mayo benefits handsomely from public tax revenue while exempted from paying city, state, or federal taxes in exchange for “improving” healthcare access for struggling communities. While no one is questioning legality of these investments, ethically the loss of rural hospitals is hard to reconcile when Mayo pours $1.34 billion into offshore tax havens to reduce their tax liability.   

Ice cream may melt on a 23-mile drive, but ill and injured people may actually die traveling that same distance. Movements like “Save Our Hospital” are garnering national attention with good reason, as they are David bravely taking on Goliath.

To ensure access in rural communities, non-profit hospital institutions should provide transparent pricing to patients and share financial performance data with communities. Benjamin Disraeli said, “there are three types of lies – lies, damn lies, and statistics.” Mayo has fractured trust by misrepresenting operating losses in Albert Lea to justify hospital closure, Dr. Noseworthy condoned prioritizing patients based on their pocketbooks while third quarter earnings went through the roof, and hospital leadership condescendingly compared driving 23 miles in labor as being equivalent to buying ice cream. 

Places like Mayo are systematically dismantling rural care facilities without accountability for the generous tax exemptions they receive. The loss of one more rural hospital this year will be a loss for the entire nation. The battle for affordable, accessible, and high-quality health care is one worth fighting. Rural health care is far more important than ice cream.