Tuesday, May 20, 2003

Study finds gaps in health care



By Tim Bonfield
The Cincinnati Enquirer

Compared to other Midwest cities, the supply of doctors in Greater Cincinnati is "significantly" below average in 14 of 33 specialties.The supply of nurses and the fiscal health of area hospitals also are worse here than in other nearby cities, according to a report released Monday by the Greater Cincinnati Health Care Data and Trends Task Force.

"What we have found is a lot of substantiation of a lot of the anecdotal information we've been hearing about in our community," said Lynn Olman, president of the Greater Cincinnati Health Council and the spokeswoman for the task force.

The 17-member task force was formed last year by the Cincinnati Business Committee and the Health Improvement Collaborative of Greater Cincinnati. Its members represented doctors, nurses, insurers, hospitals and employers, but not patients, consumer groups or governments.

The study compared health trends in Cincinnati to two groups: a Tristate group including Columbus, Dayton, Indianapolis, Lexington and Louisville, and a Midwest group including Minneapolis, Milwaukee, Nashville, Pittsburgh and St. Louis.

UNDERSTAFFED
Relative to other regional and Midwest cities, Cincinnati has substantially fewer physicians per capita in 14 specialties. They include:

• anatomical/clinical pathology
• anesthesiology
• cardiovascular disease
• general surgery
• neurology
• ophthalmology
• pulmonary diseases
• colon and rectal surgery
• diagnostic radiology
• gastroenterology
• neurological surgery
• orthopedic surgery
• radiation oncology
• thoracic surgery.
Source: Greater Cincinnati Health Care Data & Trends Task Force
Among the findings:
• The supply of specialist physicians per 100,000 residents was 15 percent lower in Cincinnati compared to the Tristate cities and 14 percent lower than the Midwest cities.

• Of 33 specialties examined, 14 were in significantly lower supply, including anesthesiology, cardiology, general surgery, neurology, ophthalmology, lung disease, neurosurgery, thoracic surgery, orthopedic surgery and radiation oncology.

• Two specialties were considered in excess supply in Cincinnati: pediatrics and occupational medicine.

• The supply of registered nurses was 19 percent lower in Cincinnati than other Tristate cities.

• The average profit margin for Cincinnati hospitals was a negative 0.9 percent in 2001, compared to a positive 3.2 percent for hospitals in other Tristate cities.

• Malpractice insurance rates here were higher and rising faster than in many other nearby cities.

• The overall penetration rate of managed-care health plans was lower in Cincinnati than elsewhere in the Midwest.

The task force was formed last year in the heat of controversy over allegations that Cincinnati was suffering from a brain drain of specialist physicians, which had raised deep questions about the future of health-care quality for Tristate residents.

During a series of public hearings held in Cincinnati by a subcommittee of state legislators, a parade of doctors, practice managers and hospital executives told officials that many doctors are leaving town for better pay and that groups are struggling to attract new doctors to town. They also said high numbers of doctors remaining in town are pushing retirement age.

All these concerns were described as affecting waiting times for appointments, the ability of hospitals to provide emergency care, and the ability of the health-care system to keep up with new technology and the rising demands of an aging population.

Many of the doctors' claims were dismissed at the time by insurers and employers as anecdotal. Even now, disagreement remains over whether Cincinnati doctors really get paid less than colleagues in other cities and whether the quality of health care in the city is suffering.

"I think the report shows that there's some opportunity for improvement in Cincinnati. I think it also shows there isn't a crisis at the present time," said Paul Beckman, vice president of the southern Ohio service area for Anthem Blue Cross and Blue Shield.

Anthem and others dispute the idea that most doctors in town are underpaid.

Beckman does say that "certain specialties" are in short supply, and that concerns about nursing supply and the hospital fiscal situation are real. However, Beckman said most hospitals in town already are getting better contracts from insurers and that only so much can be done to address a nursing shortage that appears to be nationwide.

Ultimately, however, the insurers are just trying to serve their clients - the employers.

"We need to get the business leaders together with the hospitals to decide on what a reasonable profit margins are for hospital systems," Beckman said.

Doctors, however, see vindication in the report.

"The report confirmed what we've been sensing in the city for a while," said Dr. Joe Hackworth, a cardiologist and former president of the Academy of Medicine of Cincinnati.

However, Hackworth said few people seem openly concerned about physician supply shortages or any of the other health-care issues.

For one thing, few people pay attention to health-care issues until they - or someone they love - gets sick. Even then, very few people can compare the hassles they face getting good care to what goes on in other cities, he said.

"But I do think these (health concerns) will show up down the road when people find out they have to go out of town to get care," Hackworth said.

Monday's task force report was described as a first phase, with more study planned to delve into issues raised by the statistics.

Among the still unanswered questions raised by the report: How does compensation for Cincinnati doctors compare to doctors in other cities? How did Cincinnati's supply of doctors and nurses get so low? What should be done about it, if anything?

"This report was just about supply. It doesn't try to answer why it got that way or whether it is good or bad. We will let people draw their own conclusions," Olman said. "But we do have some areas to work on. And one of the biggest questions we have to decide is what kind of health-care system do we want to have in Cincinnati?"

E-mail tbonfield@enquirer.com.

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