By Ronald Barg, M.D.
I was recently told by my son that Lankenau was becoming a heart hospital. It had to be true, he heard it on Action News. As an active member of the medical staff this was the first I heard about the coming changes. I was not alone, most of the members of the medical staff heard about the projected changes in similar ways. Over the next several days we were all confronted with questions from our patients we could not answer. A hastily organized staff meeting took place where the president of Lankenau confirmed the planned changes but left the medical staff with more questions than answers. Cardiac surgery and high tech invasive cardiology within the Main Line Health System would be concentrated at Lankenau Hospital and some as yet defined clinical services would move from Lankenau to Bryn Mawr Hospital. What would prompt a financially successful hospital to plan such sweeping changes? According to the Main Line Health Administration these changes were necessary to maintain the viability of the system.
A closer look at the situation, however, would indicate the changes planned and the way in which they were announced were ill-conceived. One of the key elements that was missing in the public announcement was the goals of Lankenau Hospital and Main Line Health. I would submit that the primary goal of a community hospital is to meet the health care needs of the community it serves. Lankenau Hospital has functioned as a successful high tech health care provider for West Philadelphia, the Route 1 corridor and the eastern Main Line. The conversion of Lankenau to a heart hospital leaves these communities disenfranchised, and this feeling is quite evident in speaking with the residents of these communities. Other lesser goals are to support the medical staff, employees, educational programs and research programs that are focused around the hospital. The medical staff, with the exception of the cardiologists, obviously have an ill-defined future at Lankenau. Their ability to function as anything other than a cardiac support service is in question. Can the specialists continue to attract referrals and adequately care for their patients at a facility that only does cardiology? Do they need to relocate their practice and thus start from scratch? The primary care physicians have other problems. Where can they care for their patients? Will their practice be compromised by a move to another hospital? Employees of Lankenau who are not involved in the care of cardiac patients are concerned that they will be displaced. There is a lack of confidence in the changes that are planned and many are concerned about the long-term viability of the institution and their jobs. The educational programs are in limbo. Their ability to attract quality house officers is compromised by an uncertain future. Lankenau Hospital has a history of high quality research. Where do these programs fit into the future? All of the above issues have been addressed only with lip service and no clear-cut answers have been issued.
The ramifications of the planned changes will be harmful and long-lasting for Main Line Health. This will severely compromise the ability of Lankenau Hospital and all of Main Line Health to attract quality physicians in anything but cardiac services. The reputation of Lankenau Hospital to deliver quality non-cardiac care has been instantaneously harmed. The referral patterns of the community physicians have been disturbed. Although on the surface this should not affect cardiac services, the fallout of these changes will change the non-cardiac referral patterns and as a consequence, affect the referral patterns for cardiac care. A significant amount of cardiac services are gotten thru primary care referral patterns. These will change, resulting in the movement of patients, cardiac and non-cardiac to other institutions and health care systems.
The effect on Bryn Mawr Hospital is a little more complex. There had been rumors that Bryn Mawr would close with movement of services and physicians to Lankenau. This announcement would seem to reinforce a commitment to keep Bryn Mawr Hospital open and active. A closer look, however, does not support this. The projected need for hospital beds across the Main Line system show a continued decline. A large percentage of the revenue generated at Bryn Mawr relate to their cardiac services. It is hard to imagine the loss of revenue related to movement of these services to Lankenau can be made up with services moved from Lankenau to Bryn Mawr. The most important adverse effect of the proposed changes and how they were announced has to do with perception within the patient and physician community. These decisions were done without physician or community input. The problems that these changes would create were not adequately addressed at the time of the announcement. This has created a feeling of distrust between the administration, the medical staffs and the community. In a time of fast-paced change the ability of a health care system to survive is based on the ability of all parts of the system to work together to make changes with well defined goals and appropriate input from all sources. It is in this way that Main Line Health has jeopardized it’s future survival.
Although it seems clear that the plans announced by Main Line Health are ill-conceived with an inadequate plan for implementation, these types of decisions and the problems that accrue will become increasingly common as our health care system evolves. There is a need for change and an inadequate structure to make the change in an organized fashion. As the health care system changes, jobs will be lost, patients disenfranchised and physicians displaced. The successes will occur where there are well-devised plans for the future and a good working relationship between the administrative side, the physician side and the community side of the triangle. Physicians need to get reinvolved in administration to make sure the changes that occur are done with the needs of our patients and fellow physicians in mind. We need to cease to be viewed as advocates of a outdated health care system, but rather, as a voice for rational change with the goal of high quality health care for our patients with the reality of cost constraints in mind.
Ronald Barg, M.D., is an internist on the medical staff at Lankenau Hospital.