Growing Pains

Net Losses-and Gains

But LMHS is not without competition, and the musical beds might reflect an awareness of that. HCA, a Nashville, Tenn.-based corporation that owns 191 hospitals across the country, plans to consolidate its two Lee County hospitals by moving Southwest Florida Regional Medical Center from its present location in downtown Fort Myers to the campus of Gulf Coast Hospital in south Fort Myers, right in HealthPark's back yard.

Though this is a net loss of 200 beds, Mark F. Weber, president and CEO of Southwest Florida Regional Medical Center and Gulf Coast Hospital, boasts that the new facility will be "the only full-service hospital providing services ranging from obstetrics and pediatrics to open-heart surgery, neurosurgery and organ transplantation." (Currently, Southwest Florida Regional Med-ical Center has the region's only organ-transplant center).

Despite dueling strategies, LMHS and HCA do appear to be on much more civil terms than NCH and HMA. John Wiest, chief financial officer, and Jim Nathan, president of LMHS, both agree that the region is "blessed" with excellent health-care choices. If there are tensions between the nonprofit (LMHS) and for-profit (HCA) models, they're handled politely.

HCA's Weber explains that "both not-for-profit and for-profit hospitals provide charity care, and are incurring increasing bad debts." Employers and insurance companies are requiring patients and family members to spend more out of pocket, which in many cases, they're unable to pay.

According to both hospital groups, the problem is not greedy hospitals that don't want to serve the poor, but a failing health-insurance system.

"Insurance costs are on the rise for a variety of reasons, from the rising costs of drugs and other medical supplies and devices, to the rising costs associated with providing care to the uninsured," says Weber. And, he notes, "Health-insurance companies are more profitable today than they have been in the past 20 years."

Wiest agrees. Medical malpractice costs, he says, have put pressure on physicians to shift to outpatient and less risky business options. That search for the safe dollar, from sources like elective orthopedics (think rotator-cuff repair from a tennis or golf injury), for example, "has forced hospitals to compete more vigorously for patients."

Still, increased competition may not be altogether a bad thing for the public. Both institutions cite big plans to offer more and better services. Dr. CB Rebsamen, LMHS' chief medical officer, rattles off a list of innovative techniques and services not available even a few years ago that have improved patients' survival rates and quality of life, including "clot-buster" drugs, "space-age" implants and prosthetics, and greater safety measures.

Weber concurs. "We talk a lot about the rising costs of health care," he says. "However, if you look at the benefits we have delivered for a dollar invested in health care over the past few decades, they are tremendous."