Something in the USA has to Work Right: A

Non-Profit Hospital in Virginia Actually Does

by John Stanton-24.03.2015

It is easy to severely criticize the state of

many things in the United States of America: the US
President and Congressbowing to the demands of the
national security community to exempt their $ 1 trillion (US) spending from
sequestration mandates. The demise of Detroit, Michigan and another round
of water shut-offs scheduled for April that will affect nearly 100,000 residents (the
Detroit bankruptcy case judges ruled that residents have no inherent right to clean
water). The geopolitical brinkmanship with Russia and China that, if pushed too far,
could lead to World War III. The odious double standards applied to leakers of
classified military and intelligence information js repulsive: former US Army general
and CIA director David Petraeus gets no jail time for passing off military secrets to his
lover Paula Broadwell, yet former CIA analyst John Kiriakou gets two years in federal
prison.
Then there is the much maligned Patient Protection and Affordable Care Act
(ObamaCare), which happened to shed an unwanted bright light on the often seedy
political/special interest mechanics of the health care industry. Open Secrets reports
that for the year 2014 there were 392 hospitals and related organizations that
employed 802 lobbyists (even the Carlyle Group known mainly for defense and energy
related interests was a client). Over half, 54.1 percent, according to Open Secrets, of
the 802 lobbyists were revolving door individuals, those that move seamlessly from
government oversight of health care practice to lobbying positions in industry that
seek to limit oversight of their operations. Former health industry employees move
into government positions as well.
Even defense contractors have muscled their way into the health care industry. If they
can track missiles, Lockheed Martin says, then they can track patients.
Is there anything in the USA worth positive coverage?
Chef Garrett: If not a Surgeon, a Chef

Inside the Washington, DC Beltway in Arlington, Virginia there is a medical facility

known as the Virginia Hospital Center. It is a non-profit organization whose Chairman
of the Board is a no-nonsense doctor and administrator named John Garrett.
He also is a practicing cardiologist/thoracic surgeon who takes on patients regularly
(Chairman Mao would have applauded this back-to-the-fields approach for the benefit
of the masses). In an interview with C-SPANs Brian Lamb in 2009, Garrett talked
frankly and informatively about being at the helm of the Virginia Hospital Center and
the issues that impact his surgical practice and the hospital operations he oversees.
It is worth tuning in to what Garrett has to say because the machinations of the health
care industry in the USA, and the hospitals and practitioners who operate in that
machinery, exist in a messy stew of complexity that also includes
suppliers/manufacturers of drugs and medical equipment; lobbyists/lawyers, national
politics, and special interests of all types ranging from the Academy of Nutrition and
Dietitians to Naturopathic healers. His insights carry weight as all of us, rich or poor,
or somewhere in between those poles, will ultimately turn to practitioners like Garrett,
and the people and facilities he administers, to save our lives or, at least, minimize our
pain and suffering.
And yet most Americans know very little about the nuts and bolts of the US healthcare
industry or the people in it who brought them into this world and will likely see them
out of it too. They know little abut the difference between non-profit and for-profit
healthcare institutions or the challenges that medical professionals face. Americans
generally are capable of talking up the soundbites from listening to many pro and con
ObamaCare advertisements or the latest television commercial for 1-800-ambulancechaser, but not what is on the minds of physicians as they ply their trade.
Roaming Clergy
Thirty days in Garretts sprawling Virginia Hospital Center campus, as a sometimes
delusional, onery patient, provided a golden opportunity to observe close-up his people
at work. Being hammered and immobilized by an MSSA staph infection is not the way
I would have liked to conduct an investigation into the operation of a large hospital.
On the other hand what better way to experience the healthcare system at work than
by being immersed in it as patient and skeptical journalist/observer. After five
surgeries, an induced coma, one failed escape attempt, in-home nursing care for two
months, and umpteen visits to infectious disease, wound care, and thoracic specialists,
Ive earned some credentials as a veteran patient. As an assistant, teacher and coach at
a high school my health plan is not gold plated, but certainly a fine one. The bills will
come due shortly and there will be empty complaints on my part as the alternative

involved ashes and wind.

One oddity was notable during my hospital stay, at least to me. Laying in the hospital
bed staring at the cracks in the ceiling, I was interrupted now an then by unsolicited
individuals who turned out to be lay clergy. My first encounter went something like
this. Stanton: Hello. Lay Clergy: Hello. Stanton: Who are you? Lay Clergy: I am
a lay member of clergy, would you like a prayer? Stanton: No but thank you. What
denomination are you? Lay Clergy: Episcopalian. Later there were members of the
Catholic and Methodist Faiths who visited and one who was a multi-faith person.
At any rate, we turn to excerpts from Doctor Garretts interview with Brian Lamb,
edited for clarity.
"We are a not for profit hospitalnot for profit hospital doesnt mean we dont make
money. We have to make money. But it means that we dont have shareholders, that
were not responsible to anybody but our community. We are a 501(c)(3) organization,
tax exempt, and basically what we do here is we try to either break even or have a small
margin of profit. Last year we had a 1.6 percent margin. So what we do with that profit
is we invest it back into equipment. You know we try to have the latest and greatest
that medical science has to offer. Two years ago we purchased a $7 million dollar cyber
knife. Thats a very specialized piece of radiation equipment. But thats what we do
with our money. We dont give it out to shareholders. But its not to say that we dont
need to make incomeWe employ a lot of people, and this is not charity"
"So many patients just want you to do what you do, theyre grateful for it, they dont
need to know a lot of details, theyre interested in when they can go back to work,
theyre interested in the likelihood of them dying. But a lot of the other details I think
theyre not too interested in, and so it really puts the burden on us to, I mean, we theres certain things you need to know, and we try to tell patients those things even if
theyre not too interested."
"we offer all private rooms to patients, regardless of their need to or ability to payI
think its unacceptable to share a room in this age with another sick person. Its better
for the patient to have a private room. Thats the main reason we did it.
Medicare and Medicaid Woes
"about half of what we do here is Medicare and Medicaid, so about half of our
admissions in this hospital [are for] Medicare and Medicaidwe lose money on all
Medicare and Medicaid patients. Medicare and Medicaid covers at best about 80
percent of the cost, not the charges, but the costAnd so the thing that I guess I want
to tell people is that so far what weve seen is thegovernment controls cost [and to do

so] they just pay you less, and we take that, we accept that, but we would have to
change what we do if not for the private insurance carriers whom we aggressively
negotiate with to get rates that are 140 percent of Medicare. Because were able to do
that, were able to make our 1-1/2 percent margin so that we can buy a cyber knife for
$7 million dollarsIf we did not get extra money from your company [C-SPAN health
insurance], if all we got was what Medicare paid, then do the math. We lose 20
percent. Well, were a business. We cant lose money. So we either go out of business or
we offer less so that we can break even. Well, offering less in healthcare means that we
dont give you the latest and greatest, which you know is not as good."
"Doctors charge separately in the hospital. So, if I do a Medicare operation, a
Medicare coronary bypass surgery, I accept what Medicare pays me: Its about
$2,000Surgeons are paid globally, so you know if I operate on you, I get one
payment and you and I are married, So, for that month or until I get you well, thats
what I get paid. So, I can see you 10 times a day, I can you know if you have
complications, come in in the middle of the night, do whatever it is, I get that one
paymentAnd for the hospital its similar. They get whats called a DRG payment, and
its based on the diagnosis. So, for bypass surgery, I think its about $18,000 that the
hospital would get from Medicare to pay for whatever happens to that patientit costs
more than that. Im not sure exactly how much more than that. I mean, my - were way
beyond what we charge, What we charge and what we collect is totally different"
"There used to be more money in the systemmedical care gets better and better every
year, New technology, its expensive, but its better and better. Things used to be
cheaper, but you know were of the mind that theres nothing thats too expensive. We
want the latest and the greatest. Were willing to pay for it, and we have. But that
occurs at the same time in parallel that were getting paid less, the hospitals getting
paid less.
You know I - most doctorstruly did not go into medicine to make a big income. I
think at least the physicians in my generation were attracted to medicine by you know
what you can do for people, and the idea that you could be independent, work for
yourself, sort of be your own personwhat we do in a hospital as our default is to help,
is to save people, and in doing that we dont think about the money. We dont. Its the
last thing on a physicians mind is what money were spending to bring someone back.
Young Americans
young physicians see a different horizon than guys and girls in my era,and I think
theyre much more protective of their private time. I think that theyre much more
eager to be employed, to not have the responsibility to run their practice. I think part
of thats because its hard, the opportunity to hang out your own shingle now is very

difficult. Its too expensive. You cant afford it. And so you know young people dont
want to take that risk, and theres more of a shift mentality you know. In my group, we
sort of never get away from it, even on our nights off, youre still a little bit on edge. Its
what you do. Its part of your life, and I think that the newer generation of physicians,
theres more of a you know you work your shift, theyre long hours, but at the end of
things you really are off and you have your life. That is what it is.
Chumley, Get me Out of Here
"a lot of people that come into emergency rooms dont want to be there, They didnt
plan to be there. Its not like you have a relationship with me, you picked me as your
doctor, I operate on you and something doesnt work out right, thats different.
Emergency room, you come in, you dont want to be there, you dont know anybody,
nobody knows you. If its really a bad situation, theres lots of things going on, things
can drop through the cracks without tight protocols.
"what motivates someone to have a for-profit is to profit, but I think not-for-profit is
the best for the country because I think its cheaper. I think if not-for-profit hospitals
can adopt some of the fiscal restraints that for profit hospitals have, it would be a
valuable thing to do. But keep that savings as opposed to giving it out to shareholders.
But in a full profit system, that money savings goes to shareholders. In our system it
goes back into this hospital."
Scary Things
"the thing that scares me the most [about the healthcare debate] is just the thought
of having sort of like a massive [government] Medicare or Medicaid [system] and
having all of the inefficiencies that brings, and ending up with a system that is poor, a
hospital system thats poor and having no ability to offer really the best to our patients.
Thats what scares me the mostwe lose 20 percent on Medicare admissions, and so if
we lost 20 percent on everybody that came in, wed have to do something different,
and as part administrator, the first thing I would do is limit our capital budget. So, the
new stuff that we buy, every year we buy $30 million dollars worth of new equipment
here, that would stop. It would have to stop. We would have to lay off people because
wed have to make up that 20 percent, so the easiest way to make it up is to not buy
new stuff, and thats what we do in our personal life. But when youre talking about
healthcare, new technology is expensive, and the people that are driving new
technology expect a return on their investment."
"I think everybody needs insurance, so you know if you dont have insurance, you need
to get insurance.Im not a politician, but theres something to be said about

insurance reform and making insurance more competitive so that even people that
dont have a lot of money can have some insuranceYou know the only person that
ever asked me about how much something cost was someone who had money but no
insurance. They want to know whats it going to cost because theyre going to write a
check for itSomehow we all need to feel some of the pain of other than writing a
check for the insurance company. We need to feel that cost issue. But I do think there
needs to be insurance reform, and I think everybody needs insurance, but I would start
with trying to make there be more competition between insurance carriers so that
theres affordable insurance."
John Stanton
John Stanton is a Virginia based writer. Reach him at captainkong22@gmail.com
Posted by Thavam