August 27, 2007
Mr. Carlyle Walton
Takoma Regional Hospital
401 Takoma Ave.
Greeneville, TN 37743
Dear Mr. Walton:
I would like to thank you for all the assistance Takoma has given PATMOS in the past, especially in providing pricing information for many of its routine outpatient services and even discounting them to the uninsured who comprise 60% of my patients. Even after Takoma became a part of the Wellmont Health System (WHS), it has continued the same policy of making pricing information available so that I can better assist my patients in determining cost effective strategies for diagnosing their medical problems.
The purpose of this letter is to make four requests.
1.That Takoma lower the prices of the services mentioned above. Ever since Takoma has become a member of WHS, the prices of the services mentioned above have gone up substantially – most of them by more than double, some as much as tenfold, and all well above Medicare reimbursement for them. You should know that even though Laughlin has yet to provide a price list of its services (despite my multiple requests), I have found through feedback from my patients that the facility fees for these services are now generally much less than Takoma’s. Physician practices in Johnson City and Kingsport are sometimes providing better value than both Laughlin and Takoma. Some of my Greene County patients are willing to use them despite the inconvenience. In the future, I hope that Takoma will re-evaluate these prices and decide to reduce them.
2.That Takoma assist PATMOS in recruiting, relocating, and providing a reasonable income guarantee for a physician to join me in this practice. During our meeting last fall, I mentioned that I was looking to add another physician. Because Takoma was going through negotiations with WHS at the time, you recommended we postpone the discussion. I would like to bring it to your attention again because increasingly I have to turn new patients away (many who are uninsured) in order to be able to see my established patients in a timely fashion.
Takoma has had a policy of assisting other medical practices with recruiting, relocating, and providing reasonable income guarantees for new physicians, even some who (like me) do not admit to your hospital. In fact, with your new hospitalist program I would imagine that many of your new physicians do not admit to the hospital. It would only be fair to assist my practice as well. In addition, PATMOS has benefited Takoma directly by referring patients there and relieving it of the burden of some of its uninsured.
PATMOS, I believe, adds unique value to our community. It now has nearly 8000 total patients and 5000 uninsured. Since starting in 2001, there have been over 30,000 total visits with over 20,000 from patients without insurance or with high deductibles. There probably is not another private practice in this country with a similar record of service to these neglected populations that does not presume upon other taxpayers either through direct government grants or non-profit incorporation. Having another physician here would enable the practice to double the hours its services are available to these persons.
3.That more WHS specialists have regular clinics at Takoma. Being able to refer patients to the cardiologists at Takoma has been a major benefit for my patients and the community. Extending this to other specialties would be a tremendous service as well. I am finding it very difficult for even my insured patients to obtain an appointment within a month with the following specialists – rheumatologists, neurologists, pulmonologists, urologists, pain medicine specialists, psychiatrists, and orthopedic foot specialists (not a podiatrist).
4.That Takoma hospital and / or its foundation or WHS and / or its foundation enter into a discussion with PATMOS about how to assist some of the uninsured patients that I identify through my practice who could benefit from strategic and cost effective specialty referrals and procedures.
I try to take care of as many medical problems of my uninsured patients as possible before referring them on to specialists. In addition, PATMOS has and will continue to use its own financial resources to pay for tests and referrals for patients who truly cannot afford them. However, I find on occasion uninsured patients with medical problems that require services that extend beyond this practice’s capabilities and who (along with the general community) would benefit many times more than what these services cost. For example, I have patients who would benefit unequivocally from various orthopedic procedures, from thyroid ablation, and from many other procedures this practice cannot provide or even afford.
Caring for people without insurance who need expensive procedures is a complex issue. Fortunately, most of the procedures would be definitive so that for many there would not be the expense of follow up procedures or protracted care. I know of no other way to deal with these patients except on a case by case basis, which is where my experience in providing cost effective care should be of value. I believe I could identify the patients best suited for strategic assistance and could work in partnership with your foundation to see that they obtain the care they need as inexpensively as possible. I would be happy to bring some of these cases before your foundation in the near future.
I hope I have not presumed too much with these four requests. I believe they are reasonable, fair, and consistent with the mission of your hospital. I look forward to hearing your responses to them in the near future.
Sincerely,
Robert S. Berry, MD
