Wednesday, July 21, 2010

Our community in the Middle Keys is at a turning point to meet its health care needs. Fishermen's Hospital Board of Trustees has a vision on the table that emphasizes a new way of looking at health care delivery to our community. Let me explain.

This vision emphasizes primary care and making it more available, and running Fishermen's as a rural primary care hospital. This would make Fishermen's Hospital a community hospital that serves everyone in our community, including long-term residents, winter residents and tourists. These groups would include both the insured and uninsured.

Fishermen's needs to be a full-service hospital with an emergency room, and provide inpatient and outpatient medical, surgical, and rehab services. The facility should also provide laboratory services and a full array of diagnostic testing. Fishermen's received a Critical Access Hospital designation from Medicare in February 2010, which allows for higher Medicare reimbursements -- plus a lot more services.

Let me first explain what is meant by a Critical Access Hospital. This does not mean taking care of critical cases by any means, or only having just an intensive care unit, as some have interpreted this designation to mean. The best definition for a Critical Access Hospital is a "rural primary care hospital."

It's a primary care hospital with a focus on preventive care and the general essential, everyday service needs of people in a rural community, such as those of the Middle Keys community, without traveling the distance to a metropolitan populated area. Should a patient require more significant services than a rural primary care hospital can provide, those patients will be sent to the best possible place for those vital services.

As an example of preventive care service, the hospital can provide information to diabetics with nutrition, exercise and weight loss programs. In addition, Fishermen's can provide general surgery and pain management services. If we are successful at providing these primary care services, then the specialists will follow. This includes specialty services we do not have now, such as a rheumatologist and an endocrinologist. We can have diagnostics for digital mammography, MRI, CT and cardiology.

It is important to note that the ER will not be the principal focus. We will emphasize our primary care physicians, have clinics up and down our service area to care for our community, and hospitalize sick patients if necessary for short stays.

We'll have the opportunity to use swing beds -- a special designation for a Critical Access Hospital -- to rehab patients, keeping them where they live and where they want to be following surgery or after an illness, and keep them in their own community, where they would also have support from their family and friends. For example, we can keep our postoperative orthopedic patients here and take transfers from Lower Keys Medical Center for rehab after surgery, or send patients needing an ICU stay or acute care longer than four days to Lower Keys Medical Center or Baptist Hospital on Kendall in Miami, where we currently send our cardiac patients now requiring specialty care.

Doing these things will enable Fishermen's to employ our own physicians, nurses, and clerical staff to work in these clinics.

This is a vision for a different kind of health care delivery system than we currently have, and one that will gain strong community support as well as bring our physicians back into supporting our hospital.

I think everyone in our community needs to sit down and think long and hard about what they want, and let the members of our Fishermen's Hospital Board of Trustees know where you stand. We will be making this decision over the next 45 days.

Dr. Scott M. Burns is the chief of staff at Fishermen's Hospital.