Clinical trial
Supporters and detractors of Carilion’s plans seek to win hearts and minds

Dr. Edward Murphy is in the middle of a heated campaign, but he is not running for office. The CEO of Carilion Health System is trying to muster support for a plan to change the nonprofit hospital chain into a health-care organization resembling the Mayo Clinic.

Like a candidate stumping for votes, Murphy has been holding a series of community meetings, from Salem to Smith Mountain Lake, explaining why Carilion needs to undergo a $100 million transformation into a multi-specialty clinic.

Under the clinic model, Carilion would hire hundreds of physicians to create a multi-specialty group focusing on patient care, medical education and research. Murphy says the reorganization would streamline Carilion’s operations and help patients navigate the health-care system to get the treatment they need.

Not everyone is buying into the idea. An alliance of doctors not employed by Carilion says that the move could put them out of business. These physicians maintain private practices but use Carilion’s hospitals.  They fear that Carilion will close its facilities to doctors who are not employed by the health system.
In his community meetings, Murphy counters that the clinic plan is necessary for Carilion’s survival. The health system ended its last fiscal year with a $93.6 million surplus. But Murphy contends that Carilion cannot sustain its current position in the face of rising health-care costs. He projects that by 2011, Carilion will cease to have surpluses and will no longer be able to maintain and upgrade its medical facilities.  At that point, Carilion would have to sell its assets to a for-profit company.

Carilion’s solution is to:
• build a 100,000-square-foot clinic in the Riverside Center business park south of downtown Roanoke;
• recruit a larger pool of physicians;
• computerize and codify all patient records; and
• create a partnership in a clinical research institute with nearby Virginia Tech.

But Murphy’s grim assessments of Carilion’s current course have not convinced Dr. Jesse T. Davidson III, a vascular surgeon who is part of the Jefferson Surgical Clinic in Roanoke. “Dr. Murphy has presented this argument in very black or white terms,” says Davidson, a member of the board of The Coalition for Responsible Healthcare Inc., a group of about 200 local physicians who have voiced their opposition to the clinic proposal.  “It’s either the clinic model or we sell the hospitals to a for-profit corporation.  We believe there are other options available.”

The coalition was born out of an October meeting for nearly 300 physicians who practice at Carilion’s hospitals. The audience included doctors who are in independent practice and others who are employed by Carilion. After Murphy and others addressed the group, the doctors showed their skepticism by voting 198 to 88 against the clinic plan.

But Murphy says that the majority of the physicians involved in the vote were not employed by Carilion. “The decision we’ve made is how the people in our group will organize themselves,” he says.  “People outside the group just don’t get a say in that, just like we don’t get a say in what they do or how they conduct their business.  I think within the group there is real mounting enthusiasm about the direction we are going in.”

Carilion spokesman Eric Earnhardt acknowledges that its change of direction is unusual for the health-care industry. “We’re not aware of anyone else trying to change from an integrated delivery system model of health care, like we have now, to a clinic model,” he says.  (An integrated delivery system is a health organization with physicians and hospitals offering a wide range of services to patients in a region.) “What Carilion is doing is taking aspects of the clinic model we have observed elsewhere that we think will work well here and incorporating them. We’re not trying to overlay the entire Mayo Clinic model onto what we have here, just what we think will work.”

Davidson and the coalition believe  those changes will lead to a Carilion-controlled health-care monopoly, which could influence how patients choose physicians in addition to closing the doors of Carilion hospitals to nongroup doctors. “All the multi-specialty clinics that have proven successful have had a closed-staff policy,” Davidson says.  “That will drive private-practice doctors out of the community.”

The coalition’s opposition hasn’t stopped Carilion from proceeding with its plans. Groundbreaking for the clinic is scheduled for next spring.