Renewed Medical Center Focus On Tap at Methodist

The Daily News
April 29, 2008
By Scott Shepard

When a search committee at Methodist University Hospital started looking for a new CEO, they had a demanding wish list: someone with diverse experience to run a large, complex facility; an academic mindset to serve relationships with the community's universities; and - toughest of all - someone who could lure primary-care doctors back to the Downtown Medical Center.

Who they got was Kevin M. Spiegel, who has run hospitals big and bigger, is an experienced teacher, and even has a strategy for bringing doctors into the fold. Spiegel began work in March.

"He told me how, every other night of the year, he and his wife take a doctor to dinner; he's constantly wooing doctors, learning how he can help them and partner with them," said Bryan Simmons, an infectious disease specialist at Simmons & Tettelbach who is medical director of Infection Control at Methodist University and was the voice for physicians on the search committee.

"You know the hospital administrators are going to protect their interests, so I concentrated on how he would be as a physician advocate and an advocate of private-practice physicians. With Methodist and (University of Tennessee Health Science Center) we have administration and structure, but private physicians are more random; we come and go."

Following the population

In recent years it has been mostly go and mostly to East Shelby County. That's a long-term threat to the hospital. Traditionally, primary-care doctors account for a huge number of admissions. Social and economic factors are driving them out of the central city.

TennCare pays 40 to 60 percent of the rates of private insurance, and the inner-city population increasingly is becoming a TennCare population. Likewise, Medicare reimbursements have been going down for seven years; private insurance companies base their payment formulas on Medicare, so that money also has gone down.

It adds up to a three-way squeeze that drives doctors east in search of private-pay patients.

"(Methodist University) Hospital once had a much larger private staff," Simmons said. "A lot of doctors now live out east and ask themselves why they should drive 40 minutes when they could go to Baptist or Saint Francis."

When TennCare began in 1993, St. Joseph Hospital administrators said the exodus of doctors would kill the place. Less than four years later, St. Joe merged with Baptist Memorial Hospital and was closed.

By 2001, the 19-story Baptist Memphis along Union Avenue closed, and was torn down in 2005.

"St. Joe was once the world's largest private-practice hospital," Simmons said. "Now, a lot of people are worried that Downtown hospitals are a phenomenon of the past."

Bring 'em back Downtown

To reverse the trend, Spiegel said, means dealing with such realities. It's illegal to pay doctors for referrals or even to give them a break on rent, so there must be a new strategy.

"There needs to be a good job of tertiary care, but at some level you also need to bring in that family doctor, to rebuild the infrastructure of primary care," Spiegel said. "You have to look for doctors who are dedicated to patient care; if the doctor is focused on money you probably don't want them."

One major attraction of Methodist University, he said, is a core group of primary-care doctors dedicated to such a mission. They're developing a strategy to identify good candidates and then team-sell the idea that Downtown offers personal and professional rewards outside of money.

Spiegel began work after a tour of duty as president and chief operating officer of 350-bed Trumbull Memorial Hospital in Warren, Ohio. He's credited with expanding Trumbull's market share and developing a regional cancer service in conjunction with Cleveland's University Hospitals.

Back to the classroom

Prior to that, Spiegel was senior vice president of the 1,100-bed Westchester Medical Center in Valhalla, N.Y. With its affiliation with the University of Tennessee Health Science Center, Methodist offered something similar to the New York experience.

"I love the academic complexity; I missed that when I was in Ohio," he said.

Spiegel was also an assistant professor in the Masters of Public Health program at Hofstra University in Hempstead, N.Y. For 13 years he taught courses in health policy and health business ventures.

At some point, he said, he hopes to teach at the University of Memphis, where Methodist Healthcare sponsors several health administration programs, with classes often led by Methodist executives.

"I work day and night," Spiegel said.

Nurse Peggy Troy, COO of Methodist Le Bonheur Healthcare, described Spiegel as "a high-energy leader."

Added Simmons: "If he's got a problem, he's too much of a Type A. And he puts it all into his work."

Spiegel said he discovered something else in Memphis that only a well-seasoned health care professional can fully appreciate.

"Spirituality is an integral part of the healing process; if you want to enhance the patient experience, you integrate it," he said. "I wanted to go to a faith-based organization that believes their mission is to sustain a whole culture that cares about the patient."