Health-care exec: Expect an ‘oligopoly of hospitals’ for the future

Health-care service is changing not only in Prince George’s County but across the nation.

The shifts are so dramatic that small hospitals in communities across the nation will likely not survive what is coming their way, says Neil Moore, chief executive of the private nonprofit Dimensions Healthcare Systems — which operates hospitals in Prince George’s County.

He would know. Moore is overseeing the transition of the county-based health-care system into the larger corporate hands of the University of Maryland Medical System (UMMS) — and has had to weather the outcry of a decision last year to shutter operations at one local hospital to respond to the changes.

Moore spoke to The Washington Post about the future of the industry, as well as the status of the proposed regional medical center in Largo that is currently under review for approval by state regulators.

Question: What impact are the changes in health care having on hospitals, such as the ones Dimensions operates in Bowie and Laurel?

Answer: “If you read what is happening in health care you will see that single hospitals are not surviving anymore because of the changes in Medicaid and Medicare reimbursement and other industry dynamics. … I would not be surprised if we are headed to an oligopoly of hospitals where there is no longer a sprinkling of little hospitals across the country but large health-care institutions.

… This is something that is happening industry-wide with the Affordable Care Act and the focus on providing better health care in an outpatient setting.” (Moore explained that this thinking led to the decision about reducing services at Laurel Hospital, where volume declined significantly.)

Question: Has the recent reversal regarding Laurel Hospital made you rethink the Dimensions board’s decision to convert the hospital into an ambulatory care facility?

Answer: “In my mind it was a sound decision, and my position hasn’t changed. Nothing new came to life and [UMMS, community members and elected officials] basically just adopted what the Dimensions board came to in terms of our conclusion. …

When you are losing $20 million a year, as a management team what do you do? If the board had not made the decision, someone else would’ve questioned our fiduciary responsibility.”

Read more: New lease on life for long-troubled Laurel regional hospital

[Univ. of Maryland Medical System take-over of Pr. George’s hospitals seen a must]

Question: What kinds of things has Dimensions done to put its financial house in order ahead of the expected merger with the University of Maryland Medical System?

“When you have a merger, you need to to be in good business order. We have implemented a strategic plan focused on three goals: becoming more cost-effective, providing good patient care and reducing costs. We have renegotiated supply chain contracts for all three facilities we operate. We have made improvements to our contract with SEIU 1199 (the labor union representing most hospital workers) and added programs that increase revenue.

Our cardiac program under Dr. Jamie Brown has handled 200 heart cases since it launched two years ago and we’ve had no deaths. We received a 3-star rating for our program which only 10 percent of hospitals in the country have.

We have been on this journey to be more efficient, cutting positions and re-purposing departments so as not to spend more money than necessary. We established wellness clinics in Suitland and will open another at the pavilion in Laurel.

… It is a challenging institution but if you look at the details, we are leaps and bounds ahead of where we before. It’s not the same Dimensions of 10 years ago.”

(Soon after Moore became Dimensions’ chief executive in 2012, he implemented an electronic medical record-keeping system that the company paid for in full. Obtaining a loan was cost-prohibitive because of the interest rates. Moore said their decision, though painful, to pay for the new system with cash saved them millions in inefficiencies and labor costs in the nearly four years since.”)

Question: Do you agree with Maryland Health Care Commissioner Robert E. Moffit that there is room to reduce the scope and size of the proposed regional medical center design?

“Our goal is not to change the mission of the original medical center. This hospital will not only serve Prince George’s but all of Southern Maryland … The other element is recapturing market share. You have 20,000 residents seeking care outside the county. If you give people what they want, they won’t travel to DC. If you recapture just a fraction of that, it would justify the size.”

Question: How has all the politics surrounding Dimensions, historically and presently, impacted your job? And why do you think elected officials have insisted on UMMS taking over operations as soon as the certificate of need [CON] for the hospital is approved by the state?

“It’s not affecting us operationally.

I have never worked in an institution that has had as much political involvement as this one. But I feel insulated from the politics. I’m only in Annapolis when I need to be. My job is to run the hospitals in the communities we serve.

You know the ills of the past. Everyone knows but now, we are in negotiations about how things will change once the CON is approved and UMMS takes over. I don’t think anyone has all the answers yet.”