One on One is a weekly feature offering excerpts of interviews conducted by The Evening Sun with newsworthy business leaders. Robert M. Heyssel, M.D., is president and chief executive officer of Johns Hopkins Health System.
Q. There have been recent reports about Johns Hopkins selling its health maintenance operations to Prudential Insurance and also about the closing of the North Charles and Homewood operations. Is this a move toward retrenchment for Hopkins from its previous expansion plans of the 1970s and 1980s?
A.Let me speak to those two things separately.
With regard to the decision to sell the insurance underwriting membership portion of the Johns Hopkins Health Plan to Prudential, that was a decision taken almost a year ago -- if we could find the appropriate buyer that we could have a long-term relationship with.
Based on where the insurance markets were going in the '90s, a single, small regional player was going to have more and more difficulty competing against large, nationally based insurers. Employers wanted to be able to offer, through one company, a string of insurance products ranging from traditional indemnity insurance to have the freedom of choice through the traditional HMOs-, PPOs-, managed care. I think if you look at the largest employers in this area, most of them by this time have gotten into those kinds of relationships. So if you take AT&T; and Bell Atlantic as an example, which Prudential handles, that's exactly where they are. So we really felt that to compete successfully in that market was going to be very difficult. But on the other hand, we wanted to retain the delivery sites, the provider side of this, for ourselves. And that's exactly the relationship we have with Prudential. We have a 10-year contract with them.
So we're going to do what we think we know how to do best, which is as a provider of medical care across a broad spectrum, and Prudential will do the thing that they know best, which is to underwrite and insure and to market health insurance products.
With regard to the North Charles, and I again want to separate something here, we will maintain and really build Homewood North, which is the ambulatory [walk-in] care portion of that with the Wyman Park Medical Associates. We're only closing the acute, inpatient units. And we're doing that because it just didn't make any sense to continue to operate a small, undifferentiated acute medical surgical hospital in this climate, with everybody's occupancy rates down and so forth. It neither made economic sense for us to do; it was not a strategic importance to us, and so we decided to close that portion of it. . . . So this is not a retrenchment. If other opportunities came up that looked good to us, we would certainly take them. But, we really believe the future is in what we have now invested in, a major ambulatory care center and a provider side for us for managed care.
Q. Johns Hopkins is well known as the innovator of medical procedures throughout the country. However, a lot of politicians and health care observers would say that one of the problems with American medicine is we've fallen in love with advanced technology. I believe one statistic I heard recently is that there is more magnetic resonance imaging done in Maryland than in all of Canada. What can be done about that? Do you think that is a legitimate criticism?
A. I think it's a legitimate criticism to the extent that we have not very often first assessed the technology and where it is most useful so that it tends to get, I think, over utilized.
I think that on the other side of that, if we take MRI or CAT scanning before it, a lot of very evasive and sometimes truly dangerous, and commonly very uncomfortable procedures are simply done away with along with hospitalization that went with those. I guess the best example is probably. . . for discs and other spinal problems where people walk in in their street clothes and crawl in the MRI or the CAT [computerized axial tomography] scanner and get a diagnosis of a disc or some other problem without a needle being stuck in their spine, without going in the hospital for anything. So, I guess actually the ease of doing those things and the lack of danger just leads to people doing them much more rapidly. . . . And, yes, there probably are too many of the machines. . . . So I don't think there's any question that we have more than we need.
Now if you want to compare it to Canada, you might ask whether they've got as much as they should have. Their lengths of stay are a lot longer. There is queuing for lots of things and along the border. I understand Canadians with dollars are crossing the border to get things they can't get in Canada. So, someplace in between the wonders of Canada and the wonders of America, there probably is a middle ground and we haven't found that.
Q. For the first time, labor and industry during this last [Maryland] legislative session, joined together to try just have an effective study of physician rates within hospitals. Not the hospital rate, but the physician rate. And they were shot down by the physician lobby. Would you welcome such a study of costs?
A. Certainly. I just think that physicians will say that only 18 or 20 or 22 percent, or something like that, of the health dollar goes to physicians. Well, but that's still been the most rapidly increasing part of Medicare Part B and, in fact, [of] other rates.
And secondly, there is significant -- in my judgment -- distortion between what different physicians are paid within the system. Procedurally oriented physicians can make an awful lot of money. The person who listens to, spends time with and cares for people who don't [want] procedures and the physicians who don't do procedures are undercompensated for what they do. So amongst other things, I think there ought to be a realignment to some significant degree of that. But that also isn't a new thought of mine.
A colleague long since dead who was the director of Massachusetts General Hospital made similar comments 15 years ago, just as he was leaving Mass General and going to Rockefeller. He was not popular in Boston, so what I just said may make me unpopular in Baltimore, but I still believe that.
Q. It was interesting at a recent lecture on access to health care. I believe a member of your hospital staff got up and said, 'All you've been talking about prevention here all day. We were talking about preventive medicine 50 years ago; we're no closer to it now than we were 50 years ago. When are we going to get serious about preventive medicine?' which people say, I would imagine you agree, is one of the cures to high medical costs?
A. Well, I don't think I go so far as to say we haven't been serious about it for 50 years and that we ought to get serious now. After all, the major push is to get immunizations for polio, certainly that's got to be called prevention. The constant barrage of information concerning diet, smoking, exercise, what have you -- have got to be important aspects.
I think, to get back to my earlier comment about access, it's there we have to get serious. If you [went] out . . . and talked to 30 or 40 young women who only received prenatal care in the last trimester [three months of pregnancy], or none at all, and asked them why they didn't go to the doctor or to a hospital, it turns out it's not because they thought they couldn't pay for it. It ranged from, 'I was afraid of the doctor,' 'I was afraid of the large institution,' 'I didn't know I was supposed to,' incredibly, 'I was afraid to tell my mother,' 'I was afraid to tell the school because they'd throw me out,' 'I didn't have time.' I mean the reasons for that are legion, but they're not financing, and I think that's because we don't pay proper attention to attitudes and reach people where they can [be reached] easiest -- through churches, through schools and elsewhere.
And, you know, if you can cut the rate of prematurity [of babies] by 15 percent, you will save a bundle of money, not just now in the short term on neonatal intensive care, but in the long term on some significant portion of children who are damaged and really can't make it in society ultimately very effectively.
So I think that when I say prevention, we have to begin to get at some things through community-based programs which could really make a significant difference, not only in costs, but in quality of life and probably in the economic life of the community. . . .
Do you think that the lack of knowledge, the lack of information FTC on the part of some people is responsible for the resurgence of some of the diseases which we thought were essentially eliminated, such as measles among children, which you've recently seen coming back?
Q. Absolutely. That's exactly my point. I mean the idea of having measles back in the community is preposterous in a society like this. I don't think that through the schools and through our other efforts, we have focused enough on educating people and helping them to understand what needs to be done. And you know the schools are an ideal place to do this through, which is I guess happening out at Roland Park [Middle School]. I noticed that those children are now being immunized for measles, but I don't think we've emphasized that enough.
A. What is Johns Hopkins Hospital's strategic plan for the next five years and beyond?
Q. One obviously is to complete and open the ambulatory care building.
And secondly to take advantage of that opportunity through looking at how we do our work and focusing on patient-centered care for quality. I think we give quality care now. I think we give pretty good service; I think we can do it better. The third, to focus on the workforce in terms of training and looking at the possibility of restructuring a good deal so that we can cross-train people to do multiple tasks. We've got an awful lot of one-task kind of people working here, as is true in all hospitals. To work with the community on the community health aspects that I'm talking about, we hope to have a program in place within the next couple of months which will build off that and set some real targets for ourselves to look at the community from the viewpoint of epidemiology and set some targets to see if we can intervene and cut down the incidence of stroke and heart disease, of children being admitted to the hospital with asthma and recurrent tracts of asthma and of low-birth-weight babies and perhaps immunizations and so forth. And finally, to build and expand the primary care provider network. And stay solvent.