Obstetrics on hold

Missoula’s hospitals kiss and make up


The winds of change began blowing again in Missoula’s health-care community as St. Patrick Hospital and Health Sciences Center announced last week that it would be “pausing” its plans to open a new obstetrics unit at the downtown hospital. The move comes near the end of a year that’s seen leadership shake-ups at Missoula’s two hospitals, and may indicate a shift away from increased competitiveness between St. Pat’s and Community Medical Center.

For more than 12 months St. Pat’s has been busy constructing and outfitting its new OB unit, made up of six labor, delivery, recovery and postpartum rooms for low-risk deliveries. The unit would have cut into a share of the health-care market long cornered by Missoula’s other major health-care facility, Community Medical Center. Accord- ing to an Oct. 17 press release from St. Pat’s, construction of the unit was expected to be complete in December. “However, key operational components necessary for the unit to open are not in place and a considerable amount of work remains,” the release states.

According to St. Pat’s spokeswoman Mary Anne Sladich-Lantz, St. Pat’s new CEO Jeff Fee received feedback from hospital staff and the community at large indicating a desire to have the two hospitals collaborate, rather than compete, in service areas like obstetrics.

“In order to be respectful of the medical community and the community at large, we decided to pause for a moment and reconsider all of the issues,” says Sladich-Lantz, who couldn’t say how much St. Pat’s has already invested in the new unit. “If we choose to move forward it will be because after considering all of the issues, we will have decided that the OB unit and the model we are considering will be a good option that doesn’t currently exist for families in Missoula.”

Missoula has seen unprecedented competition between its two not-for-profit hospitals over the past three years. Both provide mission-based health care, meaning they provide services to all patients, regardless of their ability to pay. As such (though their spokespeople don’t like to talk about it), both hospitals compete for high-margin patients and procedures to make up for revenues unrealized on patients who are unable to pay, and on procedures that receive minimal reimbursement from Medicaid, Medicare and health insurance companies. Competition for such higher-margin patients rose to new levels last year when Community launched its CareFlight helicopter transport program in direct competition with St. Pat’s Life Flight. Meanwhile, St. Pat’s was busy building the OB unit and a regional rehabilitation program (which opened earlier this year), two areas where Community had long provided the only local options.

“I would say the last couple of years there has been more of a competitive spirit,” Sladich-Lantz admits.

But 2006 has been marked by changes of leadership at both hospitals, and that has opened the door to a shift away from that competitive spirit. In January, CEO Steve Witz announced he was leaving St. Pat’s to take a job at Purdue University. Fee took over in June, and days later Community’s CEO Tom Moser unexpectedly resigned. Community appointed Thomas A. Reitinger as interim president and CEO in July. Those changes, both hospitals’ spokespeople say, have resulted in renewed conversations between Community and St. Pat’s about the quality of health care in the region.

Fee told the Missoulian in June that competition could be destructive if one hospital spreads existing resources too thin in pursuit of the other hospital’s market.

“We should avoid getting into competition where it dilutes the quality of service,” Fee said then, adding that further development of good relations among Missoula’s medical community was one of his top priorities.

Though neither hospital’s spokesperson would point fingers, both indicated that their hospitals’ current leaders are more willing to consider collaborative efforts than previous CEOs.

“We are at a place of hoping that the two health-care facilities in this community can come together and figure out how best to serve health needs in Missoula and Western Montana,” Sladich-Lantz says.

Because it is home to two major hospitals, Missoula serves as a regional health-care hub for Western Montana and parts of Idaho. This year both Community and St. Pat’s received the Mountain-Pacific Quality Health Hospital Quality Award for their commitment to health care in the region. In the spirit of collaboration, the hospitals teamed up on a print advertisement announcing “A Big Win for Healthcare in Missoula.” The mutually congratulatory ad features both hospitals’ logos and the text: “This high honor recognizes each hospital’s success and continued improvement in quality of care, and is truly a testament to the caliber of health care available in Missoula.”

“Neither hospital [alone] has the capacity to handle the patient flow that Western Montana offers. We need both hospitals,” Community spokeswoman Karen Sullivan says. “As two not-for-profit entities, do we have responsibilities to meet the needs of our communities? The answer is yes. So we need to get to the table and talk about areas where we can collaborate to better meet those needs. Will competition remain? Realistically, yes.”

No official talks are yet planned, but Sullivan says the hospitals are already looking at areas where they can beneficially collaborate, such as streamlining medical staff credentialing at both hospitals and sharing telemedicine resources.

However, Community is still searching for a permanent CEO, and while there’s a renewed collaborative spirit in the interim, that could change when a new executive takes charge.

“There is an openness today. Whether that continues is certainly going to depend on new leadership at Community,” Sladich-Lantz says.

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