Will medical mall benefit patients?

By Dr. Carl Aschoff

Before proceeding with the $40 million expansion of medical services, outcomes and costs for the Physicians' Clinic of Iowa's medical mall need to be carefully examined.

In my judgment, there are only two justifiable reasons for PCI's plans to build new offices for 70 physicians out of a total of more than 300 physicians on the staff of our two hospitals: to improve patient care outcomes and to curtail the spiraling costs of health care. I do not believe either of these will be accomplished by such a move.

The five buildings now occupied by the physicians of PCI are owned partly by the physicians. When vacated, the owners will still be required to service any debt and pay the taxes, insurance and upkeep on those buildings until they are sold. This may take a while as there is already an oversupply of office space in Cedar Rapids.

After relocation, they also will be responsible for the same expenses on their new building. Where will this money come from? The owners. Will this force the physicians to raise their fees? Will it increase supply-driven demand?

Coordination of patient care has been shown to improve health care outcomes, but a new building for the specialists at PCI will not, in itself, accomplish that worthy goal. A medical mall by definition and common usage includes most if not all of the medical disciplines and this will not be the case in the proposed plans.

Well-coordinated care is dependent on primary care practitioners such as family practice, internal medicine, OB/GYN and pediatrics, yet PCI has no primary care practitioners or other key specialties such as cardiology or pulmonology. In this electronic age, coordination of patient care requires systems to support appropriate sharing of information between physician clinics, hospitals, home health care agencies, long-term care facilities and other providers, not physical proximity.

Cedar Rapids has 14 medical labs and three imaging centers scattered throughout the city in addition to those services at both hospitals. The addition of lab and imaging services in the PCI proposal will only divide that pie into small pieces for all concerned. Will a “certificate of need” be required? Will it be approved?

At a recent dinner for the physicians of this area hosted by Mercy Medical Center, the keynote speaker was Don Berwick, a pediatrician and president/CEO of the Institute for Healthcare Improvement, who was recently nominated by President Obama to be administrator of the Center for Medicare and Medicaid Services. You may have read in these pages that our community has been recognized by the Institute for providing high-quality, low-cost care when compared to most of the rest of the nation. Dr. Berwick said that status was hanging by a thread and when a slide of the rendering of the proposed PCI building and medical district was projected, he said, “You have enough. You have enough.”

Enough said.

Dr. Carl R. Aschoff is past president, Mercy Medical Staff, and past president, Linn County Medical Society. Comments:

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