'One on One with Jeff Lytle' ... Rick Scott’s past brush with Medicare fraud happened too long ago to be an issue in his campaign for governor, says a local medical industry leader.

Rick Scott's past fraud role irrelevant

Joe Pinion on 'One on One'

Joe Pinion, the CEO of the Physicians Regional hospitals in North and East Naples, is this week’s guest on "One on One with Jeff Lytle.’’

Pinion also sizes up foreign women coming to the USA to deliver babies who become U.S. citizens, his firm’s new ad campaign, national health care reform and the impact of the economy on local health habits.

This is an edited transcript of the first half; video highlights as well as partial video/texts of past interviews are available at naplesnews.com/oneonone.

The entire 30-minute program airs Sunday at noon on Comcast CN14.

Lytle is editorial page/Perspective editor of the Daily News.

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Lytle: The big story from the election is the gubernatorial nominee for governor, Rick Scott, a former executive in the health-care industry.

Does that make a difference to your world?

Pinion: Well, the governor’s race is important for the all the citizens in Florida, especially on the health care side of things as we try to un-peel this onion of health care reform that we’re looking at and what the states are going to be doing individually. As you know, a lot of states have filed some lawsuits against pieces of the legislation that are proposed.

From a perspective of the candidates, I’m going to be interested in what both of the candidates have to say over the next few months before the election in November.

Rick Scott, coming as a businessman into the fray, I guess you’d say, may add something a little different. He does have a health care background so he’s fairly knowledgeable about at least our side of the issue.

But the other candidates, I’m really not that familiar with them yet, and I want to learn a little bit more about what they’ve got to say over the next few months.

Lytle: Part of Scott’s background isn’t good. His firm, Columbia/HCA Healthcare, which used to manage or own two hospitals right in our backyard in Fort Myers, was involved in big-time Medicare fraud.

How will that affect his credibility and his leadership on health care issues of concern to all Floridians?

Pinion: Well, evidently it didn’t Tuesday with the vote. I don’t know the specifics of what occurred with Rick and Columbia/HCA at that time, though I was in health care at the time.

Lytle: Yes, you were. You were here in Naples.

Pinion: Actually, that’s correct. I was in the corporate office of Health Management Associates.

Columbia/HCA is not the only hospital system in this country that’s been sued by the federal government for mistakes made in billing or other issues.

It can call some attention to him. Obviously, there was a little bit of this and that going on between Bill McCollum and Scott during the campaign. But all in all, I’ll be looking at what the real issues are with health-care reform today, and what maybe Rick, as a businessman, brings to government.

Lytle: Should his background and his leadership position with Columbia, should that be an issue?

Pinion: I don’t think so.

Lytle: Because it’s just too far removed?

Pinion: It’s in the past, and I really don’t know ... it doesn’t look like personally he was involved in what went wrong.

Lytle: Physicians Regional Medical Center’s publicity campaign, your ad campaign, your public relations push is fascinating. You’re not just saying, "Hey, Physicians Regional hospitals are here.’’ You’re recruiting the leading doctors in Collier County, putting them in your television and your print ads, and it’s almost in-your-face to the NCH Healthcare System — like there’s a new leader on the block, and it’s us.

Pinion: Well, we share our medical staff with NCH and the community.

Lytle: Yes, but these guys are in your commercials. These guys are your stars.

Pinion: We invited all the medical staff to participate in the commercials. Some wanted to; some were a little camera shy, like me.

We felt that what we’re really about in delivering health care is good physicians and good nursing care. If you notice, a lot of our advertising is about our nursing as well.

We’ve got beautiful facilities. We’ve got great equipment and technology. But we decided focusing on who gives that care, who provides that care, and it was really where we were coming from in regards to quality.

We’re measured every day, and more so today than ever before, with the quality performance indicators that now the government publishes monthly in the newspapers. You can go online and look at the quality things.

Well, the quality is really provided by those people — the physicians and the nurses.

So our focus this past year is on the positively great things that doctors do in our facility and nurses do in our facility.

Lytle: Is it working?

Pinion: Absolutely.

Lytle: How’s your market share?

Pinion: Our market share in a down economy has done very well.

I can’t speak specifically to it because we are a publicly traded hospital company.

Lytle: Oh, you can tell me.

Pinion: Oh sure, but I’d be telling everybody else, too.

We’re very cautious about that.

Lytle: Talking about your facilities brings up an interview that you gave a year ago to a magazine called Doctor’s Life. And you referred to your facility at the Vineyards, formerly Cleveland Clinic Hospital, as the Ritz-Carlton. What’s that about?

Pinion: Well, it’s about a high standard; a service standard that the Ritz is famous for, and that’s what we’re working toward and on every day: high quality scores. We use the Press Ganey system of polling our patients and our doctors and our employees to tell us where we’re doing the right things right, and where the things are that we need to do better.

The Ritz-Carlton does that. Our facility, I think, compares to a nice hotel, when you look at the accommodations we have, etc.

But again, that’s not what we focused on in our advertising. We focused on marketing the care we give.

Lytle: You went on to refer to the Collier Boulevard campus as more of a country club.

Pinion: I think when you look at it, yes. One’s got nice granite and things on the outside. The other one has a beautiful glass, Florida-style, more of a country-club-style look to it.

Lytle: Is that what medical consumers are really going for these days?

Pinion: I don’t know. I don’t know.

Lytle: Well, you should?

Pinion: We’ve done very well in the market. Our hospitals are very successful, and I’m sure the attractiveness of them has something to do with that.

Lytle: Talking about something totally unrelated, but I need to make sure I get to this before we run out of time.

People from Miami tell us about pregnant women from outside the country coming into Miami specifically to deliver their babies at a public hospital in Miami called Jackson Memorial.

Since then, we hear that Miami is not the only place reporting this; that it’s also a big issue in Texas, where thousands and thousands of babies are born at hospitals, especially public hospitals, where women come in from outside the country just to have their babies.

Number one, the tab gets picked up by someone else, and number two, those babies become citizens instantly. And what that does to the citizenship status of the mother, I don’t know.

The question to you is, have you heard of this? Is this an issue in your world? And do you have any insights?

Pinion: Well, we read about it all the time, especially in the border states — California, New Mexico, Texas, Arizona, etc. Obviously it’s in the news recently, with some of the legislation they passed within their state (Arizona).

We deliver care to whomever shows up at our door that needs it at that time. We’re going to do that regardless of who the person is or where they came from.

But it is an issue? Obviously, and some hospitals are burdened by that to a degree.

Lytle: Has that happened at your hospitals?

Pinion: I don’t recall of anyone in particular. I will look into it and get back to you on it.

But our birth rate right now is fairly stable in this market. A lot of the young community have left because of the economy, so it’s fairly flat.

I think Lee Memorial CEO Jim Nathan even spoke to that a little bit the last time he was on this program.

Lytle: Yes, last time he was here.

Pinion: But I’m not aware of a problem that we’ve run into.

We’re actually working with the Women’s Health Center and Immokalee Health Center to see what we can do to help deliver some of the Medicaid and other families that aren’t able to access care in some areas.

Lytle: If a woman were to come to one of your hospitals about to give birth, are you even allowed to ask who she is or where she’s from?

Pinion: Not really. We take care of the patient first and we worry about those other issues later.

Lytle: Are you ever allowed to ask where she’s from or who she is?

Pinion: No, only in relation to if something were to occur to them, perhaps a language barrier at home, or other things like that, we may ask questions with regard to, is this language spoken at your home? If something occurred to you, in an emergency or whatever, and we need to call somebody in the family. Only on situations do you ask anything that personal.

The main thing is to take care of the need immediately and then get the other information about the person — where they live or whatever.

Lytle: This sort of leads into national health care. There are a lot of people very, very upset about the federal legislation.

Is it as awful as they would have us believe? Is it hurting your industry or helping it?

Pinion: Well, we’re still trying to find out exactly what is in the legislation. As you are aware, and I’m sure the public is aware, a lot of that legislation got passed without any debate so that we could kind of hear on front end what they were talking about doing.

So we’ve spent the last few months since it was passed in March trying to vet through all those pages, a couple of thousand of pages of legislation.

As it’s proposed, and I believe there is some need for reform, there’s no question about that in health care. It’s mainly toward the insurance side of reform.

Obviously, if the government says they can cover these 32 million or 34 million people over the next four years with insurance, it’s very good for us. Because we’re taking care of those patients now, and we’re actually seeing a little more of it now because of people who are unemployed, out of their benefits who still need health care delivered to them.

The doctors in our community, the hospitals in our community — not just Physicians Regional, but Lee Memorial Health System, NCH Healthcare System, etc. — are seeing an increase, I’m sure, in all of that. So we want to see these people insured if that’s where the program is going to go.

But it could be three to four years before the money is in place to have those programs to insure those people. In the meantime, we’ll continue to cover them as we do now.

Lytle: Is there anything necessarily to fear? We hear stories from the critics of this legislation saying that it will affect people’s abilities to choose their doctors, to choose their care, etc.

Is that true?

Pinion: You know, Jeff, I think the one thing that concerns me the most about it is the pressure it puts on the medical physician side of the community.

A lot of physicians are seeing this burden placed on them now. They’re seeing a maturing population, of which I’m one — 65 next year. Seeing more health problems occurring, therefore, puts more pressure on the physicians’ side. If they’re concerned about the reimbursement they’re going to get, or not get ... because a lot of the cuts in health care that are necessary to put the money in place to provide the insurance in the future for the Medicare, Medicaid program, the federally funded parts of the Medicaid program for the states ... it’s coming out of their pockets and the hospitals’ pockets.

We’ve got to be more efficient in the meantime. We’ve got to deliver care at a higher quality. We’re measured on that. And in the future, proposals are to reward hospitals that provide a better quality of care to make it a more efficient and more effect health-care system.

So there is some reimbursement that’s there, but in the meantime, while these systems are being put in place to measure the quality, etc., it’s putting a burden on doctors. And I think it’s going to drive some potentially great doctors in the future away from health care, and out of the market, perhaps even out of the country.

That concerns me a great deal.

Lytle: Could it drive more doctors into concierge care? Or all the way out?

Pinion: It could drive them all the way out. I’m concerned about that. Yes, I am. And I am concerned what that says to the students in the schools right now that are considering health care as an occupation in the future as well.

Lytle: Let me ask you about the economy’s impact in your industry in a different way.

I understand that people, especially who have lost their jobs and might have lost their insurance as well, and might be just trying to make ends meet, they will wait longer to go to a doctor about an illness or feeling not well. And then when they do go seek medical help, they’ll go to your emergency room. Is that correct?

Pinion: Yes.

Lytle: And then once they do wind up as a patient with you, they are sicker and it costs more to treat them than it would have been in the past.

Pinion: That’s correct. It is a problem. And it occurs every time there’s an economic downturn or a recession. You begin to see that.

They’ll talk to their physician and say, I’m really not feeling good, but I don’t want to go into the hospital. Is there something I can take at home and see if I can get better first?

A lot of times they don’t get better first. Sometimes they do. But they do come back into the hospital a little more ill, a little harder to take care and the length of stay and the treatment regiment takes longer.

We’re not paid more for that, in most cases. Most of our payments come from negotiated contracts with insurance companies or the federal government where they pay a flat fee for taking care of a specific diagnosis. This puts a lot more burden on the hospital in regards to that. And the public, obviously, is getting sicker.

Lytle: But in some cases, you won’t get paid at all.

Pinion: In many cases, we don’t. That’s correct.

Lytle: What’s the percentage on indigent care these days?

Pinion: In our market, somewhere between 3 and 5 percent.

Lytle: Of your hospital in-patient?

Pinion: In-patient. That’s correct.

Lytle: And that includes doctors’ fees, tests, x-rays.

Pinion: It’s going up a little bit right now with the economy the way it is.

Lytle: So 3 to 5 percent of services you provide are written off?

Pinion: Written off, yes, completely.