ST. LOUIS CONSULTANT DISCUSSES HOSPITAL MERGER

While Marc Smith declared the St. Louis hospital consolidation he helped orchestrate a success, he told Cape Girardeau medical and business professionals Tuesday they should develop their own answers to the region's health care questions.

The Southeast Missouri Business Group on Health, an organization devoted to studying how local health care impacts business, sponsored the forum at the Drury Lodge.

Smith, who is a Ph.D., is a vice president with BJC Health System, formed by the 1993 merger of Barnes and Jewish hospitals and Christian Health Services. The merger took a short 47 days to complete, driven by each party's recognition of its own strengths and weaknesses, Smith said.

Today, the system owns 14 hospitals and seven nursing homes, with relationships to 20 other hospitals. It netted $1.5 billion last year.

BJC operates on the concept that the days of single-unit hospitals in metropolitan communities are over. One unit can't provide all needed care effectively or serve every patient in a geographical area, Smith said, but a combined system can. Also, limited resources may be used more effectively.

Before putting programs in place, BJC studied thousands of statistics about the people it would serve.

"We must understand what it is the people actually need," Smith said. "It isn't what they want, demand or what we are trying to sell them."

Because money is the bottom line in the health care industry, the St. Louis group also focuses the concept of charging a fixed fee for specific services rendered for a certain amount of time. When money is determined in advance, physicians involved are encouraged to render the proper amount of care, Smith said. However, negotiated prices must be fair to both the physicians and patients.

BJC attempts to keep its rates competitive or even below average. While quality is important, Smith said, most hospitals are comparable in providing most services. It is price that counts in the end.

The consultant also discussed a need for primary care physicians in hospital consolidation, and said some specialists are considering retraining to enter the primary care field. BJC wants to "realign" those physicians in the St. Louis area, attracting them to their medical facilities.

Smith said BJC didn't come to Cape Girardeau to buy St. Francis Medical Center or Southeast Missouri Hospital.

"BJC is close to Cape, so you can see our foils and our strengths," he said. "We didn't achieve BJC by taking someone else's model. We achieved success in our first year because we extended to the community."

Mary Dunn, executive director for the Southeast Missouri Business Group on Health, said Smith's invitation to Cape Girardeau had nothing to do with encouraging a merger between the city's two hospitals. However, she said there is obvious waste in Cape's medical system that could be addressed.

"The vision of BJC is very exciting," Dunn sai~d. "We want to know where health care is going and what role we play."