“I think he’s been under strain from overwork,” Kelley said. “We’re short at least one orthopedic surgeon. Unfortunately our recruiting efforts have been unsuccessful so far.”
“He looked ill to me,” Traynor said. “I advised him to see a doctor, but he only laughed.”
“I’ll have a talk with him,” Kelley promised. “Maybe he needs a little time off. We can always get a locum tenens for a few weeks.”
“Well, so much for that,” Traynor said, trying to compose himself more in keeping with his role as chairman of the board. “Let’s get our meeting underway.”
“Before we do that,” Kelley said, flashing one of his winning smiles, “there’s something I have to say. My superiors are very upset about the negative ruling on the CON for open-heart surgery.”
“We were disappointed about that as well,” Traynor said nervously. He didn’t like beginning on a negative note. “Unfortunately it’s out of our hands. Montpelier turned us down even though we thought we’d made a good case.”
“CMV had expected the open-heart program to be up and running by now,” Kelley said. “It was part of the contract.”
“It was part of the contract provided we got the CON,” Traynor corrected. “But we didn’t. So let’s look at what has been done. We’ve updated the MRI, built the neonatal ICU, and replaced the old cobalt-60 machine with a new state-of-the-art linear accelerator. I think we have been showing remarkably good faith, and we’ve been doing all this while the hospital has been losing money.”
“Whether the hospital loses money or not is not CMV’s concern,” Kelley said. “Especially since it’s probably due to minor management inefficiencies.”
“I think you are wrong,” Traynor said, swallowing his anger at Kelley’s insulting insinuation. He hated being put on the defensive, especially by this young, brazen bureaucrat. “I think CMV has to be concerned if we are losing money. If things get much worse we could be forced to close our doors. That would be bad for everyone. We have to work together. There’s no other choice.”
“If Bartlet Community Hospital goes under,” Kelley said, “CMV would take its business elsewhere.”
“That’s not so easy anymore,” Traynor said. “The two other hospitals in the area are no longer functioning as acute care facilities.”
“No problem,” Kelley said casually. “If need be, we would ferry our patients to the CMV hospital in Rutland.”
Traynor’s heart skipped a beat. The possibility of CMV ferrying its patients had never occurred to him. He’d hoped that the lack of nearby hospitals would give him some bargaining power. Apparently it didn’t.
“I don’t mean to imply that I’m not willing to work together with you people,” Kelley said. “This should be a dynamic relationship. After all, we have the same goal: the health of the community.” He smiled again as if to show off his perfectly straight white teeth.
“The problem is the current capitation rate is too low,” Traynor said bluntly. “Hospitalization from CMV is running more than ten percent above projections. We can’t support such an overrun for long. We need to renegotiate the capitation rate. It’s that simple.”
“The capitation rate doesn’t get renegotiated until the contract term is over,” Kelley said amicably. “What do you take us for? You offered the present rate in a competitive bidding process. And you signed the contract. So it stands. What I can do is start negotiations on a capitation rate for ER services, which was left out of the initial agreement.”
“Capitating the ER is not something we can do at the moment,” Traynor said, feeling perspiration run down the insides of his arms. “We have to stem our red ink first.”
“Which is the reason for our meeting this afternoon,” Beaton said, speaking up for the first time. She then presented the final version of the proposed bonus program for CMV physicians.
“Each gatekeeper CMV physician will be allocated a bonus payment provided his number of monthly hospital days per assigned subscriber stays at a given level. As the level goes down, the payment goes up and vice versa.”
Kelley laughed. “Sounds like clever bribery to me. As sensitive as doctors are to economic incentives, it certainly should reduce hospitalization and surgery.”