"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 goaclass="underline" 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."
"It's essentially the same plan CMV has in effect at the CMV hospital in Rutland."
"If it works there then it should work here," Kelley said. "I have no trouble with it, provided it doesn't cost CMV anything."
"It will be totally funded by the hospital," Beaton said.
"I'll present it to my superiors," Kelley said. "Is that it for this meeting?"
"That's it," Beaton said.
Kelley got to his feet.
"We'd appreciate all the speed you can muster," Traynor said. "I'm afraid we're looking at a lot of red ink on our balance sheet."
"I'll do it today," Kelley promised. "I'll try to have a definitive answer by tomorrow." With that, he shook hands with everyone and left the room.
"I'd say that went as well as could be expected," Beaton said once he was gone.
"I'm encouraged," Caldwell said.
"I didn't appreciate his impudent suggestion of incompetent management," Traynor said. "I don't like his cocky attitude. It's unfortunate we have to deal with him."
"What I didn't like hearing was the threat to ferry patients to Rutland," Beaton said. "That worries me. It means our bargaining position is even weaker than I thought."
"Something just occurred to me," Traynor said. "Here we've had this high-level meeting that could possibly determine the fate of the hospital and there were no doctors present."
"It's a sign of the times," Beaton said. "The burden of dealing with the health-care crisis has fallen on us administrators."
"I think it's the medical world's equivalent of the expression, 'War is too important to leave up to the generals,' " Traynor said.
They all laughed. It was a good break from the tension of the meeting.
"What about Dr. Portland?" Caldwell asked. "Should I do anything?"
"I don't think there's anything to be done," Beaton said. "I haven't heard anything but good things about his surgical abilities. He certainly hasn't violated any rules or regulations. I think we'll have to wait and see what CMV does."
"He didn't look good to me," Traynor reiterated. "I'm no psychiatrist and I don't know what someone looks like when they're about to have a nervous breakdown, but if I had to guess, I'd guess they'd look the way he does."
The buzz of the intercom surprised them all, especially Beaton who'd left explicit instructions there were to be no interruptions.
"Some bad news," she said once she hung up. "Tom Baringer has died."
The three fell silent. Traynor was the first to speak: "Nothing like a death to remind us that for all the red and black ink, a hospital really is a very different kind of business."
"It's true," Beaton said. "The burden of the work is that the whole town, even the whole region, becomes like an extended family. And as in any large family, someone is always dying."
"What is our death rate here at Bartlet Community Hospital?" Traynor asked. "It's never occurred to me to ask."
"We're just about in the middle of the road," Beaton said. "Plus or minus a percentage point. In fact, our rate is better than most of the inner-city teaching hospitals."
"That's a relief," Traynor said. "For a moment I was afraid there was something else I had to worry about."
"Enough of this morbid talk," Caldwell said. "I have some good news. The husband-and-wife team that we and CMV have been recruiting so actively has decided to come to Bartlet. So we'll be getting a superbly trained pathologist."
"I'm glad to hear it," Traynor said. "That brings pathology up to speed."
"They've even purchased the old Hodges house," Caldwell added.
"No kidding!" Traynor said. "I like that. There's something wonderfully ironic about it."
Charles Kelley slipped into his Ferrari coupe, started the engine, and gave it some gas. It responded like the engineering marvel it was, pressing him against the seat as he accelerated out of the hospital parking lot. He loved to drive the car, especially in the mountains. The way it hugged the road and cornered was a true delight.
After the meeting with the Bartlet Hospital people Kelley had phoned Duncan Mitchell directly, thinking it was a good opportunity to make his presence known to the man at the pinnacle of power. Duncan Mitchell was the CEO of CMV, as well as of several other HMOs and hospital management companies in the South. Conveniently the home office was in Vermont where Mr. Mitchell had a farm.
Kelley had not known what to expect and had been nervous when he called, but the CEO turned out to be gracious. Although Kelley had caught the man preparing to go to Washington, he had generously agreed to meet with Kelley outside the Burlington Airport general aviation building.
With CMV's Learjet in its final stages of fueling, Mitchell invited Kelley into the back of his limousine. He offered Kelley a drink from the limo's bar. Kelley politely refused.
Duncan Mitchell was an impressive man. He wasn't as tall as Kelley, yet he emanated a sense of power. He was meticulously dressed in a conservative business suit with a silk tie and gold cufflinks. His Italian loafers were dark brown crocodile.
Kelley introduced himself and gave a brief history of his association with CMV, mentioning that he was the regional director for the area centered around Bartlet Community Hospital, just in case Mitchell didn't know. But Mitchell seemed acquainted with Kelley's position.