Taking the pulse of future health care
By DON DODSON
News-Gazette Staff Writer

   CHAMPAIGN – During the last half-century, health care became big business for Champaign-Urbana.
   Hospitals underwent a building boom and a consolidation. Two big clinics blossomed, and from them sprouted two large health maintenance organizations. Patients flocked into Champaign-Urbana from miles around.
   But the building boom, for the most part, is over. A Texas-based physician management firm now oversees Christie Clinic, and Carle Clinic is looking for a way out of red ink.
   Still, observers say health care will continue to be a major segment of the Champaign-Urbana economy well into this century – but with some different emphases. Among them:
   – More attention will be given to preventive health, to long-term care and to gerontology.
   – Demand for nurse practitioners, home health aides and other specialties will swell. But will there be enough workers available?
   – The federal government will continue to intervene in health-care financing, for better or for worse.
   Whatever happens, thousands of jobs are at stake. Carle Clinic employs about 1,800 people, and the Carle Foundation another 1,900. Add to that 1,280 at Provena Covenant Medical Center, 650 at Christie Clinic, 140 at PersonalCare Insurance and about 200 at the Mental Health Center. And that doesn't even count most nursing homes.
   Some observers think most employment growth in health care will occur outside the hospital setting.
   "Personally, I think employment will remain flat in hospitals . . . but long-term care services, assisted living and services offered in the home will continue to grow," said Sandi Jones, vice president of patient services at Covenant.
   The aging population will create that new demand, said Sandy Lewis, chief executive of the Mental Health Center and vice president of behavioral health at Covenant.
   "People living longer means they'll need more assistance to live in the community," she said. "What that opens up is demand for more home health services and home aides that will assist people to live in their own home for as long as possible."
   The problem is, health-care providers may not find all the employees they need.
   Covenant President Diane Friedman, who serves on a national advisory board on work-force development, foresees continued shortages in health care.
   She cites a lack of dentists as dental schools close, as well as shortages of pharmacists and nurses.
   "The real issue is people have more choices," she said. "There are too many available jobs on North Prospect. If you're looking for jobs at a certain pay level, there are many more options available than there were a few years ago."
   And retail jobs, she said, are often perceived as being easier than nursing jobs.
   Jones said she expects the overall number of doctors in Champaign-Urbana to decrease in coming years.
   "There will be less depth in some of the existing specialties and more in primary care and internal medicine," she said. "There will be a greater focus on gerontology."
   Cathy Emanuel, vice president of business development and strategy at the Carle Foundation, noted that new medical specialties are surfacing.
   "At Carle, we have physicians who are expert at taking care of hospital patients. They don't see patients on an outpatient basis," Emanuel said. "We call them hospitalists. All they do is see hospital patients."

Downward pressure on physician pay
   Doctors' incomes are likely to change, too, in the coming decade, said Alan Gleghorn, the chief executive officer at Christie Clinic.
   "They won't necessarily be paid less, but certainly there are downward pressures on income," he said. "The big thing for physicians is they're going to be much more focused on having more time off and flexible work hours.
   "Obviously you'll make less if you're working 40 hours a week vs. 80," he said. "There's really been a shift in the mind-set of new physicians – quite different from a few years ago."
   The change in income will likely vary with the type of doctor, said Richard Arnould, a professor of economics at the University of Illinois who specializes in health-care economics.
   "There will be a flattening in pay to a decline in pay for specialty providers and secondary-care providers, and an increase in pay for primary-care providers," he said.
   Meanwhile, Arnould expects to see growth in the "doctor extender" field – specifically nurse practitioners or highly trained nurses who provide services once done by doctors.
   Christie's Gleghorn points to other likely changes in the health-care work force.
   "More people are asking for and being granted more flex time, so it might be that two people fill one job," he said. "The number of positions will not fluctuate that much."
   Gleghorn foresees labor shortages in imaging technology, professional nursing, laboratory technicians and pharmacy technicians.
   "There are more glamorous jobs in computer science and the Internet, and health care has lost some of the appeal it had a few years ago," he said. "It's probably not as attractive because of the explosion of jobs in other fields."
   Still, he said more workers will be needed to "support consumer aspects of the system," such as helping patients understand and pay their bills.

The future of Carle and Christie
   Arnould, the UI economics professor, said he expects the Carle and Covenant/Christie systems to continue to be the two major health-care providers in East Central Illinois. But either or both could be facing changes.
   "I expect that one or both of the providers in the community will have involvement with a national provider, either through ownership or management or some type of affiliation," he said. "It's difficult to predict the impact that would have on the local community."
   The same might be true for local HMOs – Carle's Health Alliance Medical Plans and PersonalCare Insurance of Illinois.
   "It wouldn't surprise me if we saw the ownership of either of the HMOs change at some point in the next few years or decade," Arnould said. "HMOs absorb a substantial risk, and one has to be reasonably large to spread that risk efficiently. ... Will they continue to be comfortable owning their own insurance product and taking on that risk?"
   Covenant became part of a much larger health-care system as the result of a three-way merger a few years ago.
   Friedman, the Covenant president, said that if there is any further consolidation involving Covenant, it will come from within the Catholic health-care system.
   And she predicts a reduction in overall capital expenditures.
   "I don't see anybody coming in and building a new hospital," she said.
   Capital projects, Jones said, generally will be limited to the replacement of technology and the purchase of new technology, with the emphasis on cardiac care, cancer care and senior care.
   Carle's Emanuel also doesn't foresee many building projects.
   "I would think we'll have more programs in technology and information systems than we will in buildings," she said.
   In particular, Carle will be investing a lot in online medical records, said John Snyder, senior vice president for operations at the Carle Foundation.
   "Five years down the road, automated medical records will be a reality. All the data will be available when you need it," he said.

Consulting your doctor via telemedicine
   Telemedicine – using interactive video communications – will become more common. Emanuel said Carle is working on a demonstration project using telemedicine to monitor at home a patient with congestive heart failure. The practice could reduce the need for the patient to come to the doctor's office as often.
   Telemedicine is also being used to train EMT providers in outlying areas and to provide continuing medical education to rural doctors, she said.
   Christie's Gleghorn said his clinic and others will likely take advantage of Internet strategies. Patients with interest in prostate cancer, for example, will be directed to Web sites with information about it, and patients will routinely send e-mail to their doctors in order to get prescriptions refilled.
   Lewis, the Mental Health Center executive, said Internet access and telemedicine may well change the way psychiatrists see their patients.
   "Psychiatrists could do interviews over long distances," she said. "There are some pluses of doing that.
   "It's not as intrusive into privacy if you're doing it from the safety and security of your own home, rather than an office building or site," she said. "There's still a stigma or concern about privacy, about seeing a mental health professional."
   Look for the Mental Health Center to branch out in new directions.
   It's already expanded services greatly in the last decade with the opening of Centerpoint and the TIMES Center.
   "We're going to be continuing to look at avenues for providing affordable housing for people with disabilities," Lewis said.
   Lewis said she'd also like to expand vocational opportunities for the disabled, noting that the center has "a long working relationship" with the Developmental Services Center.

Competition and consolidation
   Another factor affecting health care in Champaign-Urbana is what happens to rural hospitals in surrounding towns, she added.
   "There will be continued regionalization of services, and a lot of that regionalization will be either quickened or slowed down depending on what happens with (government) reimbursement," Lewis said.
   "Can small rural hospitals survive? It depends on what Congress does with reimbursement. If we don't have the same number of rural hospitals, the market will be forced to regionalize," she said.
   Carle's Emanuel said she expects to see more competition from regional providers.
   "In the southern part of our territory, Barnes Hospital is starting to move forward," she said. "You'll see regional centers develop relationships with other providers. Both Kirby (Hospital in Monticello) and Hoopeston are linked with Carle via telemedicine emergency departments."
   Covenant's Jones said the biggest question up for grabs is how – or whether – Carle Clinic and the Carle Foundation choose to consolidate.
   "Once they have one board and control all the cash in one place, they have formidable cash reserves," she said. "They can merge with other players on their own terms as opposed to being stand-alone."

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