Community conversations by Michael Abraham
Bill Flattery, CEO of Carilion’s New River Valley Medical Center.
The plan, at first, was to be ready for a huge wave of COVID-19 patients, said Bill Flattery, CEO of Carilion’s New River Valley Medical Center. With his unique perspective on the current COVID-19 pandemic and the region’s medical community’s plans to keep us safe, Flattery is a key health leader in the region.
He began our conversation telling me why the initial response was targeted differently than hindsight would have dictated. “We planned for an influx of patients that never materialized. We increased in-patient capacity by about 40% and by 80% in our emergency department. Social distancing worked really well here; I can’t say enough good things about our citizen response. People did the things they needed to do. Google Data showed me that citizens of Montgomery County were staying at home.
“In some cases, they stayed away from the hospital even when they shouldn’t have. Our emergency department volume dropped by more than half. Our in-patient volume never went up.
“We stopped doing non-emergency procedures. One reason was there was no personal protective equipment and we couldn’t test patients for coronavirus before admitting them for other reasons.”
Carilion has a coverage area as far south as Galax and the North Carolina border and as far north as Lexington. Flattery’s hospital gets patients from the New River Valley and beyond.
“I think we would have had far greater spread (in infections) if social distancing wasn’t being followed.
“The issue we have now is that people are afraid of coming to the emergency department and the hospital, even when they should come. Studies have shown that up to 80% of people are either very concerned or somewhat concerned about contracting COVID-19 from another patient or hospital staff if they come to the Emergency Department. This is completely fallacious. Our emergency department is a safe environment. If you come in on an emergency basis, we triage – we assess you – outside before we even let you in. We have also invested in enhancements to our HVAC system to cleanse the air.
“If you come to our emergency room today, it will look clean, smell clean, and be clean. It is cleaner than my home and I feel safer there than at home. I can say with a high degree of confidence that if you come to the New River Valley Medical Center and you are not infected with COVID-19, it is highly unlikely that you will become infected here.
“People are not getting needed care because of unwarranted fears. We have seen patients with ruptured appendixes who have not come in until days later when far more damage had been done. If we catch it soon, it’s a straightforward operation. If it ruptures, there are all sorts of complications. We’ve seen infected gallbladders and bowel obstructions. People are just trying to tough it out. Time is extremely critical. People are just hurting themselves.
“Some people think the hospital is overwhelmed and they don’t want to burden the health care network. They think the system is overstressed. We’re not, at least not now, not here.
“We know from testing people for COVID that we’re not seeing many positive. We’ve not seen a single positive test in our hospital since April 1st. Frankly, we shut down the economy because we didn’t have the needed PPE and we didn’t have the tests. Now, we need to transition back to work while asking people to do the simple things that we know work. Wash your hands. Don’t touch your face. Cover your cough or sneeze. Wear a mask when indoors. Love the other people in this community enough to protect them from you while they protect you from them. If we do those things, we’ll be fine.
“We need to test people when appropriate, do contact tracing to see who infected people have been around, and ask people who test positive to isolate. We shut down the economy because we couldn’t test, couldn’t contact trace, and isolate individual break-outs. We can do that now. And we can allow more flexibility in our lives. So let’s be smart, be safe, and stick with the basics. We cannot stay shut down. But we can be safe, smart and personally responsible.
“COVID-19 is more infectious and thus more lethal than the flu. We understand the normal flu because we’ve long dealt with it. It happens every year. It feels normal. We have some immunity and we can get our flu shots. COVID-19 is novel. It’s new. We have no immunity, so all of us are vulnerable. It is affecting people with co-morbidities and otherwise healthy people in peculiar ways. The range of symptoms is big. It affects and attacks many systems in our bodies. It’s all scary and new.
“When the (Virginia Tech and Radford University) students come back, they will have to be responsible. Or they will put themselves and the general population at risk. They will wreck their own college experience and will imperil the community.”
Flattery explained that American hospitals are businesses, thus susceptible to the profit imperative. He said that much care is uncompensated, but that hospitals need to make enough money in some areas to cover those. “The United States of America is the only industrialized nation that I know of that allows for-profit insurance companies to exist. All others are part of some socialized government funded program. Insurance companies are keeping $0.20 to $0.25 on each dollar spent on health care. I am loathe to think they’re adding that much value to the system. They see our health care as their loss. They try to deny payment to us. We employ an army of people to argue with them to pay for needed treatments and they employ an army of people to say ‘just say no.’ For our older patients, Medicare pays promptly for our services. They don’t pay a lot, but they pay enough. The administrative overhead is less than 1% while the for-profit insurance companies keep over 20%. They add limited value.
“Here in the US, we’re spending by far more on health care than other industrialized nations, but our outcomes are not better, sometimes worse. Our access to care is sub-optimal. We’re just not winning. We’re not doing better. We should be learning from this pandemic is that nationally we’re not investing enough in our public health infrastructure.
“Carilion needs profit, but that is not our motive. I firmly believe that if we do the right thing by our patients, provide safe, high-quality care, and a good experience, profit will follow.”
Michael Abraham is a businessman and author. He lives in Blacksburg.
