EDINBURG, RGV – By combining inpatient specialties and emergency room specialties with the outpatient specialties, DHR Health believes it is providing improved continuity of care.
Dr. Robert Martinez, chief medical officer for DHR Health, spoke about this aspect of the health system’s strategy in an exclusive interview with the Rio Grande Guardian during a ribbon-cutting ceremony for the opening of four new institutes inside the group’s Health Medical Office Building.
The new institutes are: DHR Health Ear, Nose and Throat Institute; DHR Health Plastic & Reconstructive Surgery Institute; DHR Health Surgery Institute; and DHR Health Vein Institute.
“As you can imagine, it requires a lot of work and a lot of money and effort to have all these subspecialties here full-time but we have done that and we have built our bench,” Martinez said.
“Not only the spectrum of care but we have built the bench to allow those folks to treat you.”
Martinez gave some examples.
“You need some kind of reconstructive process from a trauma, in the emergency room you get that high-level care but they are also the ones that follow you up and continue to see throughout your treatment as an outpatient,” Martinez said.
“Unfortunately, some of these things can linger on for months if not years and it is important for those folks that know exactly what happened and treated you in the emergency room to be able to follow you through.”
Martinez said such continuity of care is common place in big cities but relatively new to the Rio Grande Valley.
“It is very easy (in a big city) because of the number of people that are there. In the Rio Grande Valley that has been very difficult, because of payer mix and these docs being able to survive on their own.”
Martinez said there are “a lot of issues” with locum tenens coming in. “When they are necessary, they are necessary. They come in for a short time and then they leave. That presents a problem with continuity.”
Martinez said DHR Health is “particularly proud” of having such doctors embedded full-time and asking them to do both inpatient and outpatient work.
“And they are happy to do both – provide that level of expertise in the emergency room so you are seeing a burns doctor or a plastic surgery doctor when that is required for a high level injury in the emergency room. But, you will also see them as an outpatient.”
Martinez said this approach is new to the Valley.
“Before, you either did not have the sub-specialty so the patient had to be flown out of here for severe emergencies. Or, things just didn’t get done. Our docs did everything possible but the spectrum of care was not there, all the way. Either docs weren’t interested in coming here or they could not afford to live here because they could not be supported. There were not enough patients of a particular kind.”
Martinez then ran through some examples to make his point.
“A high-level plastic surgeon that was actually willing to do ER work. They are glad to do cosmetic surgery but we need those guys to help construct and reconstruct in the emergency room. Burns patients, the same thing. We are not a full-fledged burns center but our guys have worked in burns centers. So, they will stabilize the patient and see them in the ER and transfer them out. This makes a significant difference,” Martinez said.
“Those are the things that have been missing (in the Valley) for years. We have never had them here so we are particularly proud that we have now been able to do that – to provide that whole spectrum of care. I think a lot of folks are beginning to understand what that means. A lot of other emergency rooms will not have those subspecialties to see you in the emergency room.”
Asked if this approach sets DHR Health apart in the Valley, Martinez answered affirmatively.
“That willingness of the outpatient physician and surgeon, that level of coordination is what is significant. Our docs coming in here know that that is what we are going to do and that is what we expect them to do and they are happy to do it. I think what you see in a lot of other cities is that folks are happy to do the outpatient work but they do not want to have to do the emergency room call or the traumas. It requires a high level of specialty, to be honest with you,” Martinez said.
“Coming in here, those docs know we need both. If they need to see some kind of plastic surgery case in the hospital they are going to see it. The same in the emergency room, they are going to see it. It is not something we don’t have. We have it. And we have been able to incorporate that very, very well. That is still growing but that is what sets us apart, no doubt.”
Coming Home
In his speech during the ribbon-cutting ceremony, Martinez spoke about how, today, physicians are “coming home” to the Valley, once they have completed their medical residencies.
“We did not see a lot of that before because there was not a lot for them to come back to. Organizations were not willing to support the high-level subspecialties. They were more worried about just covering their bases. They have had to go away for medical school residency. (Thanks to UT-Rio Grande Valley School of Medicine) that does not have to happen any more, luckily,” Martinez said.
“These docs are coming back and are able to help either shape or join the center we are trying to create and bring another level of expertise.”
Martinez said patients are starting to see the benefits.
“When you have multiple folks working in an institute like this, that is what you start to get: a very high level of service in a particular thing. That is what we are striving for and that is what you are going to see. They can treat you for whatever but when it comes to a particular thing, some docs like breast reconstruction, some docs like big, bad, facial trauma and reconstructive surgery. We have all of that. That is what sets us apart. You really start to get a high level of service that you see in other cities.”
Reaction of community doctors
Asked if having a large bench full of subspecialties is proof that DHR Health has become a system, rather than just a hospital, Martinez spoke about how the group’s approach has been accepted by community doctors.
“We decided a while back that that is where we wanted to go. It involved certain steps that needed to occur, some of them were painful, some of them were hard to deal with. It was really about getting the community physicians to not fight the effort but see why it was important that we provide this comprehensiveness,” Martinez said.
“Everybody uses their own strengths and weaknesses. Some were willing to step aside and say, you know what, that guy does it better than I do, let’s let him do it. The competition thing goes away. The understanding and the communication with the docs in the community to join that mission was the most important thing.”
The result, Martinez said, is that some physicians have stopped doing some things and started to concentrate on others.
“It is because the other guy was coming in and he or she could do it better. If you can do it, great, but we expect that all the time. It worked out nicely because physicians always want to do the best they can and at the end of the day they always make the right decision. Sometimes you just have to talk to them and convince them. We have to realize we are not individuals, we are a team.”
Trauma Center
Asked how DHR Health’s efforts to secure Level One Trauma Center status is going, Martinez said:
“It is going very well. We are starting to see the volumes increase, which means that the patients and the providers of the transportation services are starting to realize we also have that level of service higher than anybody else here. Hopefully we are doing a very good job in providing that service in a timely fashion, as timely as we can get. We are relatively happy with the results.”
That said, Martinez acknowledged that while the integration as a whole is working, some things have been changed.
“We have started to see a higher level of patients than we could have anticipated, which is good. To be that trauma center you are required to have that number of trauma cases, for expertise reasons. Everyday we learn something new, something we can improve or do away with to help the patients have that care at a high level. So, we think it is moving along well.”
Asked when the final accreditation for a Level One Trauma Center will arrive, Martinez said: “As soon as the volumes are met. We are happy with the processes. I do not think it will be too long at all.”
Asked for any wrap-up remarks, Martinez said: “I would like to remind everyone that Doctors Hospital is a system for the community. Those of us who started this dream, most of us were born and raised here. It is nice to see it come to fruition. We are not perfect but we are striving to be and we think we provide a higher level of service with a lot of the subspecialties, more than anybody else does. We are happy to hear comments on how to improve the system.”
