By Knute Buehler / Bulletin guest columnist

Published by The Bulletin: July 04. 2009

Sometimes, it takes escaping from ones daily affairs, as I did last week to visit family and friends in our nation’s capital, to realize what has become of one’s normal day-to-day work environment.

As I gazed at the Lincoln Memorial, it became strikingly apparent to me that a medical civil war had begun in my hometown. After years of simmering dispute between Bend Memorial Clinic and Cascade Healthcare Community, the opening salvos were unleashed the past few weeks with criminal charges being filed against CHC employees, followed by a barrage of press releases, articles, editorials, lawsuits and even full-page color ads. As a community member, it saddens me, and as a physician, it embarrasses me.

My sadness rises from losing something special in our community. Twelve years ago, when my wife and I were scouting the country for places to start our medical practices, the Bend medical community was a bright star. The hospital was renowned for an innovative approach to holistically treating patients’ mind, body and spirit. The physicians were trained in some of the best universities in the country and were known for their outstanding collaborative patient care. The hospital and physicians had even partnered to develop their own insurance company (now Clear Choice Health Plans) to benefit our most needy citizens. Being part of a medical community that has squandered such a worthy legacy is an embarrassment.

Now, we are left with the beginnings of a medical civil war that makes Neff Road look increasingly like the Mason-Dixon Line, with the hospital on one side and BMC the other. If this continues, we will all be bloodied by the fallout such battles bring to the combatants and innocent bystanders. It is essential that health care professionals and the community bring an end to this medical civil war by not taking sides but rather rallying around a new vision of health care in Central Oregon.

Before we can create a new vision, it is important to understand how we lost our way. The conflict in Bend is not unique. In communities across the country, the economic underpinnings of our health care system are failing. This crumbling medical economic system has been repeatedly compromised by patchwork government intervention. Similar to the Missouri Compromise that put off solving the conflict between the states decades before the Civil War, the final seeds of destruction were set years ago with federal price-fixing legislation in the 1990s. Like all wage and price-fixing schemes, it eventually creates such adverse behaviors that the system collapses under the weight of accumulated inefficiencies (for a more detailed account, see the recent New Yorker article by Atul Gawande). Since Oregon had its Medicare rates fixed at one of the nation’s lowest levels, we are at the leading edge of this problem.

The dispute between the BMC and CHC rightfully reflect both organizations’ efforts to keep their respective businesses afloat in hard economic times. Physicians everywhere responded to the initial price-fixing challenge by working harder. As doctors reached the limits of their work capacity, some developed ancillary revenue streams such as imaging and surgery centers putting them in direct competition with hospitals. This is when the long union between physicians and hospitals began to unravel.

Hospitals then retaliated by hiring their own physicians and developing valuable clinical service lines that sometimes competed with other providers. Like the South’s slavery-based economy, many realize the harm and injustice of the present health care system, but fail to act. The barriers and risk to changing the health system status quo have been too high for most physicians and hospitals to develop a new economic model.

However, a new way is clearly needed. One could take either the BMC or CHC side of the civil war, but this is a fool’s choice. For the winner, without fundamentally addressing the crumbling health care system, will soon feel the wrath of pent-up economic and political forces. Through any number of different routes, I suspect the health care equivalent of General Sherman’s fiery march through the South will soon be afoot.

So instead of waiting for this medical civil war to continue to tear apart our community and compromise patient care, let us put an end to this battle. It is altogether fitting and proper for us to appeal to CHC and our medical professionals to form a new accountable health care organization for Central Oregon. This system should encourage physicians and CHC to work as partners focused on improving the health of our community and delivering cost-effective care. Both need to break from old ways of doing business — hospitals need to be more physician directed and managed; medical providers need to be more open to integrated organizational structures. There are new shining star medical communities, such as Bellin Health, Geisinger Health and the Mayo Clinic, that have already accomplished these integration goals and are good role models.

What can you do to help? Voice your opinion — talk to CHC and BMC board members, physician leaders and your personal physician, write letters to the editor, post blogs or send me an e-mail (KBuehler@bendable.com) with your thoughts. Importantly, insist that CHC and local physicians come together to work as a team focused on bringing value to patients through cost-effective care and improving the health of our citizens. We, as a community, have the ability to bring an end to this medical civil war. We cannot afford to wait for federal intervention. Sometimes, it just takes a bold proclamation that the old way of doing things is no longer acceptable here.