Jim Nathan: Health Care in Southwest Florida

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Jim Nathan, CEO of the Lee Memorial Health System for over thirty years, gave a very enlightening presentation last week as part of Shell Point’s 2015-2016 Medical Breakthroughs & Discoveries series. For those who do not interface very much with mainstream health care (there are millions of us in Florida, either by personal choice or, more often, due to financial or geographic restraints), an hour of health care statistics might be the last thing you’d want to experience. Certainly, I did not expect the CEO of one of the biggest public health systems in our country with more than a million patient contacts a year, to speak openly about the economics of health care, or to emphasize personal responsibility and community outreach as necessary components of that system which includes 6 hospitals, Golisano Children’s Hospital, a new $140 million medical campus in south Lee County, The Shipley Cardiothoracic Center, a network of clinics and public outreach facilities and programs, and partnerships with organizations like The United Way and Healthy Lee.

In his ‘spare’ time, Nathan has served as a volunteer in many organizations including Southwest Florida Community Foundation, Florida Gulf Coast University Foundation, the American Heart Association, the American Red Cross and other health care associations. He was the founding chairman for the United Way of Lee County. Among the many honors and awards Jim has received are the Clara Barton Humanitarian Award from the American Red Cross, the Business Building Leadership Award from the Chamber of Commerce of Southwest Florida, and was named to the Junior Achievement Business Hall of Fame. A few years ago, Nathan was named a Person of Distinction for the Past 25 Years by the News-Press Media Group.

For all of this monumental body of work over decades, one would have expected perhaps a very dry, matter-of-fact rendering of the facts and figures related to health care; I certainly did. But I discovered, rather quickly, that Jim Nathan is a very passionate and fully engaged champion of health care accessibility, affordability and innovation. And he has a great, down-to-earth sense of humor that, like a spoonful of sugar, helps the medicine go down – the medicine being some rather harsh realities about our health, how we address it as a nation, and how that impacts us here in Southwest Florida.

Nathan’s opening remarks were not couched in justification or self-serving platitudes. There was nothing apologetic on behalf of the medical services community. “Health care as we know it today in this nation…the status quo is simply not working. We have the finest, most expensive repair center health care delivery system in the world, and it is clearly ineffective for what we need today. It was not built around the fact that people will live for a long period of time with complex chronic illnesses.”

Still not pulling any punches Nathan stated unequivocally, “We are helping to bankrupt our nation, in terms of health care.” He explained that while there really is enough money in our country for health care, the distribution and disbursement mechanisms in place are ineffective and wasteful. Clearly, Nathan wants us to understand that partisan politics plays a major role in the current state of health care in our country, and that asking our elected officials to fight each other over issues rather than work together to help solve this problem is not productive. “We’re helping to fuel our political divide.” With a light touch of sardonic humor, Jim tags, “And if you were not aware that there is a political divide, you missed something and I’m proud of you.”

Nathan pointed out how many complex pressures have contributed to the overall state of health care in our country: Consolidations, acquisitions and mergers like the ones being sought by four of the country’s five largest health insurance corporations; voters wanting less government funding; lack of a comprehensive population health program as opposed to our current per procedure system; shortages of medical professionals; constantly changing payment and reimbursement models; and, the impact of an aging population that perhaps “has not taken as good a care of themselves earlier in their lives as they should have.”  Comparing the United States to all the other industrialized nations in the world, Jim says, “We’re off the chart as far as our overall costs.”

Jim then asks, “How did we become the most expensive repair center-based health care in the world? Who is responsible? Who can we blame for this?” Using the book, ‘Who Sank the Boat?’ by award winning children’s author Pamela Allen, Jim gives the audience something to ponder. He explains that he used to read the book to his kids when they were little. “I don’t know if they ever enjoyed it. I enjoyed reading it because it was simple, it was short, and I understood it.” This draws big laughs. As he tells the story, a cow, a donkey, a sheep and a pig climb into a little rowboat for a float around the pond on the farm. But when a tiny little mouse jumps in last, the boat sinks, which begs the question – who sank the boat?  Jim tells the audience, “If you stay to the end (of the presentation), then you will know who is responsible.”

Nathan brings mountains of health and healthcare data and statistics to light, all the while illustrating the relationship between what is happening nationally and what is happening right here in Lee County. He points out that in 1991, the big threat to our country was Saddam Hussein; then it was Osama Bin Laden. “But then,” he says, “in 2011, it was ten thousand new baby boomers becoming seniors every day. Now it’s 11,000, every single day.” He illustrates just how impactful that is, especially in Southwest Florida, which boasts twice the national average of seniors by population, and has been identified by the federal government as one of the most medically under-served regions in the entire nation.

“Seniors use health care twice as frequently as non-seniors, they stay twice as long in the hospital, their services are twice as extensive or intense, we don’t have enough doctors. And,” he highlights, “A high elderly population raises the incidence of chronic illnesses.” In fact, it has been found that 75% of all medical expenditures goes to the treatment of five of those chronic conditions, including diabetes, congestive heart failure, coronary artery disease, asthma, and depression. All of these conditions are exacerbated by obesity, or perhaps even caused by it. Most seniors have at least 3 – 5 chronic health conditions, some many more than that.

Then he lowers the boom. “Our country has become the fattest nation on earth, with all kinds of major complex diseases that, in the past, people simply died of and never even knew they had.” Hammering home his point about runaway obesity in our country, Jim compares today’s statistics with those of 25 years ago. “As recently as 1990, there were no states that had adult presence of obesity greater than 15%, and there were only ten states greater than 10%. In 2014, we have no states less than 20% of their populations being obese. Three states, Arkansas, Mississippi and West Virginia are up to 35%. This is an overnight weight gain.”

For everyone, especially seniors, navigating the maze of health services needed to battle medical conditions and emergencies is a daunting task. Jim offers a hypothetical situation based on real statistics. “We all know this woman. She is 78 years old. She has 11 chronic health care conditions, she has 18 different medications and she has 12 doctors. Now I ask you, who is in charge of her health care? Is it her? Is it her 80-year-old husband, who can’t drive and has medical issues of his own? An adult family member who lives a thousand miles away?”

Nathan, whose childhood was largely about his father’s multitude of health problems, acknowledges how difficult it is, but does not lay blame anywhere. “Those 12 physicians are hard working, caring, highly skilled, talented, brilliant individuals.” His empathy is born of his own personal experiences interfacing with the healthcare industry. “I have a son with a chronic health condition now in its sixth year. He lives out in California. He’s got great physicians, they respect each other, they refer patients to each other. They’re phenomenal. But they don’t talk to each other. They’re busy. They’re doing their piece of the service program for my son, but they don’t talk with each other. I call this ‘fend for self’ medicine.”

Nathan’s presentation was jam-packed, end-to-end, with information and statistics that really show without question what a monumental and complex task he and his cohorts in the medical field have before them in their dedication to serving the community effectively.

The Lee Memorial Health System, in spite of the fact that it is completely funded by individual payers for services, Medicare and Medicaid reimbursements, and generous donations from members of the community, without any local tax support, is innovative and expanding its services to everyone, including the underinsured, uninsured, and those whose lifestyles portend poor health, with an eye to improving the general health index in the South Florida region.

I am a ‘hard sell’ when it comes to mainstream healthcare, but I walked away from this presentation with monumental respect for Mr. Nathan and the people who work so hard to help us achieve and maintain good health.

Jo List