The health care landscape across western Montana remains strong, with more surgeons practicing near Missoula on a per-capita basis than in other regions, and care at the end of life costing less than it does elsewhere in the country.
At the same time, Dr. Dean French said Monday, the city is short on medical specialists, housing remains a challenge, and the state’s sheer geography makes it difficult to create a sustainable medical platform.
“We have nine acute-care hospitals and 60 critical-care hospitals, and that’s a lot of resources for 1.2 million people,” said French, who serves as the CEO of Community Medical Center. “The problem is, they’re spread out over God’s green earth. That makes it very difficult to create a sustainable medical platform.”
French joined Dr. Samer Khodor, the physician executive of ambulatory care at Providence St. Patrick Hospital, in discussing the state of health care in western Montana during City Club Missoula’s monthly gathering.
Both physicians acknowledged the state’s medical shortcomings, including a lack of specialists, personal behaviors regarding health, and a general misconception among state lawmakers over health care costs and how personal expenses are tied to the insurance industry.
But Missoula’s medical care remains strong, trending ahead of other regions of the country. The number of practicing surgeons is 15 percent greater than in most other places, and end-of-life care costs significantly less.
“The number one cost of health care right now is the last six months of life,” said French. “But we have the lowest number of people who spend the last six months of their life in an ACU than just about anywhere else in the U.S.”
French said the progressive medical trend dates back several decades, when the health care industry in Missoula emerged as a national leader on end-of-life decisions, particularly around one’s wishes surrounding death.
That trend continues today, driving more people from a costly hospital setting to one “that’s far more compassionate and appropriate for that time.”
“When I came to this community in 1988, I was surprised at the level of medical services,” French said. “The level of medical services at UCLA and Santa Barbara were less than Missoula. So many things are in place here that are still lacking in other parts of the country.”
French said the local economy also has diversified over the past decade, and the state’s passage of Medicaid expansion has had a positive impact, ensuring more people receive care.
While practicing in Thompson Falls, French said, 27 percent of his patients had no means to pay, putting physicians like him in a difficult position.
“Right now, for (Community Medical Center), our self-pay rate is 0.8 percent,” said French. “I didn’t think I’d ever see that. The bad news is, Medicaid expansion sunsets in June 2019. That’s a red-letter day and it’s marked on my calendar.”
As the medical industry moves away from a fee-for-service model, it’s working to put more responsibility on the patient.
Khodor, who left the Colorado Permanente Medical Group for Missoula last year, said just 10 percent of the factors that determine health care results are tied to the health care industry.
As much as 40 percent is tied to individual behavior, and an estimated 20 percent is tied to social and environmental factors.
“There’s a lot of talk on health care, and there’s no doubt that delivery and access need to improve,” said Khodor. “But it’s not the only conversation. In the U.S., we spend the most on health care, and we spend disproportionately less on social services, and these things play a role.”
While Missoula County scores well in food security, unemployment and access to care, its population of uninsured citizens stands above the national average. The city’s housing issues also outpace both the state and national trend, playing a detrimental role in health care outcomes.
Khodor said recent statistics also suggest that 18 percent of the county population still smokes, 24 percent drink excessively, and 22 percent are considered obese. Changing such personal decisions could improve overall health care in the community and drive down costs.
“There’s more and more ownership being placed to everyone,” said Khodor. “Us as patients, we have accountability too, to do the things we need to do. There’s patients I had that just wanted to take a pill. It was easier to take a couple three blood pressure pills than actually get 20 minutes of exercise three days a week. We need to modify that so we’re all accountable.”