Strictly Business feature: QandA with Robert J. O’Keefe of BFMC [The Bakersfield Californian]

Dec. 18--Health care is an issue that touches literally everyone, so it's no wonder there is passion on both sides of the aisle as Congress ponders changing what is widely viewed as a broken system.

We chatted with Robert J. O'Keefe to get his thoughts on challenges the industry faces here in Bakersfield.

Name: Robert J. O'Keefe

Occupation/Title: Chief Executive Officer

Company: Bakersfield Family Medical Center / Heritage Physician Network / Coastal Communities Physician Network

Family: Significant other, two children, American Bulldog named Maggie.

Question: How do you feel about the public option under discussion in the health care reform debate?

Answer: I firmly believe that providing basic health coverage to those that truly cannot afford it is something that we should consider. I also believe that the provision of this care is to some extent, currently being provided at hospital emergency rooms across the country. Unfortunately, the current situation is untenable. By accessing emergency rooms during an acute episode the vital components of prevention, screening and overall wellness are not provided. I feel that without reform, with or without a public option, our current system is unsustainable.

Q. There has been talk for years about a nursing shortage. Is this still a problem in Bakersfield, or has that shortage eased somewhat? Why or why not?

A. There is a local, regional and national shortage. I understand that there may be the possibility of a new nursing school opening here. BFMC/HPN is extremely interested in sponsoring scholarships and is committed to the furthering of nurse education. Nurses, nurse practitioners and physicians assistants are invaluable members of our healthcare delivery system.

Q. Health care has traditionally been insulated from economic downturns to some degree because people continue to get sick regardless of economic conditions. What impact, if any, has the recession had on you?

A. BFMC/HPN has continued to experience growth across all of our groups during this period. Some of the individual books of business have reduced in size while others have grown significantly.

Q. Are you hiring at all? What kinds of positions do you have open?

A. We are currently hiring with openings for physicians, medical assistants, reception, radiology technicians, certified coders and, of course, nurses.

Q. Rural areas and smaller cities have always had more difficulty recruiting medical talent compared with larger, urban areas. What's been your experience with recruiting talent to Bakersfield, and what are you doing to address that challenge?

A. Clearly recruiting to our community is a challenge. I believe, however, that our community continues to evolve as a desirable place to live, raise a family and work.

Q. Managed care, when it was introduced, was touted as a means of holding down costs. Is this the model we will continue to rely on to rein in the cost of care? How effective has it been?

A. The delivery of care via a fully integrated model like we have at BFMC would reduce costs dramatically. A high level of communication between primary care and specialists, priority care clinics for the chronically or acutely ill, 24-hour-a-day, 7-day-a-week nurse case management, employed hospitalist physicians, and much more, is what we provide and what produces the best possible outcomes.

Q. Is capitation a good strategy for the Bakersfield market?

A. Capitation in general terms creates a strategic alignment where both the payor and payee are vested in delivering well managed, high quality care.

Q. What's more popular in Kern County, HMOs or PPOs, and why?

A. These products in a health insurance organizations portfolio have in recent years become more similar than distinct. Premiums and benefit design vary from year to year, plan to plan. An answer relative to "popularity" would be difficult to formulate.

Q. Independent practices have all but vanished in Bakersfield. Can a sole practitioner survive in this market? What are the pros and cons of going it alone?

A. The challenges of the economic model for sole practitioners beginning a practice today are daunting. Expenses related to facility acquisition, medical malpractice coverage, staff, equipment, etc. require significant capital outlay and reserve. Our model at BFMC has become a preferred option. The number of physician applications we receive today has increased significantly over past years.

Q. How would the proposed ban against rejecting people with pre-existing conditions change the cost of premiums?

A. That would be an actuarial calculation that I have no knowledge of. People with pre-existing conditions must be accommodated and provided for in our healthcare system.

Q. Opponents of health care reform haven't offered much in the way of an alternative, with the possible exception of tort reform and doing something about the cost of malpractice insurance. Would that alone be enough to reverse or at least slow cost escalation that has outpaced inflation for decades?

A. Quite simply, the elimination of waste. I do believe that certain physicians at times practice a form of "defensive medicine," whereby they are appropriately fearful of litigation. Additional tort reform would be a valuable consideration.

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