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Island's only urologist says he'll leave in June

Whidbey Island’s only urologist announced he will close his practice by the end of June unless Whidbey General Hospital takes over his clinic and pays him a $325,000 annual salary.

Dr. Benjamin Hu’s ultimatum, made at Monday night’s Whidbey Island Hospital District board meeting, produced looks of surprise on the faces of unsuspecting board members.

Hu ended his lengthy presentation which detailed the financial problems facing modern island medicine by proposing that the hospital district purchase his practice and hire him as a regular staff member at $325,000 annually.

In such an agreement profits from surgeries and related medical care would go directly to the hospital. Whether proceeds would cover the costs is uncertain at this time, but Hu thinks it would be profitable for the hospital.

Hu said that when he opened his practice in Coupeville in 1991 he was a 31- year-old practitioner with his whole medical career ahead of him. He had envisioned a thriving practice in a great community. Now, though his patient load is steady and his family has put down roots on the island, he’s being forced out.

Over the past 15 years Hu has seen his costs increase tenfold and his profits shrink dramatically.

In 1991 Hu was one of five urologists on staff in Island County. He was being paid reasonably for claims filed through Medicare and his malpractice insurance premium was only $564 per year. His practice had launched well and he thought it destined to thrive.

Fast-forward to 2006. Dr. Hu must now pay $23,941 a year for malpractice insurance and he receives less money in repayment from Medicare than he did in 1991 for many procedures.

Case in point: For a radical prostatectomy 15 years ago, the Medicare payment the doctor received was $3,425. In 2006 the same procedure will be reimbursed only $1,548, a drop of over 55 percent from 1991.

Washington State currently ranks 42nd in Medicare payments per beneficiary, according to a 2004 government study. This means doctors in Washington receive less to treat Medicare patients. Coupled with rising malpractice premiums the effect is financially devastating on surgical specialists in private practice.

If Dr. Hu packs up and leaves Whidbey, the impact will be felt by many. Currently, he has 1,832 patients; he performed 438 surgeries at the hospital in 2005.

His leaving could also threaten the hospital’s status. Hu is also the only urologist “on staff” at the hospital, providing ten hours of call coverage per month for consultation. A staff urologist is a mandatory requirement of the hospital’s Cancer Care Accreditation.

Hu thinks the deal he offered the commissioners is a good one.

“A hospital-owned ‘Whidbey General Urology’ service would be very profitable, and even if it had to pay full market rates for a urologist, or two, the combination of hospital based services with the office based practice would practically guarantee a tenfold return on annual investment,” Hu told the board.

Scott Rhine, the hospital’s chief executive officer, hopes a way will be found to keep Hu as a staff member.

“Dr. Hu is an extremely valuable member,”” Rhine said Wednesday. “The Whidbey General Hospital board will consider his request.”

Rhine said the board has not had a chance to formally review the request but added with some urgency, “The time frame is really short.”

It doesn’t appear that Hu is bluffing. “If the hospital board and administration refuse to open their eyes to the realities of today, and hope to live in the past where they got those hospital based urology revenues and excess call coverage for free, then this community is headed into some very rough waters,” he said.

A 45 minute drive off-island to get painful and uncomfortable kidney stones surgically removed could be the scenario facing some Whidbey Island residents if Hu shuts down his practice next month.

Hospital officials are sympathetic to Hu’s plight, understanding the dilemma from firsthand experience. “The hospital itself has faced similar issues,” Rhine said, “it was the biggest driving change for being designated a Medicare Critical Access” site. This status was obtained this year. It limits the number of beds at the hospital but provides full Medicare reimbursement.

Hu said the problem goes beyond the government’s Medicare program for the elders, but even problems with Medicare are bound to grow as the population ages.

“Our politicians need to understand that you can’t deliver adequate health care to a population in 2006 with a 1991 budget because the baby boomer are now swelling the ranks of the Medicare population, and needing more health care,” Hu said.

If those boomers need a urologist, they may have to look beyond Whidbey Island unless Hu and the hospital board can come to terms.

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