Ex-Solantic doctor tells of intense pressure on staff to reap revenue

By Stacey Singer, Palm Beach Post Staff Writer
Posted: 11:06 a.m. Sunday                                               
Updated: 12:54 p.m. Sunday, July 10, 2011
Abridged version | Read the complete article here

When family practice physician Randy Prokes joined Solantic Urgent Care in 2004, he told state investigators, his Neptune Beach clinic brought in just $2,000 a day.

By the time he was fired from that job nearly six years later, Prokes said, that same clinic had quadrupled revenues to about $8,000 a day, reaping profit margins unheard of at most doctors' offices.

The sale of the Solantic urgent care chain to a New York private equity group this month marks Florida Gov. Rick Scott's exit from health industry management.

Shaun Ginter, the Solantic chain's former chief operating officer, said Prokes' attacks have contributed to a misunderstanding of Scott, whom he found personable, pleasant and a strategically effective businessman.

But at least one doctor - Prokes - believed the bottom-line focus too often compromised patient care by creating a sweatshop work environment for doctors and nurses.

Prokes said clinic manager turnover was high, and a succession of managers wrote him up for a variety of infractions: arriving five minutes late, failing to suggest Solantic's pharmacy at three points of contact and suggesting a patient might want to return later, when there would be less of a wait.

Prokes told state investigators that he found the atmosphere increasingly untenable, as he was pressed to see 70 to 90 patients each day.

The governor's spokesman, Brian Burgess, declined to discuss Prokes' allegations on the record. He did not respond to requests to make the governor available to discuss his management style.

Ginter said that most of Prokes' allegations twisted the truth. Emergency room-trained doctors appreciated the pace Solantic demanded, he said. Prokes, a family practitioner, perhaps did not.

Ginter said the retail concept that he, Scott, and then-CEO Karen Bowling created drew on lessons from the fast food and other retail industries. Counters were built at standing height, for example, because it speeded workflow, he said.

Ginter, now CEO of Blue Medical Supply and Equipment of Jacksonville, believes the seven-day-a-week retail urgent care clinic model is the future.

"I think we are all going to find as American society gets busier and busier, the traditional health care system does not align with people's lives anymore," Ginter said.

At Solantic's Tamarac clinic on West Commercial Boulevard in Broward County, the paperwork projected Solantic would see 6,500 patients in 2012. A year later, accountants boosted that projection to 10,600 patients.

"It's terribly simplistic, and it gets you into trouble," said Jerre Frazier, an attorney and accountant, of managing by picking desired financial results and working backward to the point of care. But that was how Scott operated, he said.

In 1996, Frazier was retained by the Columbia/HCA board of directors to assess the company's legal exposure as the government's Medicare fraud and abuse investigation grew.

Columbia/HCA had grown into the nation's largest hospital chain, in part, by buying physician practices and creating joint ventures. The doctors had incentives to refer their patients to the Columbia/HCA hospitals.

Before Frazier began to walk the halls at Columbia/HCA headquarters in Nashville, another key figure in the government's fraud case against the hospital chain emerged.

"There were no incentives for being in compliance with Medicare and Medicaid rules," Schilling said. He found that the hospitals in his area kept two sets of books. The one for Medicare auditors showed inflated costs, so that hospitals could justify higher reimbursement rates to take advantage of a funding formula that has since changed.

The hospitals also kept "real" books with different numbers. Ultimately, his whistleblower lawsuit proved among the most damaging to his employer, which eventually paid $1.7 billion to the federal government to settle criminal fraud and abuse charges.

Scott, who wanted to fight the charges rather than settle, was never charged, and said he was unaware of what his managers had been doing.

'It pays to cheat'

Frazier believes Scott's numbers-driven management style is one that now pervades health care, as executives who do a cost-benefit analysis realize that pushing the gray areas of the law, lying and cheating, is rewarded by Wall Street in terms that far outstrip the threat of penalties. After all, Scott left Solantic with stock and pay worth more than $300 million, money which helped propel him to become governor of Florida.

"There is a calculus in health care where it pays to cheat," he said. "There's a 98 percent chance you won't get caught. They just laugh and say, 'Well, we like those odds.' "