As a child riddled with asthma, Timothy Klein, MD, saw first hand what a blessing a caring devoted physician can be. As an internist, he strives to follow the Golden Rule by giving his patients the same compassionate care he received. While that may not be an innovative approach to patient care, Klein over his career has been on the cutting edge of the hospitalist trend. Today, as Medical Director of the hospitalist program at Hardin County Medical Center, he is playing a huge part in the success of the facility.
Klein spent his formative years in Birmingham suffering with severe asthma. Thanks to the devoted physicians who took care of him, he found he enjoyed medicine rather than feared it as some children do. When his father died at age 13, Klein and his mother moved to Atlanta where he encountered one of the biggest influences on his career choice. “I met a physician who was right out of medical school, who was young and energetic,” said Klein. “I had always been drawn to medicine and so I started asking him questions. He let me hang out with him after school making rounds at nursing homes and hospitals. It solidified that medicine is what I would do.”
After graduating from the University of Alabama, Klein returned to Birmingham for his medical training at the University of Alabama School of Medicine. He completed a one-year straight medical internship followed by his internal medicine residency at Methodist Hospital in Memphis. “There was no question about what I wanted to do. I had always leaned toward internal medicine since it was such a broad specialty that covers prevention, diagnosis and treatment of disease in adults so you are always challenged,” said Klein. “My desire to be an internist came from my exposure to nursing homes and hospitals in high school. I even made rounds in nursing homes for physicians in medical school to make money. The elderly and geriatric care are important to me.”
When it came time to launch his career, he initially planned to join a group but decided to open his own practice. “At the time I was married to a classmate and we were going to join the same group,” said Klein. “When they offered her $20-30,000 less than what they did me for same position, we started our own group.”
Klein says that was the best decision because the practice grew like kudzu. “We were blessed early on that there was a new Methodist Hospital in Germantown that courted me to work with them,” he said. “As they were trying to direct market share to the new facility, they wanted me to work with three area nursing homes. I eventually became the Medical Director of all three facilities. I was still seeing patients in the office and had a growing population of nursing home patients, which thus provided ongoing acute hospitalized patients which was great since I had always known I wanted to have nursing homes as a part of my practice.”
With insurance regulation changes in the late 1980’s that required more from doctors to manage their nursing home patients, Klein found himself at the forefront of the hospitalist trend. “I started managing patients in the hospital for physicians,” said Klein. “This allowed for better coordination of care and more time with the patient while letting the physicians cover their patients at the office hours. At the time, I basically had found a niche in healthcare and decided to run with it. With the fee for service market this provided an opportunity to build a referral basis for the hospital. We also did some outreach to rural hospitals to help expand the market base. ”
At the end of the 1990’s, Klein divorced and felt the need to make a professional change from private practice to become a hospitalist. Although at the time it was a relatively new concept in healthcare, he was already managing patients in four hospitals in the Memphis area, which created a need for more physicians to help with the patient load. Volume reached such that he narrowed his hospitalist practice to only Baptist Hospital where he flourished.
To help balance his busy practice as a hospitalist, in 1991 Klein purchased a lake house on Pickwick Lake and fell in love with the Savannah community. In 2005, Klein moved to Savannah, commuting to Memphis for work. When the administration at Hardin County Medical Center started discussing a hospitalist program with him for their facility, Klein knew it was a perfect match for him; the hospital and the community. “They knew it was important for them to maintain their patients in their facility since they had been sending more acute patients to Jackson or Memphis and there was a desire to be able to keep folks closer to home” said Klein. “By nature they had a small number of doctors responsible for managing their patients, and they were swamped in their office. Through his extensive hospital experience, having managed thousands of acute patients, he felt there was an opportunity to keep more acute patients at Hardin Medical Center.
Klein could also show the hospital the value of building a hospitalist program. “The problem we have is the financial margin for rural hospitals is so small,” he said. “If we kept one patient a day that may have otherwise been sent somewhere else for acute care, that can positively impact the bottom line. The only way to survive is to increase volume to make up for decreased revenue. In a small hospital we can develop a program to capture more patients but can only do so much that way. We are only going to get a fixed amount based on DRG coding. That can increase if we are able to accept a higher acuity of patient. From the establishment of the hospitalist program, we have also been able grow other service areas that best address the needs of the community such as cardiology and orthopedics. We have been able to keep our census up and can maintain ourselves as a beacon for healthcare in our county. We are really a mini-tertiary care center now. ”
In his time at Hardin County Medical Center, Klein has worn several hats that were both administrative as well as clinical in nature. He is part of an employed model for physician services and currently serves as Director of Hospitalist Program as well as Chief Medical Officer. “In a small facility you wear many different hats,” he said. As such, he not only attends patients in the acute care setting and the Wound Care Clinic but also serves his administrative duties.
The challenge of interacting with multiple clinical areas and playing a role in salvaging the healthcare system for the community is something Klein is proud to be a part of. “I think we have weathered the initial storm and are moving forward. With the movement toward a hybrid system that is insurance based and more of an Accountability Care Organization model, all the players will have to come together and work together,” he said. “We are looking at the ACO model to see if we can develop our own or join one. We are a county owned hospital and want to maintain our independence, we just don’t have the deep pockets that large healthcare systems have.”
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