A proposed "evergreen" lease that would extend Duke University Health System's contract with Durham County's Durham Regional Hospital could plant the seeds of technological advancement at the community hospital, Duke and county officials said.
Although the exact terms are still being negotiated, the existing 20-year lease, which was set to expire in two years, would be extended for another 40 years under the proposal. The lease, put forth by the county, would renew automatically each year, unless one of the parties wanted to uproot the agreement.
DUHS would oversee and increase funding to Durham Regional, as well as Lincoln Community Health Center and Durham County Emergency Medical Services-which are dedicated to surgical, primary and emergency care of uninsured residents of Durham County.
"We want a long-term lease with Durham Regional, so we can invest in the long-term needs of the community," added Doug Stokke, assistant vice president of communications for DUHS.
Durham Regional would then be able to undergo much-needed renovations and update its medical equipment.
County Commissioners Chair Ellen Reckhow said the new contract would help accomplish the county's goals for Durham Regional by removing obstacles to capital investment, incentivizing the structural updates and revamping support for LCHC and EMS.
"We have agreed to reduce the lease payment to the county long-term, recognizing that Duke will have a greater investment in the hospital than the county over time," Reckhow wrote in an e-mail. "As a result, we are willing to reduce the lease payment to the County to zero beginning in 2032-with the payments for LCHC and EMS continuing."
Duke's payment to LCHC would increase by $750,000, rising from $2.1 million to $2,850,000 in July 2009, and it would increase each year with the cost of living.
The original 1998 lease was met with skepticism from some community members regarding Duke's genuine commitment to Durham Regional, said Dr. Victor Dzau, chancellor for health affairs and president and chief executive officer of the Duke University Health System. But the extension would solidify Duke's mission to eliminate local health disparities.
"[Back then] Durham Regional was in financial disaster, and we never recovered the losses," Dzau added. "We believe it's important to the county to take care of the less complicated patients there, otherwise they are competing for the same beds as more complicated patients at DUHS."
Lewis Cheek, the county commissioners' representative on the Durham Regional Hospital Corporation Board-, said a common problem within the health system is that some people try to use emergency care facilities for primary care if they do not have health insurance. To address the problem, Durham Regional should remain a "state of the art" facility to provide primary care and less intensive medical procedures, he said. As a research-based institution, DUHS can handle more specialized needs.
Cheek also acknowledged that historically there have been tensions between private community physicians and Duke Medicine physicians but that their relationships with each other and the community have improved in recent years as a result of new partnerships. One of these programs is Project Access-a joint effort involving DUHS, LCHC and community physicians who provide specialty care to uninsured people.
David Smith, Durham resident and president of the "Friends of Durham" community group, said that in 1998, his group researched the lease of Durham Regional to Duke and now he hopes considerations are made about Duke potentially monopolizing Durham's healthcare.
"There are concerns about Duke because it's getting to be the only game in town," Smith said. "But on the other hand, Duke is providing the community with a good service by covering people who aren't insured. I'm in favor of the county leasing [Durham Regional] as long as they continue to take care of the indigents who aren't covered by health insurance."
He added that he knows doctors who have quit working for Duke out of frustration with the system, but Smith himself has gotten treatment at Duke Hospital for thyroid cancer and has since switched his primary care to DUHS.
During the current lease negotiations, all parties involved-Duke, DCHC, LCHC and Durham Regional executives-have been enthusiastic, Cheek said. And the county has scheduled a meeting Nov. 24 that will be open to questions from community members.
Officials from LCHC declined to comment until terms of the lease have been negotiated.
"We are optimistic, given fruitful discussions with Duke that we will be able to reach a good conclusion," Reckhow added. "I have not heard any negative comments about the proposed amendment."
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