Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, September 10, 1995 TAG: 9509110125
SECTION: VIRGINIA PAGE: A-1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY STAFF WRITER
DATELINE: LENGTH: Long
This will be Step 2 in the remake of the not-for-profit company, based in Roanoke. The first step was the development of standards for certain common clinical procedures in order to get patients well faster and cut costs in the process.
Carilion - whose system stretches from Farmville to Big Stone Gap - says it must cut its $450 million annual budget 25 percent over the next eight years. Its ultimate goal: to control costs so it can be competitive.
It hopes to achieve that through fewer managers, group purchasing and standardization of supplies - from antibiotics to bedrails - and through other steps that include ending duplication of services and competition among its own hospitals.
The national move to managed care - as exemplified by health maintenance organizations that enroll groups of potential patients and then negotiate per-capita hospital and doctor fees to care for them - is forcing Carilion to be more cost-conscious.
So is Columbia/HCA Healthcare Corp., the for-profit company that is the nation's largest operator of hospitals; it also is Carilion's competitor in Southwest Virginia.
If it seems Carilion is taking a cue for its redesign from the giant retailer Wal-Mart, that's probably true. Columbia built itself in the image of Wal-Mart.
Started in 1987 by Dallas lawyer Richard Scott and one partner, Columbia has grown into a publicly traded powerhouse of 326 hospitals and 115 outpatient surgery centers in 36 states and several foreign countries. Five of the hospitals are in Carilion territory.
"The competition is very simple," said Thomas Robertson, Carilion's chief executive officer.
Southwest Virginia, like most of the country, has far more hospital beds than it can fill, now that insurance companies are encouraging shorter stays and more outpatient care.
To attract the limited number of patients, both Carilion and Columbia "are running fast and hard," Robertson said.
Just how fast and hard can been seen in the two systems' confrontation over Radford Community Hospital.
Carilion has said for years that it planned to build a new hospital to replace the aging one it owns in Radford. But when it applied to the state Health Department for permission to build the new facility, Columbia's hospitals in the New River Valley retaliated with their own proposal: to build a new Radford hospital.
Carilion's application includes plans for a 97-bed hospital plus space for a variety of services from doctors' offices to a fitness center, at a cost of about $60 million. Columbia proposes a 50-bed, $26 million facility based on a generic hospital design that it has used in other locations.
Not only would Columbia's project cost less, its application points out, but also the ultimate result would be fewer total hospital beds in the New River Valley. To offset the new Radford hospital, Columbia's Montgomery and Pulaski hospitals would give up some of their licensed beds. Columbia also suggests that, if its proposal is approved, Carilion surely would close its hospital in Radford because upgrading it would be too expensive.
How much room at the top?
The fight in Radford, which gets its first public hearing Monday, underscores the bigger battle that is under way between the hospital systems for market dominance all over Southwest Virginia.
When a hospital system's power was measured by the number of beds it controlled, Carilion was on top. But with more than half of the beds empty in Southwest Virginia - and across the nation - bed count doesn't cut it any more.
Now, the ability to deliver a network of inpatient and outpatient services over a broad geographic area, competitively priced, decides who comes out ahead.
Is there room for two at the top?
Until this year, Carilion was the main provider of health care in the Roanoke Valley and most of Southwest Virginia. Then, through a merger of hospital companies, five Southwest Virginia hospitals became part of Columbia.
For the health-care consumer, the issue comes down to choosing between systems, based on the number of affiliated physicians, number of sites, patient satisfaction, price of services and outcomes of services.
Building systems is what the Radford argument is about. It also explains why Columbia bought the not-for-profit Alleghany Regional Hospital this spring and turned it into a for-profit facility.
When Columbia-HCA acquired the New River Valley hospitals and Lewis-Gale Hospital in Salem through several mergers, it also obtained hospitals in West Virginia. To build a system that would link its facilities, the company bought Alleghany Regional in Low Moor, a small community midway between Covington and Clifton Forge.
Becoming part of a national chain of hospitals didn't cause any turmoil, because Columbia believes health care is local, said Alleghany Regional's new president, Ward Stevens III.
However Lewis-Gale probably will send up more experts to expand specialty services, and there is to be a greater coordination of patient services with another sister property, Greenbrier Valley Hospital in nearby Fairlea, W.Va. Also, the medical procedures for handling hip implants will be standardized for all doctors doing the surgery at Alleghany, so the hospital can control the quality and cost.
The hospital also plans to make education and illness-screening services more available to businesses and the community in an effort to prevent illness, a practice that also is gaining favor with insurers.
These things happen at any hospital that hopes to remain competitive, Stevens points out.
"We have no plans to discontinue any services or shed any program," he said.
Babies born at Alleghany who need intensive care will continue to be transported to the only Southwest facility where it's available, Carilion's Community Hospital in Roanoke, by Carilion's helicopter service.
Columbia's executives are given a lot of latitude in decision making, said Wickliffe Lyne, chief executive officer of the Virginia division and Stevens' boss.
Lyne, who has offices in his hometown of Richmond, has 15 facilities under his command, including those in Southwest Virginia. He reports to the Eastern Group president, who in turn answers to the chief operating officer in Nashville.
Virginia is one of Columbia's larger divisions, he said, and also "is a significant player" in company earnings.
A local division can have its own human resources department. It even can set up regional presidents, which might happen in Southwest Virginia, Lyne said.
"There is no Columbia/HCA cookie cutter for what goes into an office," Lyne said.
The only rule Columbia lays down for leaders is that they must stay within budget. Division expenses are closely scrutinized by administrators under similar constraints.
"I have to answer for the overhead," Lyne said.
Columbia's largest presence in the state is in Richmond, and the next largest is in the Roanoke and New River valleys. Lyne said he has promising negotiations under way in Tidewater and Northern Virginia, and the company is "actively engaged" with Gov. George Allen's "privatization initiative," an effort to get more state facilities to be self-supporting.
Columbia and the Medical College of Virginia in Richmond have been discussing ways the college could work with Columbia to offset MCV's shrinking income.
Lyne said any close relationship with MCV must wait for legislative approval.
He hasn't pursued an invitation to meet with officials of the University of Virginia Hospital in Charlottesville for similar discussions, because the medical colleges compete for business. "Probably, we will create transactions with only one," he said.
A partnership with MCV would give Columbia control of more than one-half of the hospital beds in the Richmond area.
Columbia already has joint ventures with Tulane University Medical School in New Orleans, the University of Louisville (Ky.) and the University of Miami (Fla.), and it is negotiating with medical schools in other states. Columbia shares the profits with university partners and in turn gets to market the teaching hospitals as part of its network.
Nothing specific will happen with MCV until a proposal goes to the General Assembly for approval, Lyne said. However, MCV is a joint petitioner with Columbia in an application to the state Health Department to build an outpatient surgical center in Chester, outside Richmond.
The Chester tactic is similar to what Columbia is doing with the proposal to build in Radford, an effort to block competitors who want to do similar projects.
"It's our strategy to compete on a market-to-market basis," Lyne said.
'It's going to be messy'
Until recently, Carilion and Columbia facilities pretty much stayed in their own territory, but now each wants the other's business.
Lyne said Carilion tried to increase the number of patients it gets from Blacksburg and Pulaski by pushing health care insurance contracts that excluded Columbia's hospitals in those areas.
"Carilion decided it was going to eat more and more off the Pulaski and Montgomery table, and we've said, 'No, that's enough,''' Lyne said.
The tension increased when Carilion announced it was buying a Blacksburg physician's practice and had plans to expand it, he said.
Lyne, who did his internship at Community Hospital before Carilion acquired it, has known Carilion's Robertson for years. They have worked together as officers of the Virginia Hospital Association.
The battle between the two "is going to stay gentlemanly," Lyne said. "We can be potent competitors without being enemies."
"There needs to be friendly competition," said William Downey, the new Lewis-Gale president. "I think there's enough market for both of us to do well."
Nevertheless, Robertson, the Carilion chairman, said that Columbia's counterproposal for the Radford hospital was "a real hardball strategy" that he has no intention of backing away from.
"But it's going to be messy," he said.
That's what happened in 1993 when the Hospital Corporation of America, a few months before announcing its merger with Columbia, began a battle with Holston Valley Medical Center in Kingsport, Tenn.
HCA had several small hospitals in the Kingsport-Johnson City area, but it lacked a full-service hospital; that led to an offer to buy Holston Valley.
When the purchase offer was refused, HCA bought advertising in print media telling the community that Holston Valley was not serving the area's "best interest" when it turned down the offer.
The tactics then were the same as those used by Columbia/HCA now, and that is to remind residents that Columbia is a for-profit, taxpaying business while not-for-profit facilities, such as Holston Valley and Carilion, don't pay taxes.
Columbia/HCA now is negotiating to buy Johnson City Medical Center; as a competitive move, Holston Valley and Bristol Regional Medical Center are talking about some kind of alignment.
Allowing doctors to invest
The way Columbia gobbles up medical facilities like PacMan, with its eye more and more on the not-for-profit system that delivers most of the health care in America, is inspiring new alliances.
Robertson said his company is "having a lot of interaction" with Sentara Health System, the dominant hospital system in Tidewater. Like Carilion, it is a player on all sides of health care, from hospitals to home health care to having its own managed-care company.
The influence of competition - coupled with the concern that Medicare reimbursements, which support most hospitals, could be cut by as much as $280 billion - is pushing hospital companies to seek the security of groups. Groups have more clout in negotiating provider contracts.
However, one of the remaining independent hospitals in the area, Memorial Hospital of Martinsville and Henry County, refused Columbia's purchase offer. But Memorial did become a member of the Southwest Virginia Health Alliance, made up mainly of Columbia hospitals - Lewis-Gale, Pulaski, Montgomery, Clinch Valley Medical Center and St. Luke's Hospital in Bluefield, W.Va.
Lewis-Gale Clinic, which is independently owned but shares a site and some functions with Lewis-Gale Hospital, is a member of the alliance, and Life Center of Galax recently joined. The alliance can negotiate contracts as a provider group, but it does not prohibit members from negotiating individually.
Alliance membership includes the hospitals and physician organizations associated with them, which means they can compete for managed-care contracts along with hospital and physician networks marketed by insurance companies, such as Aetna, or by Carilion.
Hospital companies want to offer a full line of services so no patient - which both now call a customer - ever has to look to a competing system for help.
Carilion has spent $3 million just setting up a managed-care division. It's eagerly buying physician practices, especially since Lewis-Gale Clinic began expanding its satellite clinic efforts. Carilion has 50 primary-care physicians as employees, most of them added in the past two years.
The next step is to make it possible for doctors to invest in the systems.
Neither Columbia nor Carilion has yet to employ this tactic in Virginia, but both say they plan to.
Carilion is exploring ways doctors can participate in its managed-care company; in Texas and Florida, Columbia already has doctors as stockholders in hospitals where they practice.
It is illegal to offer financial incentives to get physicians to refer patients to a particular hospital, but investments in managed-care companies and companies that own hospitals can make physicians more aware of being cost-efficient.
Becoming more competitive in health care today can even mean hurting yourself in order to get better. When Carilion found that the length of its patients' hospital stays was longer than at its competitors' facilities, it "made a decision" to drive down length of stay, Robertson said. The consequence was loss of hospital income.
One of the points Robertson makes is that Carilion is not in a crisis, so it can change while it still can make rational decisions.
Financially, 1994 was one of the company's best years ever, he said. Its home health-care business is up 20 percent this year. The company's bond rating has been set at A-plus, which means it can borrow money if it needs to.
The 1996 budget that will go to its board this month will show a decrease in operational costs of up to $15 million.
However, Robertson knows that the competition "has deep pockets" and how it spends its money can hurt Carilion.
Carilion got 500 referrals a year from the Alleghany hospital that Columbia bought this year. Will the new ownership cause that to change? he wonders.
The two systems' strategies are similar, he said. "That is, that we are not going to be in every market but want to dominate the market we're in."
Both Robertson and Lyne say the area will continue to have two hospital systems.
"They'll compete vigorously, which will enhance quality and squeeze cost," Lyne says.
Lyne says there are even ways in which Columbia and Carilion can work together.
``I might say to [Robertson], `Why don't we operate the helicopter transport system together?''' Lyne said.
Wickliffe Lyne, Columbia: "It's our strategy to compete on a market-to-market basis."
Columbia's Wickliffe Lyne: "Carilion decided it was going to eat more and more off the Pulaski and Montgomery table and we've said, 'No, that's enough,'" Lyne said.
One of the points Robertson makes is that Carilion is not in a crisis, so it can change while it can still make rational decisions.
Carilion's Tom Robertson: "We are not going to be in every market but want to dominate the market we're in."
"IT'S GOING TO BE MESSY."
We can be potent competitors without being enemies.
Wickliffe Lyne
Chief executive officer Virginia division, Columbia/HCA Healthcare
There needs to be friendly competition. I think there's enough market for both of us to do well.
William Downey
President, Lewis-Gale Hospital
Hospital companies want to offer a full line of services so no patient - which both now call a customer - ever has to look to a competing system for help.
EXT month, Carilion Health System Inc. expects to announce elimination of three layers of management. There will be buyouts. Some of its 14 hospitals may no longer have separate managers.
This will be Step 2 in the remake of the not-for-profit Roanoke-based company. The first step was the development of standards for certain common clinical procedures in order to get patients well faster and cut costs in the process.
Carilion - whose system stretches from Farmville to Big Stone Gap - says it must cut its $450 million annual budget 25 percent over the next eight years. Its ultimate goal: to control costs so it can be competitive.
It hopes to achieve that through fewer managers, group purchasing and standardization of supplies - from antibiotics to bed armrails - and through a variety of other steps that include ending duplication of services and competition among its own hospitals.
The national move to managed care - as exemplified by health maintenance organizations that enroll groups of potential patients and then negotiate per-capita hospital and doctor fees to care for them - is forcing Carilion to be more cost-conscious.
So is Columbia/HCA Healthcare Corp., the for-profit company that is the nation's largest operator of hospitals as well as Carilion's competitor in Southwest Virginia.
If it seems Carilion is taking a cue for its redesign from the giant retailer Wal-Mart, that's probably true. Columbia built inself in the image of Wal-Mart.
Started in 1987 by Dallas lawyer Richard Scott and one partner, Columbia has grown into a publicly traded powerhouse of 326 hospitals and 115 outpatient surgery centers in 36 states and several foreign countries. Five of the hospitals are in Carilion territory.
"The competition is very simple," Carilion Chief Executive Officer Thomas Robertson says.
Southwest Virginia, like most of the country, has far more hospital beds than it can fill now that insurance companies are encouraging shorter stays and more outpatient care.
To attract the limited number of patients, both Carilion and Columbia "are running fast and hard," Robertson said.
Just how fast and hard can be seen in the two systems' confrontation over Radford Community Hospital.
Carilion has said for years that it planned to build a new hospital to replace the aging one it owns in Radford. But when it applied to the State Health Department for permission to build the new facility, Columbia's hospitals in the New River Valley retaliated with their own proposal to build a new Radford hospital.
Carilion's application includes plans for a 97-bed hospital plus space for a variety of services from doctors' offices to a fitness center, at a cost of about $60 million. Columbia proposes a 50-bed, $26-million facility based on a generic hospital design that it has used in other locations.
Not only would Columbia's project cost less, its application points out, but the ultimate result would be fewer total hospital beds in the New River Valley. To offset the new Radford hospital, Columbia's Montgomery and Pulaski hospitals would give up some of their licensed beds. Columbia also suggests that, if its proposal is approved, Carilion would surely close its hospital in Radford because it would be too expensive to upgrade it.
How much room
at the top?
The fight in Radford, which gets its first public hearing Monday, underscores the bigger battle that is under way between the hospital systems for market dominance all over Southwest Virginia.
When a hospital system's power was measured by the number of beds it controlled, Carilion was on top. But with more than half of the beds empty in Southwest Virginia - and across the nation - bed count doesn't cut it any more.
Now, the ability to deliver a network of inpatient and outpatient services over a broad geographic area, competitively priced, decides who comes out ahead.
Is there room at the top for two?
Until this year, Carilion was the main provider of health care in the Roanoke Valley and most of Southwest Virginia. Then, through a merger of hospital companies, five Southwest Virginia hospitals became part of Columbia.
For the health-care consumer, the issue comes down to choosing between systems, based on the number of affiliated physicians, number of sites, patient satisfaction, price of services and outcomes of services.
Building systems is what the Radford argument is about. It also explains why Columbia bought the not-for-profit Alleghany Regional Hospital this spring and turned it into a for-profit facility. When Columbia-HCA acquired the New River hospitals and Lewis-Gale Hospital in Salem through several mergers, it also obtained hospitals in West Virginia. To build a system that would link its facilities, the company bought Alleghany Regional in Low Moor, a small community midway between Covington and Clifton Forge.
Becoming part of a national chain of hospitals didn't cause any turmoil because Columbia believes health care is "local," said Alleghany Regional's new president, Ward Stevens III.
However, a sister hospital, Lewis-Gale in Salem, probably will send up more experts to expand specialty services, and there's to be a greater coordination of patient services with another sister property, Greenbrier Valley Hospital in nearby Fairlea, W.Va. Also, the medical procedures for handling hip implants will be standardized for all doctors doing the surgery at Alleghany so the hospital can control the quality and cost.
The hospital also plans to make education and illness-screening services more available to businesses and the community, a practice that also is gaining favor with insurers.
These things happen at any hospital that hopes to remain competitive, Stevens points out.
"We have no plans to discontinue any services or shed any program," he said.
Babies born at Alleghany who need intensive care will continue to be transported to the only Southwest facility where it's available, Carilion's Community Hospital in Roanoke, by Carilion's helicopter service, for example.
Columbia's executives are given a lot of latitude in decision-making, said Wickliffe Lyne, who is chief executive officer of the Virginia division and Stevens' boss.
Lyne, who has offices in his hometown of Richmond, has 15 facilities under his command, including those in Southwest Virginia. He reports to the Eastern Group president, who in turn answers to the chief operating officer in Nashville.
Virginia is one of Columbia's larger divisions, he said, and also "is a significant player" in company earnings.
A local division can have its own human resources department. It can even set up regional presidents, which might happen in Southwest Virginia, Lyne said.
"There is no Columbia/HCA cookie cutter for what goes into an office," Lyne said.
The only rule Columbia lays down for leaders is that they must stay within budget. Division expenses are closely scrutinized by administrators under similar constraints.
"I have to answer for the overhead," Lyne said.
Columbia's largest presence in the state is in Richmond, and the next largest is Roanoke and the New River Valley. Lyne said he has promising negotiations under way in Tidewater and Northern Virginia, and the company is "actively engaged" with Gov. George Allen's "privatization initiative," an effort to get more state facilities to be self-supporting.
Columbia and the Medical ollege of Virginia in Richmond have been discussing ways the college could work with Columbia to offset its shrinking income.
Lyne said any close relationship with MCV must wait for legislative approval.
He hasn't pursued an invitation to meet with officials of the University of Virginia Hospital in Charlottesville for similar discussions because the medical colleges compete for business. "Probably we will create transactions with only one," he said.
A partnership with MCV would give Columbia control of more than one-half of the hospital beds in the Richmond area.
Columbia already has joint ventures with Tulane University Medical School in New Orleans, the University of Louisville and the University of Miami, and it is negotiating with medical schools in other states. Columbia shares the profits with university partners and in turn gets to market the teaching hospitals as part of its network.
Nothing specific will happen with MCV until a proposal goes to the General Assembly for approval, Lyne said. However, MCV is a joint petitioner with Columbia in an application to the State Health Department to build an outpatient surgical center in Chester outside Richmond.
The Chester tactic is similar to what Columbia is doing with the proposal to build in Radford, an effort to block competitors who want to do similar projects.
"It's our strategy to compete on a market-to-market basis," Lyne said.
'It's going
to be messy'
Until recently, Carilion and Columbia facilities pretty much stayed in their own territory, but now both want the others business.
Lyne said Carilion tried to increase the number of patients it gets from Blacksburg and Pulaski by pushing health care insurance contracts that excluded Columbia's hospitals in those areas.
"Carilion decided it was going to eat more and more off the Pulaski and Montgomery table and we've said, 'No, that's enough,'" Lyne said.
The tension increased when Carilion announced it was buying a Blacksburg physician's practice and had plans to expand it, he said.
Lyne, who did his internship at Community Hospital before Carilion acquired it, has known Carilion's Robertson for years. They have worked together as officers of the Virginia Hospital Association.
The battle between the two "is going to stay gentlemanly," Lyne said. "We can be potent competitors without being enemies."
"There needs to be friendly competition," said William Downey, the new Lewis-Gale president. "I think there's enough market for both of us to do well."
Nevertheless, Robertson, the Carilion chairman, said that Columbia's counter-proposal for the Radford hospital was "a real hard-ball strategy" that he has no intention of backing away from.
"But it's going to be messy," he said.
That's what happened in 1993 when the Hospital Corporation of America, a few months before announcing its merger with Columbia, began a battle with Holston Valley Medical Center in Kingsport, Tenn.
HCA had several small hospitals in the Kingsport-Johnston City area, but it lacked a full-service hospital; that led to an offer to buy Holston Valley.
When the purchase offer was refused, HCA bought advertising telling the community that Holston Valley was not serving the area's "best interest" when it turned down the offer.
The tactic then was the same as those used by Columbia/HCA now, and that is to remind residents that Columbia is a for-profit, tax-paying business while not-for-profit facilities, like Holston Valley and Carilion, don't pay taxes.
Columbia/HCA is now negotiating to buy Johnston City Medical Center;as a competitive move, Holston Valley and Bristol Regional Medical Center are talking about some kind of alignment.
Allowing the
doctors to invest
The way that Columbia gobbles up medical facilities like PacMan, with its eye more and more on the not-for-profit system that delivers most of the health care in America, is inspiring new alliances.
Robertson said his company is "having a lot of interaction" with Sentara Health System, the dominant hospital system in Tidewater. Like Carilion, it is a player on all sides of health care, from hospitals to home health care to having its own managed care company.
The influence of competition - coupled with the concern that Medicare reimbursements, which support most hospitals, could be cut by as much as $280 billion - is pushing hospital companies to seek the security of groups. Groups have more clout in negotiating provider contracts.
However, one of the remaining independent hospitals in the area, Memorial Hospital of Martinsville and Henry County, refused Columbia's offer of purchase. But Memorial did become a member of the Southwest Virginia Health Alliance, made up mainly of Columbia hospitals - Lewis-Gale, Pulaski, Montgomery, Clinch Valley Medical Center and St. Luke's Hospital in Bluefield, W.Va.
Lewis-Gale Clinic, which is independently owned but shares a site and some functions with Lewis-Gale Hospital, is a member of the alliance, and Life Center of Galax recently joined. The alliance can negotiate contracts as a provider group, but it does not prohibit each member from negotiating individually.
Alliance membership includes the hospitals and physician organizations associated with them, which means they can compete for managed-care contracts along with hospital and physician networks marketed by insurance companies, like Aetna, or by Carilion.
Hospital companies want to offer a full line of services so no patient - which both now call a customer - has to ever look to a competing system for help.
Carilion has spent $3 million just setting up a managed care division. It's eagerly buying physician practices, especially since Lewis-Gale Clinic began expanding its satellite clinic efforts. Carilion has 50 primary-care physicians as employees, most of them added in the past two years.
The next step is to make it possible for doctors to invest in the systems.
Neither Columbia nor Carilion has yet to employ this tactic in Virginia, but both say they plan to.
Carilion is exploring ways that doctors can participate in its managed care company; in Texas and Florida, Columbia already has doctors as stockholders in hospitals where they practice.
It is illegal to offer financial incentives to get physicians to refer patients to a particular hospital, but investments in managed-care companies and companies that own hospitals can make physicians more aware of being cost-efficient.
Becoming more competitive in health care today can even mean hurting yourself in order to get better. When Carilion found that the length of stay in the hospital for its patients was longer than at its competitors' facilities, it "made a decision" to drive down length of stay, Robertson said. The consequence was loss of hospital income.
One of the points Robertson makes is that Carilion is not in a crisis, so it can change while it can still make rational decisions.
Financially, 1994 was one of the company's best years ever, he said. Its home health-care business is up 20 percent this year. The company's bond rating has been set at A-plus, which means it can borrow money if it needs to. The 1996 budget that will go to its board this month will show a decrease in operational costs of up to $15 million.
However, Robertson knows that the competition "has deep pockets" and how it spends its money can hurt Carilion.
Carilion got 500 referrals a year from the Alleghany hospital that Columbia bought this year. Will the new ownership cause that to change? he wonders.
The two systems' strategies are similar, he said. "That is, that we are not going to be in every market but want to dominate the market we're in."
Both Robertson and Lyne say the area will continue to have two hospital systems.
"They'll compete vigorously, which will enhance quality and squeeze cost," Lyne said.
Lyne says there are even ways in which Columbia and Carilion can work together.
"I might say to [Robertson], `Why don't we operate the helicopter transport system together?'" Lyne said.
Keywords:
PROFILE
by CNB