Employees and medical staff at Lewis-Gale Medical Center in Salem spent a little over an hour Monday sharing insights and questions about health care reform with U.S. Sen. Mark Warner.

About 175 people including nurses, doctors and hospital administrators attended the meeting, which was not open to the general public. Local news media, however, were invited to attend.

The first-term Democrat from Alexandria discussed how he is trying to influence discussions in Washington to overhaul the nation's health care, as well as areas where he thinks the debate has taken a wrong turn.

He focused his comments on positions he has taken throughout the debate, including emphasizing his belief that any reform should be focused on reining in costs. He said controlling the nation's health care expenditures is vital to keeping the country financially competitive in the global marketplace.

"If we do nothing the federal deficit will get so large that it will undermine the value of the dollar and undermine our economy," he said, suggesting that the increase in health care costs should be on par with inflation.

Questions from the audience also focused on costs of providing medical care, with particular attention given to medical malpractice tort reform and reimbursement structures for the government-run Medicaid and Medicare programs.

Warner said he supported national tort reform being part of the discussion, but said that implementing a cap for damages awarded in medical malpractice lawsuits wouldn't come close to solving the problem of rising health care costs.

"I don't think it is a silver bullet," he said.

Later Warner said he didn't think a single bill would solve all the complex problems surrounding the current health care system.

Warner called current reimbursement codes for Medicaid and Medicare "nonsensical" and suggested, like others in his party, that doctors need to be paid for quality of care not just per procedure.

Lewis-Gale reached out to set up the meeting with Warner about a month ago, and has held similar discussions with other politicians representing the area, said Victor Giovanetti, president of HCA Southwest Virginia, which includes Lewis-Gale hospital.

"This is a continuation of our efforts to not only find out where our politicians stand but to give them an understanding about what we think is important during this health care debate that's going on throughout the country," Giovanetti said after the meeting.

Warner said he has already held a similar forum with people at Carilion Clinic.

Giovanetti said the biggest point he and others within HCA are stressing is that health care reform include a way to cover the uninsured.

"Access to health care is important to all of us providers," he said.

Financially, HCA hospitals in Virginia provide an average of $100 million a year in free care, Giovanetti said.

Both Giovanetti and Warner said they are interested to see if a plan to create nonprofit cooperatives would offer a way to access health insurance that would be a competitive alternative to private health insurance companies.

Warner said he would not be in favor of expanding the Medicare or Medicaid programs as a means of covering the uninsured. He stressed the need for competition in the health care marketplace, including among providers and payers.

Warner has yet to hold an in-person public town hall meeting on health care reform, but he said that he is in the process of scheduling a couple for the coming weeks. On Monday, after the Lewis-Gale forum, Warner held a live telephone town hall. About 60,000 people were invited to call in. About 4,000 people participated, according to the senator's office.