The State of Hospitals

HouTx, BSN, MSN, EdD · Nov 24, 2009

Undoubtedly some hospitals will close. But this is nothing new. I am 'tenured' enough (sounds better than old, doesn't it?) to remember at least 2 other bad cycles in which large numbers of hospitals closed. The first was with the advent of the prospective payment system (DRGs) in the early '80s... That set off a virtual reimbursement apocalypse. Then more reimbursement changes along with loss of federal subsidies pulled the rug out from under a lot of rural facilities in the mid '90s. In Texas, I believe we lost about 30% of our rural hospitals at that time.

At first glance, the situation does look grim. But we should think critically, and not leap into Chicken Little mode. A lot of these metrics are directly attributable to the current investment market. Cheap capital is no longer available to hospitals & their investment income (like ours) is waaaay down. We all know that volumes are down - major causes are unemployment & loss of insurance coverage.

Organizations with good fiscal management will survive. My organization acted early on to quickly tighten our budgetary belt. Overnight, we changed from a typical business model to one that reminds me of what my grammy used to say about the Great Depression -- "Make it do or Do without". We don't travel, we don't cater meetings, we carefully scrutinize empty positions instead of automatically filling them when someone leaves, we froze all non-replacement capital expenditures -- etc. All of our hospital departments have been flexing staff (based on patient volumes) for quite a while. Our austerity program has prompted an accelerated rate for changes like using webinars instead of face-to-face venues whenever possible. We have reorganized to shrink our "C-Level" (CEO, COO, etc) ranks.

We have been back in the black for some time now and things are starting to pick up even more. It will take a while, but I am convinced that we're on the upswing. Just think, 20 years from now you will be able to bore the 'young ones' with tales of the Great Recession.

nursej22, MSN, RN · Nov 24, 2009

If "Obamacare"(whatever that is) can assist people to obtain primary healthcare someplace besides the ED I am guessing that would aid hospital budgets.

Kabin · Nov 25, 2009

If "Obamacare"(whatever that is) can assist people to obtain primary healthcare someplace besides the ED I am guessing that would aid hospital budgets.

The 3 major hospital associations pre-negotiated a $155 billion deal with Obama for payment cuts over 10 years. Those are in the form of lower medicare and medcaid payments to hospitals. It isn't going to get any easier.

Of course, hospitals are struggling now. Your assumed hospital aid scenario won't happen for years down the road since Obamacare won't be implemented until then. And even then, hospitals will only have so many beds to fill with lower paying patients.

nursej22, MSN, RN · Nov 25, 2009

So if the money from those cuts goes to help pay insurance payments for the underinsured and they can go to a clinic to treat an ear infection instead of the the ED, isn't that a better stewardship of healthcare dollars?

belgarion · Nov 25, 2009

I too remember the rural hospital closings in Texas. I attended a meeting recently where a few numbers were thrown out. Out of 254 counties in Texas about 10% don't have ANY doctors. Nearly 50 counties have NO hospital while around 60 counties have only one.

One of the problems I have with the health care bills is the lack of a safety net for rural healthcare. I grew up in an area where most of our healthcare came from the EMS people at the VFD. The nearest doctor was close to an hour away and the nearest hospital ninety minutes. In the seventies you didn't have as many air ambulance services as there are now. How would you like the idea of a ninety minute ride on top of the hoses in the back end of a fire truck with a leg ripped open from below the knee to the groin? I know "city people" don't think about things like this but believe me, it can be scary. They may think that the loss of a small 50 bed hospital is no big deal but try selling that to the people who live there.

The people who run the rural hospital where I work are worried about this situation as are the people who depend on us for their care. A small town hospital is more that just a hospital. Often it is the medical clinic, physical rehab center, home health care provider, and DME provider. In our case, the EMS is dispatched from our ER and we use the EMTs and paramedics as emergency room staff when they aren't out on a call. All of the administrative staff have multiple job titles. The nurses handle all of the admission paperwork because we got rid of the unit clerks. There are four openings for nurses that aren't being filled. Cost containment? It's our way of life.

We need health care reform. I am just afraid that once it comes to pass in whatever form it takes the Law of Unintended Consequences will kick in as it did in the 70's and 80's and it will be the "country folks" who get the short end of the stick - again.

elkpark · Nov 26, 2009

I too remember the rural hospital closings in Texas. I attended a meeting recently where a few numbers were thrown out. Out of 254 counties in Texas about 10% don't have ANY doctors. Nearly 50 counties have NO hospital while around 60 counties have only one.
One of the problems I have with the health care bills is the lack of a safety net for rural healthcare. I grew up in an area where most of our healthcare came from the EMS people at the VFD. The nearest doctor was close to an hour away and the nearest hospital ninety minutes. In the seventies you didn't have as many air ambulance services as there are now. How would you like the idea of a ninety minute ride on top of the hoses in the back end of a fire truck with a leg ripped open from below the knee to the groin? I know "city people" don't think about things like this but believe me, it can be scary. They may think that the loss of a small 50 bed hospital is no big deal but try selling that to the people who live there.
The people who run the rural hospital where I work are worried about this situation as are the people who depend on us for their care. A small town hospital is more that just a hospital. Often it is the medical clinic, physical rehab center, home health care provider, and DME provider. In our case, the EMS is dispatched from our ER and we use the EMTs and paramedics as emergency room staff when they aren't out on a call. All of the administrative staff have multiple job titles. The nurses handle all of the admission paperwork because we got rid of the unit clerks. There are four openings for nurses that aren't being filled. Cost containment? It's our way of life.
We need health care reform. I am just afraid that once it comes to pass in whatever form it takes the Law of Unintended Consequences will kick in as it did in the 70's and 80's and it will be the "country folks" who get the short end of the stick - again.

If our system was designed and set up to make sure that all US citizens get the care they need (as so many other countries have done), instead of being set up according to capitalist, free market priniciples with a few, "bare bones" protections fo the less fortunate, you wouldn't have to worry about that. That's one of the many basic flaws with our "system."