One of the most common ways to measure the nation’s hospital crisis is to count closures, but one hospital financing expert says that’s not necessarily the right number to watch.
“If you just look at the number of hospital closures, you won’t see the whole picture,” said Duane Fitch, partner and head of the national healthcare management practice at Moran plant.
Dozens of hospitals farm last year – but even more were forced to do so get rid of key service unitsoften emergency care, labor and delivery, psychiatric care or surgery, Fitch noted.
“There have been a lot of downsizing before – it’s very rare for a hospital to be full service one day and close the next. It’s a long process of continually evaluating what services can be provided within the budget and eliminating services that cannot,” he noted. “Just because a hospital is open doesn’t mean it’s financially viable. »
The hospitals most vulnerable to this type of slow erosion tend to be critical access hospitals in rural areas, as well as safety net hospitals in low-income urban communities, Fitch said.
Their financial reality is bleak: Their patients are mostly covered by Medicare, Medicaid, or no insurer, which means reimbursement rates are quite low across the board.
And recruiting doctors and nurses to work in these environments often requires paying a premium over what comparable hospitals offer elsewhere, Fitch added.
“You have a dynamic where provider spending is significantly higher and their reimbursement is significantly lower,” he explained.
This gap puts almost all subsidized services on the chopping block, Fitch pointed out. Obstetrics is often one of the first to go: a hospital may first scale back its NICU, then scale back labor and delivery before eliminating OB services altogether. Surgery, oncology, dialysis, inpatient rehabilitation and psychiatric care tend to follow.
These types of cuts are made with the intention of stabilizing the hospital’s finances, but they rarely buy more than a little time, Fitch said. It is more common for these service reductions to delay the inevitable rather than prevent it.
The cumulative effect is a steady decline in access to care for communities that need it most, he added.
The trend described by Fitch raises the uncomfortable question: If a hospital continues to cut services that made it essential to the community, can we really still call it a hospital?
“These hospitals may become unrecognizable from what they once were — and that’s not an unusual dynamic these days,” Fitch said.
Photo: Onurdongel, Getty Images
