Commentary: The stand-alone hospital is becoming a past time

Lindsay Carey [2014] Web

By LINDSAY CAREY
STAFF WRITER

I have been working for the paper for six months now, and over this time I have attended several meetings and heard countless testimonies about the Hospital of Central Connecticut Bradley Campus and Hartford Healthcare.

There were rumors that Hartford Healthcare was planning on closing the Southington hospital and that the corporation was trying to absorb the Bradley Barnes Memorial Trust, both of which are not really true.

After speaking with the Main Street Community Foundation, we were able to debunk the rumors about Hartford Healthcare stealing the trust. It’s clear that Bradley Barnes Memorial Trust is in good hands now and is being used to benefit the town in other ways.

As for the rumors about the hospital closing, those are still going around as Hartford Healthcare has not yet revealed their plans for the future of Bradley and as far as I’m concerned, I think they’re probably still deciding.

With so much passion and fight coming from the community in support of the hospital, it’s easy for Hartford Healthcare to be seen as the bad guys, despite the numerous HHC-owned senior care and other medical facilities benefiting the town.

I don’t think Hartford Healthcare is the bad guy here. I think there’s a bigger picture.

The reality is that healthcare is changing and the stand-alone hospitals that were once located in every community can’t survive the change. It is not because these hospitals were never profitable or cannot be made profitable, it’s just how the industry is going.

After covering several stories about this issue, I began to do some research in my free time about why this was happening. I read numerous articles and spoke to healthcare professionals who reported that the closure of small stand-alone hospitals is a national trend.

I commend all the work that people are doing in town to fight to keep the hospital open; however, my fear is that the battle is much bigger. There are hundreds of Hartford Healthcares across the country, which have managed to create a network of hospitals.

The truth of the matter is large organizations are coming in and becoming corporations or merging with other hospitals. This is happening all over the country.

Chairman of Health Care Management and Organizational Leadership Angela Mattie from Quinnipiac University confirmed this for me when I reached out to her in September of this year.

“The small hospital as a stand alone is going the same way of the dinosaur,” said Mattie. “And it’s not necessarily a bad thing.”

Mattie said that merges decrease the cost of administration and management structure, leverage the expertise across the system, and infuses capital throughout the system, which helps improve the overall care.

“It’s a trend, but it’s not a bad trend,” she said. “We have to face the reality of the healthcare delivery system right now. The small stand alone community hospitals would not survive, but for the mergers.”

I spoke with another representative from a local hospital—who did not want to be named—as to why it is difficult for small hospitals to make it on their own. He gave me a number of reasons for this.

The first was that because small hospitals have a relatively small census— or volume of patients—  there are some things that are just not safe to do.

He questioned me, “If you’re going in for an operation would you rather have the surgery done at a place where they perform the procedure three times a year or 300 times a year?”

I guess his point was that more patients equal more practice and fewer chances for medical errors. Performance reviews are considered in determining the success of the hospital.

The representative also shared with me that it is difficult for small hospitals to survive without economies of scale. Being a stand-alone hospital means you’re alone. You’re fighting for yourself when you’re purchasing equipment and tools, while hospitals in larger systems are getting lower rates for the same items.

From my research, the two major reasons why I believe small hospitals are forced to merge and eventually close are because of health care reform and the increase in the cost of healthcare.

According to an article on More Content Now News by Cristina Janney called “Small rural hospitals face big

changes under the Affordable Care Act,” reveals how reduction in Medicare payments is hurting small hospitals.

“Under the Affordable Care Act, there will be a $196 billion reduction in annual increases in Medicare payments to hospitals, skilled nursing facilities and ambulatory surgical centers over 10 years,” said the article.

Small hospitals simply cannot afford cuts to Medicare payments, when most of these hospitals rely on it for 45 percent of their annual income, according to the article.

As I heard from my interviews with healthcare professionals, the quality of care is a huge part of the equation. Although, the care you receive at a smaller hospital may feel more personalized, the article said that under the Affordable Care Act payments may be based on “positive outcomes.” Hospitals rely on reimbursements from Medicare and Medicaid, but healthcare reform has made this more difficult.

In order to accommodate the uninsured, the Affordable Care Act has changed the way hospitals operate. The only way small hospitals can afford to stay open is to merge, and obviously big networks like Hartford Healthcare are looking for more facilities to absorb because it is a business and this is what businesses do.

The cost of healthcare is another issue that is forcing small hospitals to merge. The cost of hospital and ambulatory services is at an all time high. Medical technology is also expensive, but necessary in order to compete. Also people are living a lot longer now, because modern medicine is keeping them alive. This is why insurance becomes more expensive the older you get.

There are so many factors to why it’s hard for small hospitals to survive and I believe this issue is on a national scale. I have heard some people mention that Hartford Healthcare was a Goliath, but it’s just not so. Hartford Healthcare is just another cog in the system trying to survive and make a profit.

We have to accept that things in healthcare have been changing for a while now and maybe we were a little late getting up to speed. I know I didn’t realize all of the changes until I started reading up on it.

Small hospitals are not surviving around the country. It’s bigger than just Southington. If we really want to see change it’s up to us to stay informed, vote on these issues, and hold our elected officials accountable.

Lindsay Carey is a reporter at The Observer.

 

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