How will hospitals bounce back from years of growth and consolidation?

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CLEVELAND – In a pandemic, healthcare workers are heroes, risking their lives to protect ours. Since early March, hospitals across the country have been in crisis mode trying to stop COVID-19. But other things in hospitals have also stopped, like elective procedures and routine doctor’s visits that have cost hospital systems billions of dollars.

A less publicized side effect of the coronavirus has been its crippling effect on hospitals, leaving behind unintended consequences like healthcare workers’ holidays and closing emergency rooms.

As hospitals begin to rebound, how are decisions made years ago shaping the future of healthcare?

“We were a teaching hospital,” said Dr. Robert Haynie, who worked at Mt. Sinai Hospital in Cleveland for 22 years.

The hospital was sold and closed in 2000.

Dr Robert Haynie, former employee of Mount Sinai Hospital

“I came to the hospital and there was all the news channels,” recalls Dr Haynie. “And we are told we have two weeks.”

In the year 2000, there were 42 hospitals in Northeast Ohio according to a Cleveland Hospital Association registry. These hospitals had 30 different owners.

Scroll down to see the different hospitals and ownership groups 20 years ago:

Made with flourish

Over the next few years, five more hospitals would close, including St. Luke’s and Huron hospitals. Other community hospitals with suburban names like Parma Community General, Lakewood Hospital and Euclid Hospital have been taken over and reassigned.

Over the past two decades, the hospital landscape has changed dramatically due to an arms race between the Cleveland Clinic and teaching hospitals.

Today, the Cleveland Clinic, UH and Summa own 66% of the hospitals listed in 2000.

Made with flourish

The largest hospital systems would continue to grow and expand in the suburbs, across the country and around the world, while further increasing their market share in Northeast Ohio.

Despite all the changes, Dr. Haynie told us he doesn’t think patients are worse off today.

“I don’t think we’ve had a drop in quality,” he said. “I actually don’t think you can get better health care anywhere in the world than in Cleveland.”

However, Franco Foti, 67, a longtime Lyndhurst resident, told us he didn’t see the benefits. “I just don’t want to pay for things that are ridiculous fees,” he said.

Foti told us that debt consolidation forces him to pay more, as doctors’ offices are absorbed into health systems or hospitals and now collect facility fees.

Patient Franco Foti worries about facility fees

“Now everything is considered a hospital, but (my doctor’s) office hasn’t changed,” Foti explained. “I still go (to the same office) as I used to go, except instead of being billed… $ 200, $ 300, $ 400, now I’m billed $ 1,500, over $ 2,000.”

“People are really worried about our health care system and they are unhappy with it,” said Dr. Martin Gaynor of Carnegie Mellon University, who has studied hospital consolidations for the past 40 years and testified before Congress.

“The prices are high and rising. There are blatant pricing practices, ”he told members of the US Congress about a year ago in Washington, DC.

“This massive consolidation in health care has failed Americans,” he told the committee. “It didn’t give us better care or increased efficiency. ”

Dr. Gaynor told us that over the past 20 years, there have been over 1,600 hospital consolidations across the country. He disagrees with Dr Haynie on the quality of care.

“When there are mergers, between close competitors… the quality actually deteriorates,” he said.

He pointed to a study of heart attack patients on Medicare. “People who have had heart attacks and who have been treated in hospitals that faced much less potential competition have done much worse in terms of mortality,” said Dr Gaynor.

Dr Haynie told us that there are still unacceptable infant mortality and longevity rates in Cleveland.

“In fact, in Fairfax where I do a lot of community outreach, it’s more like a 2nd or 3rd world country,” he explained.

Dr Gaynor reports that consolidations, in general, lead to a lack of competition, a lack of patient options and a lack of available appointment times.

But, hospitals see their size as a strength.

A spokesperson for the Cleveland Clinic wrote the following in response to Dr Gaynor’s concerns about growth “We know that high volume medical centers can produce better results for many procedures and provide care more efficiently. and efficient ”.

“By operating as a hospital system, we are able to leverage shared resources and efficiency. Without sufficient scale, it is difficult to address future healthcare initiatives such as access, infrastructure, sophisticated HIT, affordability / costs, insurance plan coverage and more. “- Cleveland Clinic

(for the full statement from the Cleveland Clinic, see below)

A spokesperson for teaching hospitals echoed these sentiments:

“University hospitals have been able to harness the expertise and strengths of our University Medical Center, 18 hospitals and more than 50 ambulatory care facilities to care for communities in Northeastern Ohio. have chosen to join the UH system have benefited from multi-million dollar investments to improve facilities and equipment and expand access to the highest quality specialized care close to home. ”- University Hospitals

(for the complete list of University Hospitals, see below)

Now the worst case is happening: the coronavirus.

Hospitals have suffered significant losses when non-essential procedures and treatments have been postponed or canceled. The financial burden was placed on the three major hospital systems in Cleveland instead of spreading it among many ownership groups.

The Ohio Hospital Association says hospitals in the state lose more than $ 1.34 billion per month.

The losses can only increase the need for what some already see as overly aggressive collection practices on the part of nonprofit hospitals like the clinic and the UH.

“There are reports of nonprofit hospitals preying on people who cannot afford to pay,” Dr Gaynor said.

Claudia Simpkins, 73, of Cleveland, who was sued in 2019 after she was unable to pay for her overnight stay at the Cleveland Clinic.

“I got a bill from them (for) $ 26,000,” Simpkins told us.

“What do you think they’re going after you for the money?” ” we asked.

“I don’t think that’s fair,” she replied.

A quick search of the Cuyahoga County courts shows that there have been numerous lawsuits at the Cleveland Clinic against patients like Simpkins.

So we went straight to the CEO of the Cleveland Clinic, Dr. Tom Mihaljevic.

Tom Mihaljevic, MD, CEO Cleveland Clinic

“As the head (of the Cleveland Clinic), what would you say to the patients who are examining them and facing these lawsuits from your clinic? ” we asked.

“To communicate with us,” said Dr. Mihalievic. “To approach the Clinic. Often these problems can be resolved through communication.

In a world now in turmoil and hospitals just starting to reopen more services, Dr Gaynor said COVID-19 could perhaps be a red flag.

“And we will come out on the other side (of the coronavirus) determined to determine what is the best thing to do about our health care system so that it really works for all of us,” Dr Gaynor said.

Here is the full statement from the Cleveland Clinic:

“Our ultimate goal is to improve the overall health of the communities we serve. We continue to grow so that we can treat more patients and improve their outcomes. By sharing best practices and standardized care across a wider landscape, the care we provide in all locations is consistent.
We know that high volume medical centers can produce better results for many procedures and provide care more effectively and efficiently across a range of services.
At the same time, we know that there is no one-size-fits-all approach to health care. Each of our sites has a culture and each community we serve has unique needs. Recognizing this diversity makes the Cleveland Clinic stronger and able to adapt to change.
As hospitals have joined the Cleveland Clinic healthcare system, their quality and safety have steadily improved. Akron General and Union Hospital, two hospitals that have joined in recent years, received an “A” in the latest safety ratings issued by Leapfrog Group, a national non-profit organization that measures the quality and safety of patients. American health care.
As a hospital system, we are able to leverage shared resources and efficiency. Without sufficient scale, it is difficult to address future healthcare initiatives such as access, infrastructure, sophisticated HIT, affordability / costs, insurance plan coverage, etc.

Here is UH’s statement:

“The COVID pandemic has highlighted a significant benefit that results from a comprehensive and coordinated network of hospitals working together as a unified system. University hospitals have been able to leverage the expertise and strengths of our University Medical Center, 18 hospitals and more than 50 ambulatory care facilities to care for communities in Northeastern Ohio.
Community hospitals that have chosen to join the UH system have benefited from multi-million dollar investments to improve facilities and equipment and expand access to the highest quality specialist care close to home, such as services provided by the UH Seidman Cancer Center and the UH Harrington Heart and Vascular Institute.
As a health system, the UH is able to provide care more effectively. Serving Medicare and Medicaid patients, UH works as a responsible partner with state and federal governments to seek ways to reduce costs while improving the quality of care.
At UH, all patients are treated with respect, regardless of their financial situation, and no one is denied or delayed emergency or medically necessary care because of their inability to pay for services. If patients meet the established financial eligibility criteria, their bill for emergency medical or medically necessary care at a UH hospital facility may be reduced under the UH financial assistance program. You can find more information on billing and insurance services at UH: https://www.uhospitals.org/patients-and-visitors/billing-insurance-and-medical-records[uhhospitals.org]”

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