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Dealing With Hospital Closure, Pioneer Kansas Town Asks: What Comes Next?

Greenbeard

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KHN has a very good deep dive today into a small Kansas town losing its local hospital. The residents, of course, are not pleased but the whole thing raises some tough questions.

Dealing With Hospital Closure, Pioneer Kansas Town Asks: What Comes Next?
Yet, even as this town deals with the trauma of losing a beloved institution, deeper national questions underlie the struggle: Do small communities like this one need a traditional hospital at all? And, if not, what health care do they need?
And when patients here get sick, many simply go elsewhere. An average of nine patients stayed in Mercy Hospital Fort Scott’s more than 40 beds each day from July 2017 through June 2018. And these numbers are not uncommon: Forty-five Kansas hospitals report an average daily census of fewer than two patients.

Seems clear from the article the hospital was a pillar of the community (built in part with $1 million raised by the residents themselves) but the economic reality is that it doesn't fill its beds. A filled bed is a revenue stream--and to the extent it's not, as with an uninsured person, that's why Medicaid expansion helps hospitals by turning the beds the newly insured fill into revenue streams--which goes toward covering the fixed costs associated with keeping a hospital open.

The world we've been moving toward under the ACA is one in which keeping people healthy--and out of a hospital bed--becomes a revenue opportunity for health care providers. That's something of a paradigm shift in the way the health care delivery is organized, the way we think about what the health care is and ought to be, and the business models underpinning the industry. But the evolution is unavoidably gradual which means providers are in some sense stuck with a foot in both worlds right now.

The article notes that, in response to the ACA's financial incentives, over a 5-year period this hospital slowed the revolving door of patients getting discharged and bouncing back with another admission the same month from 18% of their patients down to 5.5% (!) through active outreach to get patients in for an office visit within two weeks of the discharge. Keeping them healthy, keeping them well, and addressing their needs in lower-cost settings instead of forgetting about them until they need a hospital admission is good for the patient and now somewhat financially beneficial. But keeping someone out of the hospital still chokes off a revenue source for that hospital.

Indeed, re-orienting the business models driving our health system toward rewarding those providers who keep people well saves money in the long run precisely because if people are healthy then our system doesn't need to maintain as many beds and can shed some of those expenses. That's not the primary dynamic at play here--per the article, this is not a particularly healthy community--but the "do we really need this infrastructure?" question should become more and more important in future years as we focus more on tackling health care costs and, one hopes, improving population health.

But this article hits on the two biggest concerns at present with hospital closures: the public health impact and the impact on the local economy/jobs (since a decent chunk of the costs associated with keeping such facilities open is the paychecks they're supplying).

What happens when a 70-year-old grandfather falls on ice and must choose between staying home and driving to the closest emergency department, 30 miles away? Where does the sheriff’s deputy who picks up an injured suspect take his charge for medical clearance before going to jail? And how does a young mother whose toddler fell against the coffee table and now has a gaping head wound cope?

There is also the economic question of how the hospital closure will affect the town’s demographic makeup since, as is often the case in rural America, Fort Scott’s hospital is a primary source of well-paying jobs and attracts professionals to the community.

Is it worth keeping a largely empty facility open and staffed just in case? Is health-care-as-a-jobs-program worth maintaining just to feed the local economy, particularly in areas where there may not be much else? These are questions rural areas in particular are facing right now but there are lots of communities that should be (and perhaps will be) grappling with these questions.
 
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KHN has a very good deep dive today into a small Kansas town losing its local hospital. The residents, of course, are not pleased but the whole thing raises some tough questions.

Dealing With Hospital Closure, Pioneer Kansas Town Asks: What Comes Next?



Seems clear from the article the hospital was a pillar of the community (built in part with $1 million raised by the residents themselves) but the economic reality is that it doesn't fill its beds. A filled bed is a revenue stream--and to the extent it's not, as with an uninsured person, that's why Medicaid expansion helps hospitals by turning the beds the newly insured fill into revenue streams--which goes toward covering the fixed costs associated with keeping a hospital open.

The world we've been moving toward under the ACA is one in which keeping people healthy--and out of a hospital bed--becomes a revenue opportunity for health care providers. That's something of a paradigm shift in the way the health care delivery is organized, the way we think about what the health care is and ought to be, and the business models underpinning the industry. But the evolution is unavoidably gradual which means providers are in some sense stuck with a foot in both worlds right now.

The article notes that, in response to the ACA's financial incentives, over a 5-year period this hospital slowed the revolving door of patients getting discharged and bouncing back with another admission the same month from 18% of their patients down to 5.5% (!) through active outreach to get patients in for an office visit within two weeks of the discharge. Keeping them healthy, keeping them well, and addressing their needs in lower-cost settings instead of forgetting about them until they need a hospital admission is good for the patient and now somewhat financially beneficial. But keeping someone out of the hospital still chokes off a revenue source for that hospital.

Indeed, re-orienting the business models driving our health system toward rewarding those providers who keep people well saves money in the long run precisely because if people are healthy then our system doesn't need to maintain as many beds and can shed some of those expenses. That's not the primary dynamic at play here--per the article, this is not a particularly healthy community--but the "do we really need this infrastructure?" question should become more and more important in future years as we focus more on tackling health care costs and, one hopes, improving population health.

But this article hits on the two biggest concerns at present with hospital closures: the public health impact and the impact on the local economy/jobs (since a decent chunk of the costs associated with keeping such facilities open is the paychecks they're supplying).



Is it worth keeping a largely empty facility open and staffed just in case? Is health-care-as-a-jobs-program worth maintaining just to feed the local economy, particularly in areas where there may not be much else? These are questions rural areas in particular are facing right now but there are lots of communities that should be (and perhaps will be) grappling with these questions.

This is an interesting one. There are many such inefficiencies in the health care system that eventually need to be addressed. The flip is is we have too much expensive,underused equipment often owned by doctors throughout the country.

I used to be an advocate a Medicare for all approach. Not the one proposed by Sanders but something more closely copying the current Medicare system. I am less confident in this now because I have less confidence that the current crop of politicians can create a fair and efficient system.
 
I wonder how many F-18s it would take to fund that hospital for a year?

I wonder if the fuel being consumed by the USS Lincoln fleet parading around the Persian Gulf would fund that hospital for a year?
 
I wonder how many F-18s it would take to fund that hospital for a year?

I wonder if the fuel being consumed by the USS Lincoln fleet parading around the Persian Gulf would fund that hospital for a year?

No and No.
 
It's very difficult for small community hospitals to stay viable. It's inefficient to operate a small hospital unit, and difficult to keep the facilities and trained staff for modern medical care. Often, they won't even have a physician onsite outside of business hours, and have to call in on-call staff for areas like radiology, lab, and respiratory therapy. In most cases, patients would be better served in a larger facility if they need to be admitted.

The article actually does say that the hospital 'closed', then re-opened with an emergency room and outpatient center. This sounds like the best case scenerio for this situation. The community does have access to emergency care, basic diagnostic services, and facilities for minor procedures. Anyone who needs more complex services, or is sick enough to be admitted, can be transferred to a more capable facility. There is a larger medical center 20 miles away - which isn't a significant distance for this.
 
KHN has a very good deep dive today into a small Kansas town losing its local hospital. The residents, of course, are not pleased but the whole thing raises some tough questions.

Dealing With Hospital Closure, Pioneer Kansas Town Asks: What Comes Next?



Seems clear from the article the hospital was a pillar of the community (built in part with $1 million raised by the residents themselves) but the economic reality is that it doesn't fill its beds. A filled bed is a revenue stream--and to the extent it's not, as with an uninsured person, that's why Medicaid expansion helps hospitals by turning the beds the newly insured fill into revenue streams--which goes toward covering the fixed costs associated with keeping a hospital open.

The world we've been moving toward under the ACA is one in which keeping people healthy--and out of a hospital bed--becomes a revenue opportunity for health care providers. That's something of a paradigm shift in the way the health care delivery is organized, the way we think about what the health care is and ought to be, and the business models underpinning the industry. But the evolution is unavoidably gradual which means providers are in some sense stuck with a foot in both worlds right now.

The article notes that, in response to the ACA's financial incentives, over a 5-year period this hospital slowed the revolving door of patients getting discharged and bouncing back with another admission the same month from 18% of their patients down to 5.5% (!) through active outreach to get patients in for an office visit within two weeks of the discharge. Keeping them healthy, keeping them well, and addressing their needs in lower-cost settings instead of forgetting about them until they need a hospital admission is good for the patient and now somewhat financially beneficial. But keeping someone out of the hospital still chokes off a revenue source for that hospital.

Indeed, re-orienting the business models driving our health system toward rewarding those providers who keep people well saves money in the long run precisely because if people are healthy then our system doesn't need to maintain as many beds and can shed some of those expenses. That's not the primary dynamic at play here--per the article, this is not a particularly healthy community--but the "do we really need this infrastructure?" question should become more and more important in future years as we focus more on tackling health care costs and, one hopes, improving population health.

But this article hits on the two biggest concerns at present with hospital closures: the public health impact and the impact on the local economy/jobs (since a decent chunk of the costs associated with keeping such facilities open is the paychecks they're supplying).



Is it worth keeping a largely empty facility open and staffed just in case? Is health-care-as-a-jobs-program worth maintaining just to feed the local economy, particularly in areas where there may not be much else? These are questions rural areas in particular are facing right now but there are lots of communities that should be (and perhaps will be) grappling with these questions.

Well.. and it illustrates another thing.. which is that at the end of the day... government and the insurance.. is still going to base payments on fee for service. There is a lot of lip service.. to paying for performance.. and paying to keep people healthy. but at the end of the day.. no one.. particularly the government is willing to pay you for NOT providing a service.
 
Could you offer any numbers to support your "answers", or is that asking too damn much?

I don't believe you "wonder" in the two questions you asked. Strange way to word such questions.
 
It's very difficult for small community hospitals to stay viable. It's inefficient to operate a small hospital unit, and difficult to keep the facilities and trained staff for modern medical care. Often, they won't even have a physician onsite outside of business hours, and have to call in on-call staff for areas like radiology, lab, and respiratory therapy. In most cases, patients would be better served in a larger facility if they need to be admitted.

The article actually does say that the hospital 'closed', then re-opened with an emergency room and outpatient center. This sounds like the best case scenerio for this situation. The community does have access to emergency care, basic diagnostic services, and facilities for minor procedures. Anyone who needs more complex services, or is sick enough to be admitted, can be transferred to a more capable facility. There is a larger medical center 20 miles away - which isn't a significant distance for this.

Well said. That area has been losing population for years. And the medical center 20 miles down the road has taken away patients. I drive through that area several times a year.
 
I wonder how many F-18s it would take to fund that hospital for a year?

I wonder if the fuel being consumed by the USS Lincoln fleet parading around the Persian Gulf would fund that hospital for a year?

I wonder how many welfare and disability fraud recipients would have to be removed and how many years it could stay open for the amount of money Nancy Pelosi's brother-in-law's multi-billion dollar graft would have covered?
 
Could you offer any numbers to support your "answers", or is that asking too damn much?

Wow, what an devotion to laziness in that message! YOU raise a claim and then demand others research it for you because it's too much work for you? :lamo
 
I don't believe you "wonder" in the two questions you asked. Strange way to word such questions.

Yes, too complex a thought for your neurons, or perhaps too thought-provoking.
 
I wonder how many welfare and disability fraud recipients would have to be removed and how many years it could stay open for the amount of money Nancy Pelosi's brother-in-law's multi-billion dollar graft would have covered?

My hypothetical is more practical and relevant than yours.

We spend huge amounts on military. It's real.

Who gives a GGD about Pelosi's brother in law? Not I.
 
Yes, too complex a thought for your neurons, or perhaps too thought-provoking.

Or you had a thought you formed into a really bad question--or statements that ended in a question mark. I'd suggest re-reading what you wrote.
 
Thanks to the OP for the very interesting information.

1. Yes, nuns started many hospitals. The Catholic Church deserves a shoutout for the hospitals and schools that it has founded throughout American history. I wish that more people were being taken care of by nuns and more children were being taught by nuns or brothers. But those days are gone.


2. I have read that some smaller communities without doctors depend on nurse practitioners. They are medical providers whose authority depends on the state in which they live.


a. Here in California, doctors have been successful in blocking the efforts to give more authority to nurse practitioners.
b. I have found nurse practitioners to be very patient and helpful and competent.
 
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