Why We Need to Keep Our Community Hospitals Strong
Community hospitals are under siege right now. Unlike large medical centers or hospital systems, they do not have the clout to qualify for the highest payor rates or the lowest vendor prices. And these self-standing, non-profit institutions have limited access to financing at a time when we're stuck in economic doldrums.
As a group, these hospitals seem ill-equipped for the vast changes that are sweeping through our industry: the move to expensive healthcare IT, the demands for care-coordination through structures like accountable care organizations and the continuing erosion of Medicare and Medicaid reimbursements.
However, this is not a time to kiss community hospitals good-bye. I don't particularly want to enter a brave new world with just large, impersonal health systems where all of us are just cogs in the wheel. Without these community institutions, there would be a large hole in our healthcare system, and I don't think it could ever be filled.
We've never really agreed on the definition of "community hospital," but for purposes here, I'd like to put the emphasis on "community." An academic medical center can serve an entire region, and a healthcare system can blanket many states, but a community hospital needs to remain firmly anchored to its roots –– the people it serves. Local businesspeople sit on its board, the hospital is the nexus for local healthcare services and the CEO speaks regularly at the Lion's Club.
The community hospital will be relevant as long as healthcare stays local, and I don't think that's going to change anytime soon. In fact, localness and people-power seem more important than ever in what we do. We now talk about "patient-centered care" and hospitals that can align with each physician on staff. A well functioning community hospital commands patient loyalty and binds itself closely to its physicians.
People often forget how important their hospital is until it's shut down. But you don't need a closure to remind people how valuable their hospital can be. Even something as dreadful as a natural disaster can show us the deep connections between hospital and community.
When an EF5 tornado tore through the small city of Joplin, Mo., a little over a year ago, it took 160 lives, destroyed more than $2 billion worth of property and completely leveled one of the city's two hospitals. With 357-bed St. John's Regional Medical Center out of commission, 407-bed Freeman Hospital suddenly was responsible for coordinating all medical care –– at a time when this work was more important than ever before.
Disasters like this are an opportunity for a well-run community hospital to show its stuff. Twenty-two surgeries were performed at Freeman on the night of the tornado; 135 local physicians sprung into action and more than 1,700 patients were treated in the next few days. The Red Cross, FEMA and any number of good Samaritans can come into town, but there is something special about local people helping local people. The best side of everyone comes out.
St. John's is still operating out of a temporary facility, but a new hospital will be built. Freeman continues to reach out to the community, opening a digestive health center just two months after the tornado and starting a "health academy" to help local kids prepare for healthcare jobs.
When a community hospital closes, people lose a major employer and have to drive many miles to an unfamiliar city for care. My family has a summer place in Detroit Lakes, Minn. If 87-bed St. Marys Regional Health Center were not there, people would have to drive 60 miles to Fargo, N.D. But St. Marys is still alive and strong because it is loved and respected. The doctors and nurses were efficient and friendly every time I've been there. It is pleasure to see people who truly love their work and make a difference in their community.
In Naples, Fla., where my family vacations in the winter, Naples Community Hospital is a much larger institution, with 681 beds, but it is still remarkably local. A friend of mine, a retired CEO of a specialty hospital in the Northeast, recently had emergency surgery there and raved about the professional standards and personal attention. "The care I received was first rate and the attitude of everyone in the hospital seems to be totally focused on patient care," he said. "If they had not performed surgery on me when they did, I wouldn't be here to talk about my experience."
As healthcare evolves, community hospitals are going to contend with growing challenges to deliver superior care, but it is still possible for them to succeed, provided they carry out some crucial strategies:
1. Align closely with physicians. Maintaining a great relationship with physicians is key to favorable payor contracts, successful quality initiatives and an improved cost structure.
2. Affiliate with a large system. Specialists rotating through the community hospital from a far-off academic medical center create a win-win situation: the community hospital gains physicians it could never have recruited on its own, and the AMC establishes a pipeline for new patients.
3. Engage the community. Keep a high profile by holding community meetings, producing newsletters and articles in community newspapers, and working with community-based organizations.
4. Get community feedback. Gather community members' views through meetings and focus groups to identify ways to improve programs and expose service gaps.
5. Become the healthcare hub for the community. Become indispensible to the community by steps such as holding prevention classes, building a fitness center and partnering with existing ventures in the community.
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