'Everyone is nervous': Indiana system CEO on rising hospital closures

As hospitals and services continue to shut down due to financial challenges and labor shortages, many healthcare leaders are growing more concerned.

"I think everyone is nervous," David Dunkle, MD, CEO of Franklin, Ind.-based Johnson Memorial Health, told Becker's. "When we get together, it's not, 'How are you doing,' it's, 'How bad are you doing?' Then, 'What are you doing to turn things around?'"

An independent health system, Johnson Memorial was started in 1947. The one-hospital system also has primary care centers, urgent care centers, and more than 100 physicians and other providers.

While Dr. Dunkle said he feels good about the health system from a quality and employee morale standpoint, he is concerned about financials. 

"I feel that, once again, we're not getting reimbursed for what we do. I feel that it's almost criminal the way the system has gone towards denials and making it harder for hospitals to do what they need to. Look at the rising costs of drugs, drug shortages. It's getting more difficult to navigate healthcare," Dr. Dunkle said. 

Dr. Dunkle said he's also seeing a yearly increase in employees who are not responsible for direct patient care.

"We continue to add people on the regulation side, on the side to try to help us get paid. Really, where we need more people is at the bedside. We need to be able to invest in nurses, in the physicians, in the equipment that helps us take better care of patients. That's why you look at places that are forced to cut services," he said. 

In 2023, more than 300 rural hospitals were at risk of closure due to financial problems.

Dr. Dunkle said that if rural hospitals are forced to close their doors, they could be purchased by bigger systems, which could lead to increased pricing and lower quality of care.

"No one knows the local community more than their local hospital. What you have at this local level is you have people taking care of their neighbors. Our patients are the people that your kids go to school with, that you go to church with, that you see at restaurants in the evening. You're taking care of people you're invested with in that community. You lose that when you're managed from hundreds of miles away," he said. 

To combat the rise in hospital and service closures, Dr. Dunkle said healthcare leaders need to have a more collective voice. 

"My question is, and when I talk to my peers, how many hospitals have to close? How many hospitals have to cut service? How many people have to travel 50 miles to deliver a baby? How many bad outcomes do we have to have for mothers and children in this country until finally we do something?" Dr. Dunkle said. "We have to do a better job of really getting the story out and drawing attention to how unfair the model is right now."

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