What hospitals can learn from a Philadelphia hospital closure

Hahnemann University Hospital's financial challenges came to a head last year when the Philadelphia-based academic medical center filed for bankruptcy in July and closed in September. 

Months later, Jefferson Health is seeing the effects of the Hahnemann closure in its inpatient and workforce numbers, said Bruce A. Meyer, MD, president of Jefferson Health, which is also based in Philadelphia.

Hahnemann was a longtime healthcare staple in the Philadelphia area with 496 beds, 550 residency slots and roots dating back about 170 years.

It was owned by Dallas-based Tenet Healthcare until American Academic Health System acquired Hahnemann two years ago. In April 2019, AAHS said Hahnemann may have to shut down due to unsustainable financial losses. Then in June 2019, the hospital owners announced official plans to close Hahnemann.

Jefferson Health response

As Hahnemann commenced to wind down operations, Jefferson Health discovered patients' access to care was in potential jeopardy and stationed an ambulance at Hahnemann to transfer patients to Jefferson Health hospitals, as needed, said Dr. Meyer.

"[Hahnemann] staff started looking for other jobs, and so they had a rapid degradation of their ability to staff the emergency room and floors," he said. "So, we took some patients in transfer from their ICUs. We took a bunch of patients from their emergency room … and brought them to our hospitals."

In July, Hahnemann stopped admitting patients through its emergency department but still saw urgent care cases in the department. Hahnemann officially terminated its emergency department services on Aug. 16.

After the shutdown, many of the patients who would have typically sought care in Hahnemann's emergency room ended up going to either Jefferson Health or Philadelphia-based Temple University Health System. Today, months after Hahnemann's closure, the emergency room volume at Jefferson Health has increased about 40 or 50 visits a day compared to before the closure.

Due to the higher volume, Jefferson Health has taken various steps, including removing parking meters outside its ED to allow space for ambulances to come in, as well as moving its ED patient intake area to allow for more space.

Jefferson Health also responded to the volume spike by bringing in more staff.

"We hired a bunch of people, we paid for overtime until we could hire. We were fortunate that we had capacity through our system to bring in ER physicians appropriately and other staff to manage that volume," said Dr. Meyer.

As of the end of September, Jefferson Health had hired 129 former Hahnemann employees, including Hahnemann's entire midwifery group.

And since onboarding the midwifery group, the health system has seen its annualized rate of deliveries increase about 40 to 45 percent.

Dr. Meyer said Jefferson Health has also converted a temporary medical-surgical unit into an antepartum unit, and ER administrative space into clinical care space, to accommodate volume.

Lessons learned and next steps

Jefferson Health's experience and efforts may provide new insights and lessons for healthcare organizations. Hospitals in rural areas closed at a record rate in 2019. But the closure of a 496-bed hospital in a metropolitan place like Philadelphia is less common.

One lesson Dr. Meyer learned involves preparation.

"We think we're well prepared for the unexpected in healthcare because we can't predict exactly what's going to happen in healthcare at any given time. But this kind of significant shift requires that you have an effective team and that everybody across the organization is ready to step up and come up with creative solutions and step in to do the work necessary to accommodate this kind of volume," he said. 

"It's one thing to talk about 2 percent or 3 percent increases in volume over the course of the year. It's another thing entirely to talk about an acute change of 10 [percent] or 12 percent in your volume," he added.

Dr. Meyer also views it as essential that hospitals have a good handle on their physical plant and its adaptability.

He said Jefferson Health was fortunate because it had done a lot of drills around event medicine disaster planning. During those drills, staff learned how to respond if hundreds of people suddenly arrived in the emergency room or if they had to triage 400 people across three emergency rooms.

"We've done some of those exercises. Those exercises came at enormous value to us in the acute situation [of Hahnemann's closure] that allowed us to adapt," said Dr. Meyer.

He also recommended hospitals in large communities have open conversations about patients' healthcare access to the different facilities. That way, he said, organizations are prepared for potential patient population changes that may occur.

"What the closure of Hahnemann has done is illustrate to us the vulnerability of all of our organizations and say that we have to figure out a way to overcome those barriers [when changes occur] and work together because working in siloes doesn't actually benefit the community very much," Dr. Meyer said.

Moving forward, Jefferson Health will continue meeting with other Philadelphia-based organizations, including Einstein Healthcare Network, Philadelphia College of Osteopathic Medicine, Penn Medicine and Temple University Health System.

It also is keeping an eye on a CMS appeal regarding 550 resident slots previously at Hahnemann. In August, three Philadelphia-based health systems — Einstein Healthcare Network, Jefferson Health and Temple University Health System — joined forces with Bryn Mawr, Pa.-based Main Line Health, Camden, N.J.-based Cooper University Health Care and Wilmington, Del.-based Christiana Care Health System to place the winning $55 million bid for the residency slots. In September, a federal judge temporarily halted the sale after an appeal by CMS, which funds the slots. The appeal is pending.


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