No Choice But To Care: What Happens When a Hospital Can't Shut Its Doors?

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Well into its second year, President Obama’s Patient Protection and Affordable Care Act continues to exhibit a series of growing pains as it struggles to flex its muscles and mature. As with any rapidly evolving entity, our nation’s healthcare system has been reshuffling a number of core options lately, and though only a select few draw national attention, the recent vote to keep Oak Forest Hospital up and running in Illinois' Cook County sheds new light on an escalating problem within the American healthcare structure. Namely, who pays the greatest price when a hospital is not allowed to shut its doors?

As the fledgling PPACA gains momentum, change is certainly afoot. Earlier this year the federal government placed strict requirements on those insurance companies who intend to raise plan premiums in excess of 10 percent. Last month, the same federal government announced that hospitals could no longer ignore patient satisfaction if they wanted to maintain their Medicare reimbursements without additional cuts. Prior to that, the Centers for Medicare & Medicaid Services released a set of much anticipated proposed regulations for accountable care organizations, which will arguably become the blueprints for the future of American healthcare. The draft requirements, however, make it clear to any but the largest health care providers that the future of medicine is both cost prohibitive and fraught with even more regulatory minefields than the existing system.

This is not good news for smaller, independently owned hospitals struggling to stay afloat in the current economic climate. It also emphasizes the frightening fact that each year fewer emergency departments are available nationwide, in urban neighborhoods in particular. A recent study by a doctor at University of California at San Francisco states that one out of every four hospital emergency departments has shut down in the past 20 years, even as ED visits have increased by 35%. The strain of regulatory pressures on today’s medical facilities is causing significant cracks in the foundation of America’s healthcare structure as a whole, and if not rectified in the short term, it will ultimately be the patient who is forced to do without.

When the Emergency Medical Treatment and Active Labor Act (EMTALA) was passed in 1986, requiring hospitals to provide medical care to anyone needing emergency treatment, regardless of citizenship, insurance, or ability to pay, hospital administrators across the country clamored that such a mandate would be the death knell of many of the nation’s hospitals. Imagine their surprise to hear that we as a nation have progressed so far this past quarter century as to not allow a failing hospital to close when it can no longer afford to provide for its community.

Though the basic tenets of the PPACA are laudable in their attempts to provide a broader range of coverage, in the final analysis healthcare is a business, and as such must be allowed to follow the traditional rules of commerce if it is to be expected to successfully provide an acceptable quality of service. By forcing hospitals to stay open when they are financially unable or unwilling to do so, the system effectively creates a smoke screen, tricking patients into thinking they have access to reasonable medical care when in fact the facility is scraping bottom.

While federally mandated health care does its best to ensure that no one slips through the cracks, such blanket coverage comes at a price. And that price just might be your local hospital.


Craig Garner is an attorney and healthcare consultant, specializing in issues surrounding modern American healthcare and the ways it should be managed in its current climate of reform. From 2002-2011, Craig was the CEO at a community hospital in Los Angeles County, Calif. In January 2012 Craig will offer a course on Hospital Law at Pepperdine University School of Law in Malibu, Calif.

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