Closing
Time |
Closing
Time |
|
By
John Leighty In the current era of intense competition and managed care, hospitals are finding it increasingly difficult to make ends meet. While some hospitals have reduced staff and services to cut costs, others have been forced to close. The California Healthcare Association reports an average of three closings a year over the past decade, most of them involving smaller, low-capacity hospitals squeezed by intense competition under managed care. Dozens of other hospitals have merged or changed ownership, moves that often result in some department closings as services are consolidated. A look at the numbers California typically leads the nation in the number of hospital closings. A federal survey issued this year by the Office of the Inspector General reported 38 closures in 1997 out of 4,805 general acute care hospitals nationwide; California led with six, one of which was later relicensed. There are currently 478 licensed acute care hospitals in California, according to the California Department of Health Services (DHS). "Hospitals closed because of the interrelated factors of declining occupancy, lagging revenues, and rising costs," according to the inspector general’s report. More recent figures are hard to calculate because the state doesn’t keep exact figures on closings. A survey by the Healthcare Association of Southern California showed 10 hospital closures in 1998 in a six-county region, compared with five in 1997 and seven in 1996. Experts say there’s one big factor that is bound to accelerate the closure rate—the law requiring seismic retrofitting of all hospitals by 2008. "We think there will be a dramatic closure of hospitals over the next 10 years because of this mandate, which will cost a projected $20 billion," said Nathan Nayman, regional vice president of the Hospital Council of Northern and Central California. Balancing competing concerns A vivid example of the seismic law’s impact is Kaiser Permanente’s decision to close its flagship Oakland hospital to inpatient and emergency care. Controversy has erupted over the decision to close the hospital in June and transfer patients to other facilities, primarily Summit Medical Center. Jerome McCockran, RN, an acute care nurse who has worked at Kaiser Permanente Oakland for 17 years, is taking part in a petition drive that has gathered some 10,000 signatures from health plan and community members asking Kaiser to reconsider. "This is a possible disaster in the making," McCockran said, noting that 61,000 people annually use the Kaiser Permanente Oakland emergency department. "We’re in an area vulnerable to fires, refinery explosions, and earthquakes, and when these occur, people head to the nearest hospital for care."
But Kaiser spokesperson Kim Nguyen said it doesn’t make sense for every East Bay hospital to spend millions to meet earthquake standards when strategic alliances can be made. Kaiser Permanente Oakland would still be providing outpatient care to 800,000 members, Nguyen added. The average Kaiser member is only hospitalized once every 15 years and it is usually prescheduled, so Kaiser believes there should be no disruption in patient care, she said. EDs also an issue The dwindling number of emergency departments is also a hot issue in California. Shortages of emergency care beds occurred throughout the state last winter during the flu season, experts say. In addition, many consumers are wondering whether fewer emergency departments mean longer patient transport times, which some fear could put them at greater risk. Under legislation passed last year, hospitals are required to notify the DHS, the local government, and the public of their intentions to eliminate or reduce emergency services. Before approving the closure, the DHS must examine how it would affect the community and other area facilities. However, if the DHS finds that keeping the emergency department open would threaten the stability of the hospital as a whole, the law requires the agency to allow the closure. Nurses should be especially concerned about the declining access to care caused by closures in disenfranchised areas, said Frank Moss, RN, administrative director of the emergency department at the UCLA Medical Center. In many urban areas, hospitals are in financial difficulty because of the high rate of unreimbursed indigent care, he said. "The situation is if unreimbursed care continues, there will be hospitals closing their emergency departments or closing the facilities altogether," Moss said. Patients will have to travel farther for healthcare services, he said. "This creates a bad situation for a population that is already less mobile and has trouble getting around." |
||
| What
do you think? Email us at editor@ nurseweek.com Previous
Stories How
Healthy are Americans? Green
Acres Will
the rising age of OR nurses lead to a shortage? Media
Madness Ease
the pain The
thin line
VA
launches program to reduce medical mistakes
California
California Department of Health Services Hospital Council of Northern and Central California
|
