[NPInfo] Dena's reply to "L.A. Hospitals failing"

[Jeffrey Hazzard]

What this article doesn't mention is that many more
 hospitals will
undoubtedly close in CA in the future, not due to
 insurance woes or any of
the other problems listed. Instead, the state has
 mandated that ALL
hospitals meet stringent earthquake-proof standards by
 2011 (I think that
date may have changed-- it keeps changing). Most of
 the repairs to retro-fit
hospitals are extremely costly and not worth the time,
 money, or effort to
do-- a new building would be cheaper. But certainly
 the smaller private
hospitals can't afford the cost of a totally new
 facility without the
financial back-up of a big corporate money-bag. I know
 of one hospital in
this area with a fantastic reputation for cardiac care
 that will have to
close its door and a big corporate chain couldn't be
 happier as they are
building a huge new hospital right in the same
 neighborhood-- and scooping
up cardiologists and cardiac surgeons to build their
 own cardiac center.
The days of the local community hospitals as we knew
 them in the past are
certainly gone.
Dena Galler

-----Original Message-----
From: acc-circle-bounces at listserve.com
[mailto:acc-circle-bounces at listserve.com] On Behalf Of
 Jeffrey Hazzard
Sent: Monday, September 24, 2007 6:21 AM
To: npinfo npinfo; ACC Listserv
Subject: [ACC-Circle] L.A. Health system actually
 collapsing


    (So goes California, so goes the rest of the
 nation?  --Jeff, Tampa)


Financial woes jeopardize area hospitals

 
Nearly two dozen are at risk. Losing even a few would
 mean greater strain on
the region's healthcare network.
By Daniel Costello and Susannah Rosenblatt, Los
 Angeles Times Staff Writers 
September 23, 2007 
Nearly two dozen private hospitals in Los Angeles and
 Orange counties,
accounting for up to 15% of beds in the region, are in
 dire financial
straits and in danger of bankruptcy or closure,
 according to hospital
administrators, industry experts and state data.

The troublesome development follows the closure of
 community clinics and
hospitals in recent years that has left the healthcare
 system seriously
overburdened.



We're talking about a system that is already in
 crisis.
- Carol Meyer, director of governmental affairs, L.A.
 County Department of
Health Services
If even a few other hospitals close or reduce costly
 critical-care services,
it could mean longer ambulance rides to hospitals,
 additional delays in
emergency rooms and less access to care, especially
 for poor and uninsured
people.

Among the hospitals in poor financial health,
 according to industry
analysts, are Downey Regional Medical Center,
 Centinela Freeman Health
System in Inglewood, Brotman Medical Center in Culver
 City, Century City
Doctors Hospital and four Orange County hospitals
 owned by Santa Ana-based
Integrated Healthcare Holdings Inc. including Chapman
 Medical Center in
Orange and Western Medical Center in Santa Ana, one of
 three trauma centers
in the county.

In interviews, senior executives at Centinela and
 Downey said they were
considering closing their emergency rooms. Downey's
 chief operating officer,
Rob Fuller, added that his hospital could close
 entirely as early as next
year if its financial picture didn't improve soon.

"It's fasten your seat belt it's going to be a bumpy
 ride time," said James
Lott, executive vice president of the Hospital Assn.
 of Southern California,
a trade association.

The financial woes result from a multitude of
 developments:

* An increasing load of uninsured and low-income
 patients has resulted from
overcrowding and the shutdown of public facilities.
 The number of uninsured
patients visiting private hospitals, particularly in
 poor areas, has
increased by one-third in Los Angeles County since
 2002. California's
Medi-Cal program for the poor reimburses hospitals at
 one of the lowest
rates in the country.

* The closure of Martin Luther King Jr.-Harbor
 Hospital in Willowbrook last
month left half a dozen nearby hospitals to absorb
 most of the 47,000
patients who used the public hospital's emergency room
 last year.

* Smaller community hospitals are drawing fewer
 patients as a few larger
facilities attract a growing share of doctors and
 insured patients.

* As insurers have consolidated in recent years,
 they've squeezed many
smaller facilities. Private insurance companies
 generally pay higher rates
to larger hospitals with greater bargaining power.

* New, stricter state mandates on nursing ratios have
 raised labor costs,
and a 2013 deadline to retrofit all hospitals to
 better withstand a major
earthquake is estimated to be costing medical
 facilities $110 billion
statewide.

The strains are being felt by patients.

Natalia Sanchez of South Gate took her 86-year-old
 mother, Emilia, to St.
Francis Medical Center this month after the elderly
 woman suddenly lost
feeling in her body. They waited 13 hours in an
 emergency room corridor
before the mother was placed in a room. Even then,
 Sanchez said, she could
never seem to find her mother's doctor. The experience
 was so frustrating
that Sanchez moved her mother to a different hospital.

"It was a very bad experience," Sanchez said.

St. Francis officials said the average wait time for
 an emergency patient to
be placed in a room last month grew to 11 1/2 hours.
 But they said the
hospital had added more emergency room beds and nurses
 and had adopted a new
system for treating emergency patients more
 efficiently.

The financial crisis coincides with a widening split
 between the "haves" and
the "have nots" in the California hospital industry,
 experts say.

Although large, well-known facilities, such as
 Cedars-Sinai Medical Center
in Los Angeles and Hoag Memorial Hospital Presbyterian
 in Newport Beach have
seen their profits rise steadily in recent years and
 are adding beds,
smaller hospitals, which are often in less affluent
 areas, are losing as
much as tens of millions of dollars apiece each year.

In addition, because conglomerates such as Tenet Corp.
 have dramatically
scaled back their presence in the area, many local
 hospitals are now
independently owned and don't have deep pockets to
 fall back on.

Since 1996, more than 70 community hospitals have
 closed across the state,
with a disproportionate share -- more than 50 -- in
 Southern California.
Regionally, 14 emergency rooms have closed in the last
 five years, including
10 in Los Angeles County.

That's why experts say a new wave of closures would be
 so destabilizing.

"In many areas, you have had enormous consolidation,
 and there's very little
breathing room left," said Kirby Bosley, director of
 California healthcare
consulting for Watson Wyatt, a company that advises
 employers on health
plans. At some point, she added, "we have to ask if we
 think it's fair for
people to live 15 miles from their nearest hospital.
 Twenty miles? Thirty?"

Irma Strand of Pasadena has collected more than 2,000
 signatures in a
petition drive aimed at reopening St. Luke Medical
 Center in her city. The
hospital closed in 2002 and now houses a Caltech
 research lab.

"Luke's was a very dependable facility, and it's
 needed here," she said.

Steve Lopez, chief financial officer of East Los
 Angeles Doctors Hospital,
which has operated in the red for the last five years,
 said: "I think it's
only a matter of time before several of the dominoes
 fall. It's like waiting
for that earthquake: It's not easy to predict, but you
 are pretty sure it's
going to happen."

Some experts and government officials are skeptical
 that the situation is as
dire as some hospitals and community activists depict.
 Others contend that
hospitals in financial trouble can improve by cutting
 unprofitable services
such as emergency rooms and obstetric and psychiatric
 units rather than
filing for bankruptcy protection or closing.

"You can't deny there are real challenges, but at
 least some of these
hospitals might do better if they were better
 managed," said Glenn Melnick,
a Rand Corp. economist and USC professor of healthcare
 finance.

Many agree, however, that it's been years since so
 many hospitals have been
in such dire financial straits at the same time.

For example, the 420-bed Brotman Medical Center lost
 $14.7 million in 2005,
according to state data, up from a loss of $268,000 in
 2001. Recently, the
Culver City facility has cut services, restricting,
 for example, the types
of emergency room patients it accepts from paramedics.

Brotman executives, who declined to comment, have been
 seeking funding
recently to avoid bankruptcy, according to people
 familiar with the matter.

In June, Integrated Healthcare Holdings Inc., which
 owns four Orange County
hospitals that account for 12% of the beds in the
 county, defaulted on its
debt, and some industry analysts continue to predict
 it could go bankrupt in
the near future. The company had a net loss of almost
 $20 million in the 12
months ended March 31, according to a filing with the
 Securities and
Exchange Commission.

Integrated's hospitals include Western Medical Center
 in Anaheim, Coastal
Communities Hospital in Santa Ana, Chapman Medical
 Center in Orange and
Western Medical Center in Santa Ana, which is one of
 three trauma centers in
the county where victims of life-threatening accidents
 or violence are taken
for emergency treatment.

The company said that its outlook has "significantly
 improved" since then
and that the chain is not at risk of bankruptcy. On
 Friday, Integrated
submitted a filing with the U.S. Securities and
 Exchange Commission saying
it had tentatively secured a $140-million line of
 credit.

Lark Galloway-Gilliam, executive director of Community
 Health Councils, a
Los Angeles-based nonprofit organization, says she
 worries about where the
poor and uninsured will get their care if more
 emergency rooms and
money-losing hospitals fold.

"In a few years' time, it's inevitable our community's
 already horrendous
statistics of heart disease, cancer and diabetes will
 rise even more," she
said.

The most immediate concern is how to best address the
 fallout from the
closure of King-Harbor, which was shut down last month
 when the federal
Medicare and Medicaid agency pulled half the
 hospital's funding after nearly
four years of failed attempts to reform the troubled
 institution.

The average time it took paramedics to take patients
 to an emergency room in
the immediate area around King-Harbor rose from 13
 minutes earlier this year
to 21 minutes in August, according to the L.A. County
 Fire Department.

St. Francis -- three miles from King-Harbor and one of
 the hospitals most
affected by its closing -- has seen a one-third
 increase in ambulance
arrivals in the last month, said Mike O'Dell, the
 hospital's interim
director of emergency services.

At Downey, Fuller said increased emergency room
 traffic had been
overwhelming, citing one day this month when the
 facility was swamped with
70 trauma patients at once and turned away nearly all
 ambulances for about
16 hours. He said the hospital was expected to lose
 $12 million this year
and had spent more than $100 million out of a
 $120-million savings account.

But L.A. County Supervisor Zev Yaroslavsky said some
 hospitals were
overstating the consequences of closing King-Harbor.

"If you added up all of the additional ambulances that
 all these hospitals
claimed they got . . . it was far more ambulances than
 King gets on an
average" weekend, he said at a board meeting last
 month. "It just didn't add
up. It was bull."

The County Department of Health Services has offered
 to reimburse private
hospitals for treating uninsured emergency patients
 who arrive by ambulance
from the immediate area around King-Harbor. The
 county's contract, which
covers only some such patients, offers $1,950 for each
 day of an inpatient
stay, up to six days, or $250 for an emergency room
 visit.

Gov. Arnold Schwarzenegger has said his healthcare
 reform proposal could
ease the burden on the state's struggling hospitals.
 The Legislature is
debating the proposal in a special session with the
 aim of putting a measure
on the ballot in February.

Under the plan, all Californians would be required to
 have insurance and the
state would give subsidies to those unable to afford
 coverage.

It would also require hospitals to contribute 4% of
 their profit to fund the
plan.

"Regardless of what everybody's trying to do, there's
 not enough money,"
said Carol Meyer, director of governmental affairs for
 the L.A. County
Department of Health Services.

"We're talking about a system that is already in
 crisis," she said. "I think
this is a tipping poin
       
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