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By MARK EVANS
STE. GENEVIEVE HERALD
About 40 people attended the first of two townhall meetings put on by Ste. Genevieve County Memorial Hospital (SGCMH) last Thursday at Progress Sports Complex.
Dr. Steve Pautler, CEO, outlined the challenges, strategies and goals the hospital faces in its quest to remain independent.
Considerable talk has gone around the county in he pat year or two, following Perry County Memorial Hospital and Washington County Memorial Hospital’s absorption into the Mercy system, that SGCMH was next to be swallowed up.
Pautler addressed that issue first.
“Our message here is independent status is a priority of the board,” he said. “I’ve heard a lot of different things about what’s happening and what’s not happening. And what is happening is the board is still laser-focused on trying to make this a community hospital that’s responsible to you here in the county and now and for the future.
“And so the idea that we’re talking with another organization looking towards lease management, any other change in control is just not happening right now.”
He noted that most of the hospital board members have been on it for more than 15 years.
He went over the expansions the hospital has made since its founding in 1969, then addressed the issue of hospital closings.
Of some 5,000 hospitals in the US, about 1,500-2,000 would be considered rural hospitals. Since 2005 about 200 of those have closed or been swallowed up.
He touched on what happens when a community loses its hospital.
“You lose access to health care. That’s obvious,” he said. “You lose providers that depend on the acute care hospital because, for example, surgeons don’t stay where there’s no hospital to do their work. It’s as simple as obstetricians don’t stay where there’s no place to safely deliver babies. There are direct costs. There are loss of jobs from the largest employers in town. Many towns that have a hospital closed lose their major employers because their employees want to be close to a hospital. Many retirees leave because they want the security of being near a hospital.
“And indirect costs, increased travel costs for poor, elderly, disabled, and other patients. So if the hospital closes down in a small town, then older, sicker folks have to travel farther for any hospitalization. And it is catastrophic for them. And then if they’re lucky enough to have children living nearby, they have to take off work for every incidence of care that’s involved, maybe a day, maybe two days, maybe stay overnight in a bigger town where they don’t know anyone and where everything is unfamiliar. So those are pretty scary consequences.”
He went over some of he financial challenges facing small hospitals, like getting smaller reimbursements than bigger ones.
“We don’t have an economy of scale,” Pautler said. “If you have someone that says I have a book of business with United or Aetna or Cigna or Blue Cross, and we treat 200,000, 300,000, a million people on your plan per year, you have negotiating power that we don’t. That’s really simple.”
Of course, expenses, including salaries, keep going up. Labor and supply costs are up 18-20%, contract labor charges have increased by 150-258%. Hospital total expense per patient rose by 22.5%.
However, Medicare and insurance plans have only increased payments to hospitals by 2-4%.
Despite all this, SGCMH has maintained surgical specialties like OB/GYN, breast, orthopedic and podiatry specialists.
Pautler went over the hospitals goals. They include providing training for employees, setting a great environment for patients to heal, retaining employees, having a safe environment and displaying financial stewardship for the hospital’s future.
He said the hospital is committed to recruiting eight physicians over two years, and to a Meditech upgrade of patient care.
So far, SGCMH is succeeding in hanging onto good employees, with an 83% retention rate.
He talked about the Friends of the hospital group and the hospital auxiliary and their support, as well as partnerships like the rural Parish Dental Program and Parish Nurse Program.
At the end, the floor was opened for questions.
One attendee asked how larger hospitals take over smaller ones.
“Do they come in and do they find weaknesses and come in and infiltrate, if you want to use that terminology?” she asked. “Are other hospitals, are their boards weaker and they give in, or a doctor that might be dissatisfied that helps them push their way in?”
“There are a number of ways it happens,” Pautler said. “The most common way, I’ve been on both ends of the affiliation discussion, I’ve worked in big systems, I’ve worked in small systems, I’ve worked in larger independent hospitals, and I’ve worked in other small hospitals like this. Most commonly, the hospital has some kind of financial difficulty. If a big business leaves town, or if the insurance contract changes, or if the town is just diminishing in size and all you have is Medicare patients, then it’s tougher to make that bottom line in that circumstance than in other circumstances.
“And usually there’s a slow decline and they get to a point where they’re not really sustainable on the model they had before. And if some hospitals close all together, some hospitals will close down their inpatient care.”
He also mentioned similar-sized hospital in Salem that “just hit the skids” and wound up closing down.
In other cases, he said, they close their special services and try to hold onto their “core inpatient” population. That however, usually doesn’t work.
“At some point they kind of lose the grip and they can’t maintain the inpatient because they don’t have enough other things going on to fund the 24-hour operations of a very small inpatient load,” he said. “And so then they have to go looking for help.”
Pautler summarized the situation.
“So there is five or 10 different ways that it can develop that you can’t make it on your own and you need some level of support beyond that,” he said. “And right now we’re maintaining without that and that is the goal.
“So our strength is in numbers and togetherness and like everything you said this evening about productivity and stuff, that maybe keeps them away.”
Brock Gibson, then remarked that he had served in rural health care, and gave high praise to the hospital.
“For this hospital to do what they do here in this town is very impressive,” he said. “I mean, it’s very impressive. And I’m not just saying that.
“I’m telling you that because that’s a fact. I have visited many of these hospitals. And it is a very difficult thing to do to manage a critical access hospital because of the reimbursement that you just talked about with Medicare, because they’re cost-based. So it’s a challenge to do that.”
He said of the 150 to 200 hospitals he has worked with, SGCMH is among the top three or so.
Another townhall is scheduled for this Thursday at 5 p.m., also at the sports complex.