TOPEKA, Kan. (KSNT) – One thing is near certain: any future for St. Francis means the hospital will likely look very different than it does today. Ayla Ellison is the managing editor for Becker’s Hospital Review, a hospital and health system industry magazine. She says it is possible for St. Francis to keep the doors open and continue to provide for patients; however, it would require creativity. We talked with her Tuesday night via Facebook Messenger’s Video Call.
“There are some options to try to keep healthcare services in the community (Topeka),” Ellison told KSNT News. “It may not be in the same capacity as it is now. I imagine it’s extremely difficult to try and get other hospital operators to come in and commit to try and take that over right now.”
Ellison says while many hospitals across the U.S. that have closed, they have simply ceased in-patient care but began operating as free-standing ER’s or urgent care centers in their place. She explains that St. Francis can survive, but it will require very creative ideas to reinvent the hospital and healthcare system. Hospitals that are financially solvent are being creative, focusing on population health while also cutting costs where they can and becoming more efficient in the process Ellison explained.
As a non-profit, charitable hospital, St. Francis made it clear in their search to sell that they wanted a buyer or operator who would continue their commitment to care for the poor and vulnerable–often a population that is uninsured or under-insured. While non-profit, tax exempt hospitals are required by law to provide a certain amount of uncompensated care to the community, the likelihood that St. Francis could continue it’s stated mission might be difficult if not impossible–the unfortunate, sad reality of today’s medical marketplace. Ellison points out that St. Francis has faced what many other hospitals have as well: operating in a state that has not expanded Medicaid, dealing with a large uninsured population (self-pay or those who can’t contribute to the cost of their care at all), and a rise in high deductible health plans. So, even those who are covered by insurance, sometimes the hospital still has to pick up the tab because the patient can’t pay the deductible.
“Although (Kansas) legislators can take action to possibly make the operating environment for hospitals in their state a bit easier, it may not be possible at this point for a hospital that’s on the brink of closure to allow it’s finances to rebound back to a state where it would be able to operate at margins to keep its doors open,” Ellison lamented.
She went on to say that the majority of hospital closures in the past few years, including the 21 in 2016–have been in states that did not expand Medicaid. Ellison noted the uncertainty concerning healthcare at both the state and federal levels.
We asked Ellison the top three concerns the St. Francis situation presents. First and foremost, the notes that patient access is crucial; will those living in Northeast Kansas not just have access to quality healthcare but will it also be timely? The reality is if Stormont Vail or other hospitals are required to absorb St. Francis patients, they may not be able to–especially initially. A second concern is the effect on the Capital City, Shawnee County, and Northeast Kansas economy. Ellison points out that a loss of 1,600 jobs, or even a significant number of them, could mean that people remain unemployed in the community or even choose to leave. Lastly, she says what’s happening to St. Francis is a sign of things to come.
“Although this is St. Francis we are talking about right now, study after study, has shown that states that have not expanded Medicaid, many of them are operating at negative margins. So, the situation at St. Francis is definitely not in a silo, there might be other providers that are headed in that direction as well,” Ellison warned.
So is this a ‘warning shot’ to Kansas legislators and leaders?
“I think that it is,” she replied. “And, I would imagine that in coming weeks there’s going to be much more discussion on Medicaid expansion again, and we’ll see where that heads in Kansas.”
It was just in October 2015 that another Catholic hospital in Kansas was forced to close.
Mercy Hospital Independence was another casualty in a string of dozens of rural hospitals across America that couldn’t cut it in the current healthcare climate. At the time, Mercy noted that Kansas’ failure to expand Medicaid had a significant impact but was not the deciding factor.
Still, it would have brought in an additional $1.6 million dollars each year. The New York Times noted that Mercy’s problems sparked renewed calls by lawmakers in the Kansas Capital to expand Medicaid under the Affordable Care Act (Obamacare).