Say Goodbye to Your Local Hospital?

I was at a small gathering discussing healthcare and one of the people walked up to me and said “I don’t understand why President Obama wants me dead. He doesn’t even know me.” At first I thought this was funny until I realized he was serious.

It turns out that this was a response to the discussion we were having about the future of hospitals in smaller urban/suburban areas and hospitals in rural areas. The future isn’t too bright. Where you have a large volume of patients, the administrative costs can be spread over a large number and the cost per patient is low. That’s all well and good for New York City, San Francisco, for LA, but what about hospitals that serve the average suburban, rural area? The answer is simple, there will be no hospitals in those areas; they are going to have to close because they can’t afford to stay open. In smaller hospitals, while the costs for investment in quality personnel and equipment keep going up, the number of patients being seen over which these costs can be spread is small. High overhead burden make the ability to operate these facilities profitably impossible. Ezekiel Emanuel, a White House health policy special advisor who helped shape the Affordable Care Act forecasts that ,as a result of increases in the cost of doing business, one in five hospitals, over 1,000, will close by 2020 . The administration understood that the burden of requiring marginally profitable regional and rural hospitals to acquire new technology, to automate their record keeping systems and to provide additional compliance reporting would drive them out of business. With 20 percent of all American hospitals forecast to close, where are you going to go for care when that hospital is yours?

While it has always been true that in some states the nearest hospital has been as much as 150 miles away, or even more. Such facilities, like hospitals in the Dakotas or in Alaska, have in place infrastructure to transport emergency patients over long distances. Helicopter services in the Dakotas and airplane services in Alaska are part of the emergency response landscape.

With smaller hospitals closing, larger facilities will see their service area responsibility for delivering emergency services expand. Expanding ones service area over significant distances poses new problems, especially in states like Georgia and Alabama and in areas like rural New York. Hospital who take on this burden don’t have infrastructure to quickly deliver emergent care to those people. These hospitals have no helicopters, no heliport on their roof. It’s the ambulance which drives 20, 30, 50, 75 or even 150 miles. If you live in one of those areas and you call 911, if you are having a heart attack, you can’t breathe; you have been deeply cut; or you have been severely injured in a way that requires emergency surgery, by the time the ambulance drives to you and then brings you to back to the hospital, even averaging 80 to 100 miles an hour, YOU WILL BE DEAD.

Perhaps it was this thought was caused his outburst or perhaps it was the idea that, in addition to no longer having access to a hospital that’s local, he may not have access to a doctor, any doctor, who would take his insurance.

The networks offered by insurance are so small. It is amazing how much profit is being made and how little care can be delivered. It used to be most patients had out of network coverage and you could see an out of network physician. Today, there is not a single product offered in New York which offers out of network reimbursements based on usual and customary. The best you can get is out of network benefits based on Medicare, which is 50 to 60 percent difference in what doctors charge for out of network services. Not a single Obamacare exchange product offered in New York state offers out of Network coverage. This is true in most states.

What this means to you is that if you only have one doctor in your local area that accepts your insurance because your insurance company wants to keep its network small, you may not have access to your doctor for a very long time. If things get so bad and you feel you must look elsewhere for care, the financial burden of that treatment is going to be borne by you. If you can’t pay for it; and it turns out you waited too long or what you have is life threatening, you are back to looking at two options: death or bankruptcy. It is as if you are uninsured. Even if you go to the emergency room for treatment, your emergency room treatment will probably be covered, though out of network physicians who treat you and bill separately will not be. If you need hospitalization or further treatment and the hospital you go to is out of network, even if it’s the closest hospital to you that is 75 miles from your home, the cost of treatment is on you.

People have forgotten that it is really doctors who are the ones who are interested in taking care of you, not politicians. For doctors, making a good living would be nice; but that is not what they think about. First and foremost on their mind is patient care. Like you, doctors don’t understand how they could be so outside the loop. They don’t understand, as a group, that issues like right and wrong and putting the patient first have nothing to do with what happens in Washington DC or in their state capital. The truth is for doctors and for you the current state of healthcare reflects what works for the politicians in a political sense and what works for businesses in a business sense. It is really not about giving patients the best care. In fact, it has NOTHING to do with it.

When your small town doctor folds up his tent because he can no longer afford to practice medicine and there is no one to provide you with adequate medical care, are you, too going to think that this was all some kind of plot?