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Ellen Belcher is the Dayton Daily News opinion pages editor. She writes about state government, education, the environment, higher education and all things Dayton.
Martin Gottlieb is an editorial writer and columnist for the Dayton Daily News opinion pages. He focuses on the political process itself and does such national issues as war, the economy, taxes and Social Security, as well as a hodge-podge of local and state issues.Home > Blogs > A Matter of Opinion > Archives > 2011 > March > 02
Wednesday, March 2, 2011
Editorial: Children’s hospital needs to be guarded
It’s a mistake to think that the debates that Ohio and the federal government are having about funding Medicaid just affect the poor.
Decisions about eligibility rules and reimbursement rates also matter to the doctors who see Medicaid patients and the hospitals that treat them.
For these reasons, Children’s Medical Center of Dayton is especially following the debate — for what it means for its bottom line, even its future.
Almost 50 percent of Children’s revenue comes from Medicaid. Ten years ago, that number was 30 percent. The obvious question is where’s the tipping point for Children’s, the point where there aren’t enough children covered by better-paying insurance plans to subsidize the cost of those on Medicaid.
(It’s generally agreed that Medicaid reimbursements for children and adults don’t cover the full cost of providing care, so cost-shifting is inevitable.)
As Staff Writer Ben Sutherly recently reported, Dayton is one of the smallest metro areas in the country with a free-standing children’s hospital. The “free-standing” description means that the hospital is not a satellite of another children’s hospital in another city or an appendage of a local adult hospital.
Of course, Children’s prefers to be independent and “owned” locally. That said, there are children’s hospitals all across the country that are associated with, or part of, another institution that are providing excellent care. Every community has to decide what it wants to pay for, what it values and what it’s willing to insist on.
The worst thing for the Dayton community and for Dayton Children’s would be to wake up some morning and learn that the medical center was being forced to merge or associate with another institution without the community ever having any warning or public conversation. (In the 1990s, there were private talks about it possibly joining with Cincinnati Children’s Hospital.)
Nothing dire is imminent, but the trend lines are threatening. For financial context, Children’s has been operating in the black, with no debt. It has $100 million in reserves and endowments. But its annual Medicaid reimbursements are $60 million.
It’s never good to have a hospital limping financially. When that happens, good people run the other way and the quality of care suffers (which may not always be obvious to patients who, on their own, have difficulty judging hospitals).
Moreover, if a struggling hospital can’t afford to pay expensive, hard-to-recruit specialists and sub-specialists who are money-makers for it, then it definitely can’t offer the procedures that are part of a full-service operation but that have to be subsidized.
If Children’s were to be downsized or become part of another operation that didn’t want to support all the care that’s here now, patients would have to go to children’s hospitals in Columbus or Cincinnati. Valuable time could be lost in critical situations, and families who are already stressed because of a child’s illness would have to drive significant distances for ongoing treatment or to be with their child.
On the up side, Children’s would be part of a richer institution that can command more in research grants that help absorb administrative overhead.
If Children’s were to become part of a local adult hospital, it would be a small piece of a bigger place that has different sensitivities. But adult hospitals tend to be less financially stressed. Unless it were co-owned by the two competing health systems, the hospital rivalry that exists between Kettering Health Network and Premier Health Partners would turn even uglier.
Without a doubt, Children’s Medical Center is a community asset that so many families turn to. Especially in these times, it’s a mistake to just assume that it will always be there, always at the level it is today. Unexpected things happen, money dries up.
An institution that is this important, this treasured, shouldn’t ever find itself in trouble without the community getting a very early heads up.
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