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EDITORIAL
Our View: Mini-hospitals better for docs than patients
Wednesday, December 13, 2006
Here we go again. Another knockdown fight about whether the creation of a specialty hospital is good for patients — or just for the doctors who invest in it.
This time the argument is in Springfield, where two hospitals have merged and want to build a $300 million medical center downtown. The business plan for the new Community Hospital and Mercy Medical Center suddenly has gotten iffy because a group of doctors wants to develop a surgery center that would drain patients from the newly merged entity.
Extras
Dayton went through a similar fuss when the Dayton Heart Hospital was built, and then again when local doctors set up a mini-hospital called the Medical Center at Elizabeth Place on the grounds of the former St. Elizabeth Medical Center.
Using the Springfield situation as Exhibit A (though speciality hospitals are sprouting up across Ohio and nationally), some Ohio lawmakers want to quickly pass a law that would stop the Springfield doctors from proceeding. Their proposal would require that surgery centers also operate a 24/7 emergency room, which would be so costly that the doctors probably wouldn't go forward.
Putting that sort of poison pill in law is too big a decision to make when the legislature is winding down and lawmakers are running out the door. But the issue of specialty hospitals does deserve a hearing first thing next year.
If hospitals — or what most people think of as real hospitals — are left to only provide services that "don't pay" and if they're only serving the sickest and poorest patients, that is bad public policy. Allowing that undermines the viability of full-service hospitals, ultimately compromising care for everyone. After all, almost everybody needs a real hospital that can handle anything — from heart attacks to car wrecks to gunshot wounds — at some point in their lives.
Doctors have all sorts of explanations about why they should be allowed to open their own mini-hospitals. Not all of their arguments are ridiculous or greedy.
But what they can't answer satisfactorily is: Why would a doctor who had a really sick or really poor patient send that patient to "his" hospital rather than the local hospital, where uncompensated care is picked up by the public and insurers?
To that point, the Greater Dayton Area Hospital Association says Good Samaritan Hospital anticipates that next year it will lose almost $7 million in business to the Medical Center at St. Elizabeth Place. Money that otherwise would have gone to Good Sam will now be going to doctors, which leaves less for the hospital to invest in the hospital.
The federal government had a moratorium on specialty hospitals that was in effect until last summer so it could dig into the impact of this trend. In the end, Washington didn't totally buy the argument that hospitals could crumble under the threat of "boutique hospital" competition, but it did accept that Medicare — which all hospitals rely on — was paying too much for certain procedures and too little for others.
When policy makers got done changing Medicare's reimbursement rates, suddenly specialty heart hospitals, for example, were no longer the rage — because they aren't as lucrative any more. That was an admission that something was not right and that real hospitals had a real complaint.
When hospitals have a monopoly on care, they can get arrogant and be slow to improve. But the answer to that problem is not to strip them of any chance of making money.
Financially stable, full-service hospitals are as important to sick people as financially secure doctors.
