The upstairs meeting room of Chestertown’s Town Hall was filled last Thursday night for a meeting called by the Save the Hospital coalition. Margie Elsberg of Save Our Hospital chaired the meeting, which featured a panel of Ken Kozel, CEO of University of Maryland Shore Regional Health for five counties on the Eastern Shore; Dr. Ona Maria Kareiva, an anesthesiologist from Easton who works at the Chestertown hospital, and Dr. Michael Peimer, an internal medicine specialist, of Chestertown.
Elsberg opened the discussion with a summary of the status of Shore Regional Health’s plans for the hospital. She said that Shore Regional Health, a subsidiary of University of Maryland Medical Services, originally planned to downgrade the Chestertown Hospital to a stand-alone medical facility – essentially an expanded emergency ward, with some testing facilities but no inpatient beds. Residents’ protests, notably in a packed 2014 meeting at the Chestertown firehouse, forced UM SRH to reconsider. The community response also resulted in a measure passed by the General Assembly of Maryland, requiring the hospital to stay open until 2020 – a date that SRH extended to 2022. However, if no new legislation is passed before that date, UM SRH is within its rights to carry on with its original plan, or even to close the hospital entirely.
Shore Regional Health (SRH) owns three hospitals on the Eastern Shore — one each in Chestertown, Easton, and Cambridge. Statewide, University of Maryland Medical Systems (UM MMS) owns 13 hospitals–that’s ten in addition to the three on the Eastern Shore. Also, UM SRH runs numerous other medical facilities offering a multitude of medical facilities and services including doctors’ offices, testing facilities, and various medical clinics. The Shore Medical Pavilion at 126 Philosophers’ Terrace in Chestertown–which opened a little over two years in June 2016–is owned and operated by UM SRH.
Elsberg said that UM SRH has agreed to retain some patient beds in Chestertown. However, the current plans do not include an intensive care unit, a decision that Save Our Hospital strongly opposes. She said the community will need to generate legislative support to get the action needed to prevent the hospital from closing or eliminating services. She emphasized that the facility under consideration would be a “minimal” hospital.
Dr. Kareiva said the hospital needs an ICU to care for patients with such diseases as pneumonia, who need a high degree of observation and maintenance. She said an operating room is also necessary for the community. She said Kozel has promised to provide most of what the community has asked for. “We need you to believe him and work together,” she said. She added that the community needs to use the hospital to keep it viable.
Kozel said that the nature of health care has changed significantly in the past five to ten years because of the Medicare waiver granted to the state of Maryland, meaning that health care payments are at a predetermined rate statewide. Because of this, he said, the cost of health care “is going through the roof” at 18 to 19 percent of the economy. UM SRH is under the obligation to provide access to high-quality care at an affordable rate. But it covers a rural area with a comparatively small population spread over five counties, two of which – Queen Anne’s and Caroline – don’t have hospitals.
Kozel said a free-standing medical facility – the model UM SRH originally planned for Chestertown – does 95 percent of what a full hospital does, “all except beds.” He said the plan made sense, but the firehouse meeting forced UM SRH to reconsider. The geography of the five-county area means that patients from Kent County are an hour or more away from the Easton hospital, which he said he now believes is an unacceptable distance to ask them and their families to travel. The current model is a “critical access hospital,” which would have 15 patient beds but no ICU. He said the Shore board supports the plan, although it recognizes that it’s a challenge.
Dr. Peimer said the hospital needs a critical mass of usage to stay open. It needs to keep staff at a certain level, and remain flexible. It’s important for it to be able to take care of patients locally, not send them away. That means bringing in staff to cover specialties not found in the local community. It also means finding enough hours for the nursing staff – Peimer said the hospital is losing nurses because it can’t provide enough hours for them.
Garrett Falcone of Heron Point said the hospital needs to work to bring in more primary care doctors.
Kozel said the system is working to recruit more doctors for the local community. He said UM SRH worked with Dr. Susan Ross to keep her practice open and hired a new doctor to join her practice. Specialists are also being brought in at the offices on Philosophers Terrace, including a cardiologist, an ear, nose, and throat specialist and others. But because the system needs to cover five counties, it has a limited budget for what it can do in Chestertown. “We need to cut to balance what we add,” Kozel said.
An audience member asked why the hospital needs to cut if it is operating in the black, as stated by Dr. Jerry O’Connor in an interview on public radio last week.
Kozel said the hospital previously operated on a fee-for-service basis, meaning that more volume produced more revenue, allowing the hospital to be profitable. Because of the waiver, rates are now capped. “We know our revenue for the year, and we have to use it wisely,” he said. But if the hospital provides fewer services, or if its service is rated poorly, it loses revenue.
UM SRH has been consolidating such departments as human resources and IT systems while working to keep nurse/patient ratios constant, Kozel said. It’s also working to reduce “avoidable utilization” – patients who don’t need to be in a hospital at all, especially those who are readmitted after treatment.
The whole system is on a break-even budget, he said. The patient census – those kept in beds — averages about 17 a day, but can be as low as five and as high as 25, depending on seasonal variations and other factors.
An audience member said the hospital refers many patients to Easton. Kozel said that decision is up to the doctors – what’s right for the patient. The audience member said that Easton doctors who take phone calls from Chestertown don’t know what facilities are available here. Elsberg said the perception is that Easton doctors don’t listen or care about Kent County patients.
Kozel said that 95 percent of transfers from Chestertown to Easton are decided upon by emergency room doctors who have examined the patient.
Elsberg said that closing the hospital in Cambridge will produce significant savings for Shore. Beds will be moving from that facility to Easton, she said – why not to Chestertown? Or is the system just cutting patients to justify closing the local facility?
Kozel said the UM SRH board has not approved closing the Chestertown hospital and does not intend to. He said it’s working with the General Assembly to create a plan to keep it open.
Elsberg said the system asks nurses to commute to Easton to get their full quota of hours; why not ask doctors to commute to Chestertown?
Kozel said he has no control over what doctors do. He said they could see several patients in the time they would lose driving here. A few are doing so voluntarily.
Allan Schauber of the Kent & Queen Anne’s Rescue Squad said that Emergency Medical teams are impacted by the need to transport patients to Easton. He said there had been emergency calls in Still Pond and Fairlee that very day, one of which was a woman in childbirth who had to be taken out of the county because there is no maternity ward here. All three of the available EMS teams were tied up and unavailable for any serious emergency that might have happened.
Kozel said the lack of a maternity ward was the result of the low birth rate in the local area, with less than 200 births a year. It’s impossible to keep the necessary staff in town and to keep up the level of expertise, he said. “We can’t provide all services to all communities.” He said that emergency rooms have delivered babies, but in general, the medical staff has to follow guidelines.
After several more audience members challenged Kozel on the need to transfer patients to Easton, he said he would ask his medical executive committee to look into the reasons for transfers.
Dr. Peimer said the Chestertown doctors take their jobs seriously. He said the doctors would like to see statistics on transfers out of the hospital. “We want to keep people here if we can,” he said, but the local doctors are working against “a different culture” in Easton. He said doctors have to maintain a comfort zone as far as the care their patients are getting, and the Easton doctors may not be aware of what can be done in Chestertown.
Falcone asked whether appointing Kathy Elliott, the hospital’s director of nursing at Chestertown, as executive director of the hospital, was a wise choice. He said that splitting time between the two jobs would make it difficult to succeed. He said community outreach would suffer.
Kozel said Elliott knows the system and knows what the hospital does. Nurses do 90 percent of what the hospital does, nurses have knowledge that most administrators lack. “Kathy’s got the best of both worlds,” he said. As far as community outreach, “We’re trying to get her acclimated,” he said.
Kent County Commissioner William Pickrum said the state’s budget is controlled by the governor; “We need to focus on him.” He said Gov. Larry Hogan’s constituency is heavily weighted toward rural Maryland, and Kent County should be able to “get him to pay attention to us.”
Fred Kirchner of Tolchester said that economic development is an important issue in Kent County, but “it doesn’t work without a hospital.”
Elsberg said that both sides are in agreement that Kent County should have a hospital. “The infighting is about the details,” she said. “’No beds’ is not on the table.”
Asked if Washington College is on board with preserving a full hospital, Elsberg said college President Kurt Landgraf is fully committed and fighting very hard. Landgraf knows hospitals and politics, she said, as he has previously served on a hospital board in another community for several years.
Sarah Feyerherm, the college’s Dean of Students, said the college counts on having the hospital nearby. She said it is a crucial factor in attracting both students and new employees.
Asked whether the lack of an ICU affects patients’ willingness to have surgeries performed locally, Peimer said it would make some people think twice.
An audience member asked if the lack of an obstetrics facility could be made up by using midwives. Kozel said the hospital needs full-time coverage for obstetrics. He said there are no birthing centers in Maryland, and said there might be regulatory issues behind that fact.
Carl Gallegos, a member of the hospital foundation, said the hospital realized some $7 million from the sale of Chester River Manor, the nursing home. He said the funds are being kept in the community; one of the first expenditures from the sale was a new CT scanning machine. He said the foundation needs the community’s continued support.
Elsberg, summing up the two-hour meeting, said she was encouraged by “the enormous passion the community exhibits.” She said the efforts to retain a hospital, including an ICU, are close to being on the right path. Government support will be needed to complete the community’s vision through legislation. While the local delegates to the General Assembly have done much to support the community, “we need to fire up the engines again,” she said.