While Shore Health’s community forums have been instructive to the general public in explaining the economic realities that led to Dr. Moorman’s February 1 decision to move obstetrics from Chester River Hospital to Anne Arundel Medical Center, what remains clear, above all of the statistics, is the sense of loss felt across Kent County over these cost cutting measures.
The panacea offered by the health system, so called regionalization, is a tough pill for many people to swallow. This is especially the case because, as of yet, there is no clear sign on how Shore Health’s regionalization plans are expected to unfold, aside from the construction of a new hospital outside of Easton, which is not slated for construction until 2013.
“Through the community forums we are really trying to share with the community this whole process,” said Chester River Health System’s director of PR Julie Vallecillo to the Spy. “The [regionalization] study was announced in December, and then really launched after the three board members from each health system–Chester River, and Shore Health–began meeting in February.”
With the start date of the regionalization study and Dr. Moorman’s announcement to discontinue obstetrics in conjunction with Chester River Hospital so close to each other, the concern of many coming to these forums is that the two events were coordinated in tandem.
But as Chester River Hospital’s President Jim Ross has explained at the forums, “Hospitals don’t deliver babies, doctors do.” In other words, if the ob-gyns are finding there are not enough births in the community, it is simply common sense, so the argument runs, to relocate for their own professional survival.
Participating in regionalization, meanwhile, can also be seen as Chester River Hospital’s survival tactic. If implemented properly, it could prove to be the key to solvency for regional hospitals on the Eastern Shore as the healthcare landscape continues to change under the Healthcare Reform Bill.
The immediate implications of the bill, passed in 2010, are decreases in Medicare payments, which account for the bulk of community hospital revenues like Chester River across the country. Starting this year, decreases to Medicare payments can be halted if hospitals are able to meet federal standards for productivity and quality of care. Called “value-based purchasing”, patient satisfaction and the number of readmissions will be linked to how much Medicare reimbursement a hospital receives, which creates an additional challenge for hospitals already struggling to stay in the black.
In Maryland, hospital reimbursement rates are set by the Health Service Cost Review Commission (HSRC), which follows a similar rubric of quality of care and efficiency for determining these rates, case by case.
“The reality,” said Vallecillo, “is Dr. Moorman and Associates is a private practice–that’s a business. We don’t control Dr. Moorman’s business, he is on our medical staff, he has privileges at our hospital. But it’s a relationship, we don’t employ him, so we don’t have any impact on his decisions. He makes his decisions based on what is best for his practice.”
Given that Chester River Hospital has the lowest birth rate of any hospital in Maryland, with only 183 babies delivered in 2011, Moorman and Associates’ reasoning would appear sound. Furthermore, even with a birth rate as low as Kent County’s, best clinical practice dictates that a hospital provide 2.1 ob-gyn teams, or four specially trained physicians. Each physician would require a salary deemed unsustainable by the hospital.
The long term financial sustainability of obstetrics and inpatient pediatrics, which has been discontinued for similar reasons of inadequate critical mass, is often a secondary concern for many of the community members attending the forums.
“Regardless of whether OB and pediatrics make money or not, you never, never, close them down because they are the gateway, and they have such a positive effect on other areas of your hospital,” said one participant at the forum held in Worton the evening of February 27.
The crowd, packed tightly into a spare conference room Shore Health had rented from the Kent County Community Recreation Center, erupted with applause.
One woman related a story about the sick child of a relative who was taken to Chester River Hospital early last month. When the child began having a seizure, he was referred by the hospital to Anne Arundel Medical Center, an hour’s drive away. But no one in the boy’s immediate family had reliable transportation, so they were forced to scramble for a car at the last minute.
“It doesn’t make sense,” said the woman, “someone’s gonna die, and who’s gonna be responsible? Who’s gonna be responsible?You have to take into consideration, not only people who drive, but people who don’t have transportation! So if more of the people in the county don’t come out and speak out, they are going to do anything and everything to us…and no one cares.”
“We do,” said the moderator firmly. “We do care.”
“I don’t think you do. It’s business,” said the woman, taking her seat.
Another woman spoke of a fellow churchgoer who wound up in a hospital in Fairfax, Virginia after checking in around midnight to Chester River Hospital the previous weekend.
“I do not know which or what’s over there…but I do know that it is very inconvenient to her family now,” she said. “And she happens to be a nurse practitioner!”
“…The inconvenience of it all…is so astronomical,” the woman continued, “It’s really hard for me to accept. We have been a community recently of retired people, and now I just feel that we are a community who are going to be labeled ‘those who don’t want children’ ”.
“There are very specific challenges to living in a rural area,” said Vallecillo after the forum, “If you don’t have a car, you will experience problems getting from A-Z, and the hospital certainly recognizes those challenges. I believe there is a transportation study that is currently underway, and in fact, it is a subject being tackled by our current regionalization study committee.”
“What we want the community to understand is that we too have to react to the changes that are presenting themselves to us. And we are still doing our best to provide healthcare services to the community with limited resources and facing changes and new trends in healthcare. We have to adjust. ”
Although obstetric services will formally end at Chester River Hospital as of April 1, Dr. Moorman and Associates still intend to provide pre and post-natal care in Kent County.
Michael Troup says
“Starting this year, decreases to Medicare payments can be halted if hospitals are able to meet federal standards for productivity…”
I wonder if Politifact will vacate their lie of the year award for 2010? Anything is possible. Even Reggie Bush gave back his Heisman.
Shawn Moriarty says
Four short years ago my life was saved by a very able surgeon (O’Connor) in Chester River Hospital. I have been there an untold number of times over the past decade to receive medical treatment for a chronic illness and have been capably treated each time. Both of our kids were born there (thank you Dr. LaFerla). Nothing is perfect and I am sure these people are doing the best they can in a very difficult situation that is, in some respects, probably out of their control.
Whether we like it or not, the facts on the ground are that things are going to change and they have to change if anything is going to remain at all. As a community we can find a way through this and we should reach out and support each other instead of relying on government, special programs or another hand out of our own tax dollars back to ourselves.
It is a shame that folks don’t get as riled up when the government wants to dip its hand into our pocket to take money for increased bridge tolls, alcohol taxes, gas taxes, tobacco taxes, property taxes and on and on. I haven’t been following the whole issue that closely, but I would think that Andy Harris or E.J. Pipkin should be involved here somewhere. Federal money is involved when it comes to the hospital and this is a major issue affecting a lot of people over a large area. We would like to hear from people we elect at times other than election time. What is the county or city government doing? Who is taking the lead on representing the community at large? Although this issue has the potential to cause strain in the community emotions are not going to win the day.
The hospital cannot operate on sentiment. It doesn’t pay too well. So it is a little odd that statements like, “Regardless of whether OB and pediatrics make money or not, you never, never, close them down because they are the gateway, and they have such a positive effect on other areas of your hospital,” receive a rousing round of applause. The costs to be in business as an OB are phenomenal. Years ago it took at least 30 deliveries to clear the insurance premiums to practice. That is a fact, not a guess. If you do the math in an area with the small number of deliveries we have you can see where this goes.
Michael Troup says
So as not to make anyone think I was calling Simon a liar, Politifacts lie of the year for 2010 was “Government takeover of health care.” If the government is setting its reimbursement schedule to performance and productivity standards it deems worthy, aren’t they the de facto controllers of the means of production? I often find the quote that others see as filler and make a huge spectacle of it. My bad.