The viability of rural hospitals, fighting to remain financially solvent despite implementation of additional mandates, must be balanced with the need for nurses working 12-hour shifts to have protected time for meals or breaks. Both are important and a viable resolution exists somewhere in between. Sacrificing meals and breaks for nursing staff already dangerously spread thin is not the solution to keep rural hospitals afloat. And indeed, Senate Bill 1155 passed with bipartisan support and will now head to the Governor’s desk for signing.
Only 6% of physicians practice in rural areas, yet they serve 16% of the population. Kitsap County has 443 physicians, equivalent to 2.4% of the state total and is one county experiencing a shortage of primary care physicians. Kitsap County falls below the state average in every primary care specialty across the board.
Every child deserves the best possible start in life, and the statistics show that specialist neonatologists practicing at high-volume NICUs are in the best position to provide it. Just because smaller community hospitals that have invested in state-of-the-art equipment can, technically, deliver preemies, doesn’t mean they should.
Mayo has fractured trust by misrepresenting operating losses in Albert Lea to justify hospital closure, Dr. Noseworthy condoned prioritizing patients based on their pocketbooks while third quarter earnings went through the roof, and hospital leadership condescendingly compared driving 23 miles in labor as being equivalent to buying ice cream.
CVS considers having a medical degree to be an “obstacle” to affordable medical care, which they plan to eliminate with “one-stop shopping,” having pharmacists and nurses practicing medicine by protocol. A segregated, two-tiered healthcare system will ultimately emerge as Aetna members are directed to “Minute Clinics” without access to physicians while those on other commercial insurance plans will see the physician, nurse practitioner, or physician assistant of their choice.
Confucius said, “the man who moves a mountain begins by carrying away small stones.” It is time to lay the groundwork for Kitsap residents to formally engage in meaningful dialogue with leaders of our local hospital corporation, whether operated by CHI Franciscan, Dignity Health, or a still-to-be-named corporate entity.
The American Board of Medical Specialties (ABMS) eliminated “lifetime” certification to shore up their financial outlook; a modification having little to do with quality and much to do with rate of return. Between 2003 and 2013, the ABMS member boards’ assets ballooned from $237 million to a staggering $635 million, an annual growth rate of 10.4%. MOC is outrageously lucrative. Almost 88% of their revenue came from certification fees.
How did we get here? America has struggled to balance access to hospital services with utilization, quality and price for the past 50 years. In the mid-1960’s, certificate of need laws were established to limit the supply of hospital beds and equipment, prevent overutilization of services, control costs and improve quality.
The evidence is now clear CON laws not only increase costs, but also restrict access for the underserved, especially in rural areas. Hospital bed access is expressed in the number of beds/1,000 population; on average, there are 3.62 beds/1,000 people in the United States. Recent studies by Strattman and Russ found states with CON laws have 1.31 fewer beds/1,000 overall. Kaiser Foundation found Washington and Oregon have the lowest bed ratios in the nation, at 1.7 beds/1,000, with Kitsap County having a woefully inadequate ration of 1.30 beds/1,000. In short, the evidence supports the fact that CON regulations worsen access for rural residents.
Phoebe-Putney Hospital vs. Lee County, Georgia: A Tale of Consolidation and a Little County That Could
Lee County is on their way to achieving something extraordinary; challenging the dominance of a hospital monopoly. On July 21, 2017, the CON application for Lee County was deemed complete by the Georgia Department of Community Health. A decision is anticipated by Nov. 15. If granted, the county plans to break ground on the new structure in early 2018. The CEO of Lee County Medical Center, Mr. G. Edward Alexander, stated “Our goal is to ensure that decisions for the hospital are made locally by people who live and work in Lee County.”