Possible hospital closure- Updated: Hospital Closed

[Granny_Weatherwax]

Our small city has two small hospitals. One hospital has been floundering for awhile and has been sold twice in approx 10 years. The past few months have seen the closure of multiple departments (Pediatrics, Obstetrics, and a couple of others) and multiple doctors have been let go or asked to take early retirement. The stress put on the remaining hospital and physicians has been great. The entire town has been full of rumors about a possible full closure. It was announced yesterday that earlier this month the hospital has lost accreditation and will no longer be paid by Medicare/Medicaid (two separate but related events). The hospital failed four surveys within six weeks.

The community is reeling. Many people have lost their jobs. People are scrambling to find new doctors. The state health department is helping relocate current inpatients to other hospitals.

In an already stressful health environment in which medical resources are at a premium to lose so much in such a small community is troublesome and problematic. The comments on newsfeeds worries me. Many people are cheering the closure and using anecdotes for justification; I also have negative stories as this is the hospital that completely missed my broken wrist and femoral hernia after my bike accident and sent me home barely able to walk. This is not good, however, and I hope there will be last minute changes and a new survey and an announcement that the hospital will remain open under new management. Medicare/Medicaid accounted for over 75% of the hospital income and, with it losing accreditation many private insurance companies will not pay for care (at least this is what the news report stated). even if private insurance will pay, there is no way a hospital can rely on the meagre payments from private pay and insurance. 

I hope some of the medical staff being let go will be hired by the other hospital and will be able to relieve some of the burden on that staff.

Edited January 11, 2022 by Granny_Weatherwax

[TexasProud]

Yep, our small hospital closed. Not profitable.  Impacted our community in a huge way. 

[TechWife]

The news is right - other insurers will not want to pay the hospital and they shouldn’t. If they have any insurance contracts, they are probably contingent on them maintaining their accreditation. If they aren’t, shame on the insurance company. I will be surprised if the hospital makes it through January. Frankly, I’m okay with that. 

The fact that the hospital failed multiple surveys in close proximity is evidence of incompetence that puts patients in danger. They failed, were told specifically, in great detail why they failed and were unable or unwilling to fix the problems. Not only that, before the surveys took place, they knew they weren’t meeting standards - it’s impossible for them not to know as the standards are spelled out and publicly available. I hope the other hospital can expand to absorb the community needs, but at the same time they should not be hiring any administrators or dept. heads from the old hospital and should exercise great caution when hiring anyone else. There are probably competent providers among them, but they are coming from a poor work culture and will need a lot of retraining, support & supervision to make sure bad/dangerous habits & attitudes don’t overtake the  hospital. It should be a scramble for those at the bad hospital to find work. They did not do their jobs. They put patients at risk. They may have harmed patients. Your community has not lost a great resource. They have lost a bad resource, a dangerous resource.

Throw your support behind the other hospital. Go volunteer there. Give financially if you are able. Encourage others to do the same. 

Support the people who lost their jobs by meeting their physical needs and by supporting endeavors to retrain in their existing field or another  field of work. Encourage relocation if necessary. Be a listening ear. 

I’m glad the community has now officially been made aware that the hospital is unsafe. I hope the other hospital will rise to the occasion. I’m sure the administration there is well aware of the opportunity and the responsibility. 
 

Hospitals are entrusted with a great deal when a patient comes through their doors. Many have no say in which hospital they go to. Their very bodies are dependent upon the competence and compassion of those caring for them. They are vulnerable, many are unable to communicate clearly, often they are in shock. The hospital environment is like no other. People are 100% dependent on those taking care of them - everything from medical care right on down to food, water and sanitation. The closest comparison to a hospital would be a nursing home and then perhaps a school. We should never, ever tolerate conditions that put others at risk.
Hooray for the Joint Commission! 

Edited January 1, 2022 by TechWife

[Pam in CT]

Hospitals and outpatient facilities in CT have been consolidating into networks for ~20+ years, and long before COVID one aspect of that consolidation has been the closure of smaller/ less profitable hospitals.  It's terribly disruptive to the affected patients and communities, but -- in a system based on profitability as the US system is -- it is to be expected.

The (immediate) staffing horrors, and (longer term) financial pressures that COVID is layering on top of our already-fragile sector are of real concern.  I'm particularly worried about the consequences in low population density parts of the country, which *already* were less financially viable and *already* had real difficulty attracting and retaining specialist care providers.  Where patients *already* have to travel long distances to get care.  Those are the places where hospital closures will be particularly damaging.

The next round of COVID response public policy has to turn to health sector-wide issues.  It's not enough for the federal government to underwrite the costs for vaccines and rounds of MCAB to individual patients.

[TechWife]

2 minutes ago, Pam in CT said:

Hospitals and outpatient facilities in CT have been consolidating into networks for ~20+ years, and long before COVID one aspect of that consolidation has been the closure of smaller/ less profitable hospitals.  It's terribly disruptive to the affected patients and communities, but -- in a system based on profitability as the US system is -- it is to be expected.

The (immediate) staffing horrors, and (longer term) financial pressures that COVID is layering on top of our already-fragile sector are of real concern.  I'm particularly worried about the consequences in low population density parts of the country, which *already* were less financially viable and *already* had real difficulty attracting and retaining specialist care providers.  Where patients *already* have to travel long distances to get care.  Those are the places where hospital closures will be particularly damaging.

The next round of COVID response public policy has to turn to health sector-wide issues.  It's not enough for the federal government to underwrite the costs for vaccines and rounds of MCAB to individual patients.

Tagging on - It blows my mind that people think hospitals are making out like bandits during Covid. It just doesn’t work that way. They are doing more with less. The pressure this has put on the best hospital systems worldwide is enormous. The US health systems, because of the profit model, we’re frail coming into this. There are so many competing interests in a healthcare model like ours that people simply don’t think through. How are we supposed to entice a hospital system to open a money loosing hospital in a vulnerable area when the stability of the health  system depends on their financial stability? A stand alone hospital cannot stay open anymore - the smaller the hospital, the more critical it is that they be part of a network, just to keep the lights on. It’s not sustainable in these times. The system is breaking. 

[Pam in CT]

re COVID's irrecoverable receivables

4 minutes ago, TechWife said:

Tagging on - It blows my mind that people think hospitals are making out like bandits during Covid. It just doesn’t work that way. They are doing more with less. The pressure this has put on the best hospital systems worldwide is enormous. The US health systems, because of the profit model, we’re frail coming into this. There are so many competing interests in a healthcare model like ours that people simply don’t think through. How are we supposed to entice a hospital system to open a money loosing hospital in a vulnerable area when the stability of the health  system depends on their financial stability? A stand alone hospital cannot stay open anymore - the smaller the hospital, the more critical it is that they be part of a network, just to keep the lights on. It’s not sustainable in these times. The system is breaking. 

This.

The financial avalanche that COVID has dumped onto hospitals hasn't worked its way through accounting cycles yet.

How many households are only just now getting the bills for 3-6 week stays in the ICU?  Some of those patients actually DIED; others are still physicaly unable to work; others have faced job loss; others have faced insurance loss because a family member faced job or insurance loss; some of them never had insurance to begin with.  Many of those who HAVE insurance have staggering deductibles before the insurance kicks in.

Some will enter into multi-year payment plans. Others will struggle, blow off, delay until creditors come after them. Others will lurch toward bankruptcy.

It will take literally years for hospitals to collect partial payment for thousands of patients who spent weeks in ICUs.

Meanwhile the hospitals have had to pay upfront for additional beds, additional equipment, huge hours of overtime for existing overstrained staff, training costs, hiring bonuses and/or additional pay to new/traveling staff, and on and on.

It is only a matter of time before vast numbers of hospitals will be sunk by bad debts.  Without a sector-wide bailout many will have to close.

 

Two years into this: the trope that "hospitals are making out like bandits during COVID" is just yet another redirection of blame.

The problem isn't hospitals. Or nurses. Or teacher unions. Or China. Or South Africa. Or meatpackers. Or the President, former or current. Or port workers or truck drivers or the USPS or Amazon Prime or CDC guidelines or Fauci.

It's a freaking DISEASE. A newly emergent, global, fiendishly shapeshifting, awful DISEASE.

If we can't remember who the real enemy is we will NEVER be able to deal with it. Sigh.

[Granny_Weatherwax]

After reading your replies, all I can say is this is definitely more far reaching and indepth than I expected. I appreciate both of you taking your time to write those responses. I had not thought about all of the implications beyond the surface and now have much to consider.

[Pam in CT]

1 hour ago, Granny_Weatherwax said:

After reading your replies, all I can say is this is definitely more far reaching and indepth than I expected. I appreciate both of you taking your time to write those responses. I had not thought about all of the implications beyond the surface and now have much to consider.

COVID is such a unprecedented scale, interconnected hot mess of global dominoes. Every person and organization and company on the planet has been affected. It's a global case of PTSD.

Except we're not even "post" yet.

[Carol in Cal.]

Where our cabin is is a residential area, not super isolated or anything.

There used to be two hospitals in the county—a county one and an Adventist one.  They were both pretty bad.  Then the county one closed.  That is the only reason the Adventist one is still allowed to be open.  They have a D rating.  They have been cited repeatedly for big care failures.  But they are the last one in the whole area, so super critical, so the state lets them stay open and they refer a lot of patients for transport.  Even when they don’t, a lot of folks drive a long way for care in order to avoid them.

Bottom line—keep a close eye on the other one, and don’t be lulled into thinking that they are good if they aren’t.  Have a back up plan.  Being the only game in town is definitely a mixed blessing.

Edited January 1, 2022 by Carol in Cal.

[Granny_Weatherwax]

The hospital closed.

The last two weeks have been crazy with layoffs - an entire surgical ward was told to pack up and leave as they came in to work. -and transferring of patients. Yesterday, the hospital was locked and all remaining employees were terminated by email. The clinic associated with the hospital declared bankruptcy. People are scrambling to find physicians to take them as patients (my DH included) so medication refills can be authorized and treatments scheduled. The wait time to see a physician at the remaining hospital is months long. New patients are being given a priority, esp those with prescription needs, but the closed hospital records room is locked and nothing is being transferred at this time.

The investigation showed at least one patient died due to low staff numbers and incompetent training (no one could (or would) continue CPR).

My heart aches for our community.

 

[Kassia]

11 minutes ago, Granny_Weatherwax said:

The hospital closed.

The last two weeks have been crazy with layoffs - an entire surgical ward was told to pack up and leave as they came in to work. -and transferring of patients. Yesterday, the hospital was locked and all remaining employees were terminated by email. The clinic associated with the hospital declared bankruptcy. People are scrambling to find physicians to take them as patients (my DH included) so medication refills can be authorized and treatments scheduled. The wait time to see a physician at the remaining hospital is months long. New patients are being given a priority, esp those with prescription needs, but the closed hospital records room is locked and nothing is being transferred at this time.

The investigation showed at least one patient died due to low staff numbers and incompetent training (no one could (or would) continue CPR).

My heart aches for our community.

 

That's awful and so tragic.  😞 

[Starr]

It doesn't seem like a company should be able to close up medical care without having medical records available and prior notice to patients. I'm so sorry.

[TechWife]

1 hour ago, Granny_Weatherwax said:

The hospital closed.

The last two weeks have been crazy with layoffs - an entire surgical ward was told to pack up and leave as they came in to work. -and transferring of patients. Yesterday, the hospital was locked and all remaining employees were terminated by email. The clinic associated with the hospital declared bankruptcy. People are scrambling to find physicians to take them as patients (my DH included) so medication refills can be authorized and treatments scheduled. The wait time to see a physician at the remaining hospital is months long. New patients are being given a priority, esp those with prescription needs, but the closed hospital records room is locked and nothing is being transferred at this time.

The investigation showed at least one patient died due to low staff numbers and incompetent training (no one could (or would) continue CPR).

My heart aches for our community.

 

 

I am so sorry. What tragic mess.

I hope that the state will be able to gain access to medical records so that they can be transferred. You may want to send a letter requesting a complete copy of your husband's (and any other family member who has received services there) medical records to the last known mailing address for the hospital. That way you have record of requesting it and hopefully you will have it on hand when he finds a new provider.

Enlist the pharmacy's help if/when you need Rx refills. By that time, they may have developed a way to get the refills prioritized with the remaining providers.

 

 

[Granny_Weatherwax]

55 minutes ago, TechWife said:

 

I am so sorry. What tragic mess.

<snip>

 

 

It is tragic. Three weeks from the first announcement that Medicare/Medicaid would no longer make payments to the doors being locked. So many people out of work. Others scrambling to find medical care. 

Now that information has been released regarding the death due to lack of CPR while in the hospital, there are so many questions.

[TechWife]

57 minutes ago, Granny_Weatherwax said:

It is tragic. Three weeks from the first announcement that Medicare/Medicaid would no longer make payments to the doors being locked. So many people out of work. Others scrambling to find medical care. 

Now that information has been released regarding the death due to lack of CPR while in the hospital, there are so many questions.

Follow the links here - maybe you will find some answers about what the surveyors saw: 
https://www.jointcommission.org/about-us/facts-about-the-joint-commission/quality-check-and-quality-reports/
 

 

[Happy2BaMom]

I have several hospital-based HCWs in my extended circle of contacts. They are in different areas of the country and all are saying the same thing....the health care system in the US is critically injured, some say in the early stages of collapse. No, not everywhere, but enough everywhere that quality in-hospital care will be the next Holy Grail for many people in many places for at least several years. There are far, far too many highly-experienced hospital staff - nurses, doctors, techs, phlebotomists, CNAs, janitors, you name it - who have left (in one way or another.....including some of those who show up to work every day), there are too many departments in too many places that are dangerously understaffed, and there are way too many big, huge bills that will never be paid by people who ran up multi-million dollar hospital stays. Among other things.

I don't know what the answer is, all I know is that there isn't going to be one coming any time soon. Most unfortunately. And no, the hospitals won't tell you, right up until the day the announcement is made that closure is 3 weeks away.

I'm sorry, OP. That's scary.

[Frances]

3 hours ago, Happy2BaMom said:

I have several hospital-based HCWs in my extended circle of contacts. They are in different areas of the country and all are saying the same thing....the health care system in the US is critically injured, some say in the early stages of collapse. No, not everywhere, but enough everywhere that quality in-hospital care will be the next Holy Grail for many people in many places for at least several years. There are far, far too many highly-experienced hospital staff - nurses, doctors, techs, phlebotomists, CNAs, janitors, you name it - who have left (in one way or another.....including some of those who show up to work every day), there are too many departments in too many places that are dangerously understaffed, and there are way too many big, huge bills that will never be paid by people who ran up multi-million dollar hospital stays. Among other things.

I don't know what the answer is, all I know is that there isn't going to be one coming any time soon. Most unfortunately. And no, the hospitals won't tell you, right up until the day the announcement is made that closure is 3 weeks away.

I'm sorry, OP. That's scary.

Even before the pandemic there were so many issues. Terrible, terrible management that treat staff as disposable, rather than the valuable assets they are. The desire to run so leanly that staff feel almost constantly overwhelmed with too many patients and too much work. Then add covid to to the mix and boom, things start to blow up. And now you have the domino effect of so many staff leaving, especially the experienced ones, that the remaining ones are faced with even worse working conditions than before. Not to mention some of the out of control patients and their family members who still think covid is a hoax, even as they are fighting for their lives.

[Frances]

On 1/1/2022 at 6:21 AM, TechWife said:

Tagging on - It blows my mind that people think hospitals are making out like bandits during Covid. It just doesn’t work that way. They are doing more with less. The pressure this has put on the best hospital systems worldwide is enormous. The US health systems, because of the profit model, we’re frail coming into this. There are so many competing interests in a healthcare model like ours that people simply don’t think through. How are we supposed to entice a hospital system to open a money loosing hospital in a vulnerable area when the stability of the health  system depends on their financial stability? A stand alone hospital cannot stay open anymore - the smaller the hospital, the more critical it is that they be part of a network, just to keep the lights on. It’s not sustainable in these times. The system is breaking. 

The ACA literally saved several rural hospitals in my state. Some of the rural counties had the highest percentage of newly insured patients in the country. But the congressman representing that area was one of the lead opponents of the Act, right up until his retirement. And he was re-elected by wide margins every time. So many people have no understanding of what it takes to keep a small hospital open.

[Frances]

On 1/1/2022 at 5:40 AM, TechWife said:

I hope the other hospital can expand to absorb the community needs, but at the same time they should not be hiring any administrators or dept. heads from the old hospital and should exercise great caution when hiring anyone else. There are probably competent providers among them, but they are coming from a poor work culture and will need a lot of retraining, support & supervision to make sure bad/dangerous habits & attitudes don’t overtake the  hospital. It should be a scramble for those at the bad hospital to find work. They did not do their jobs. They put patients at risk. They may have harmed patients. Your community has not lost a great resource. They have lost a bad resource, a dangerous resource.

 

I completely agree that no administrators or department heads should be hired by the remaining hospital. But based on personal experience with both hospitals and nursing homes, I think you are perhaps placing too much blame on non-management staff. They are often put in terrible situations by management and strive to do everything right by their patients, but are thwarted at every turn by management. I supposed you could say they just should have quit and found work elsewhere, but it’s not always that easy to find a better situation in the healthcare industry. I don’t disagree about the need for retraining, support, supervision, etc.

[Happy2BaMom]

8 hours ago, Frances said:

I completely agree that no administrators or department heads should be hired by the remaining hospital. But based on personal experience with both hospitals and nursing homes, I think you are perhaps placing too much blame on non-management staff. They are often put in terrible situations by management and strive to do everything right by their patients, but are thwarted at every turn by management. I supposed you could say they just should have quit and found work elsewhere, but it’s not always that easy to find a better situation in the healthcare industry. I don’t disagree about the need for retraining, support, supervision, etc.

My cousin (hospital nurse) has a friend at a different hospital. Management there continues to open beds even with no additional staff. Her friend at one point was managing 14 patients herself in MedSurg with no tech (the standard ratio is anywhere from 1:5 to 1:8 *with* a FT tech or assistant). Every single room there is now doubled. Up to 40 people stacked in the ER. No. Additional. Staff. for any of that. Her friend said that they have to hope that no more than one patient codes (starts to die) at a time, because there is no way to attend to a second patient coding. I have no doubt people are dying who might have lived a few years ago. But how much is really the caregivers' fault(s)? Some, undoubtedly. But when caregivers are constantly put in untenable and unsafe situations by management, how much is management's fault?

[TechWife]

8 hours ago, Frances said:

I completely agree that no administrators or department heads should be hired by the remaining hospital. But based on personal experience with both hospitals and nursing homes, I think you are perhaps placing too much blame on non-management staff. They are often put in terrible situations by management and strive to do everything right by their patients, but are thwarted at every turn by management. I supposed you could say they just should have quit and found work elsewhere, but it’s not always that easy to find a better situation in the healthcare industry. I don’t disagree about the need for retraining, support, supervision, etc.

Actually, I do not place blame on non-management staff.  I said that staff applying for other jobs should be looked at "very carefully." because "they are coming from a poor work culture."

Any hospital that is bad enough to get shut down has a poor work culture. Culture is nurtured from the top down. It's likely that the poor management attitudes and practices filtered down through the hospital.  When they go to another hospital, their new employer will not want those poor attitudes and practices to transfer to their organization. Because of that, they  "will need a lot of retraining, support & supervision to make sure bad/dangerous habits & attitudes don’t overtake the  hospital."

I agree that many bad circumstances are created by management decisions and the floor nurses and other providers are doing the best they can in their circumstances. But, that wears on people. It is awful to be overworked, under-resourced and unsupported by management. Continually working in that environment leads to a toxic work culture as the staff simply do what they need to do to survive. It can also lead to less -han-optimal clinical practices, either due to staffing or supply issues, and before long, the "work around" can start to seem normal. That is why I said they "will need a lot of retraining, support & supervision to make sure bad/dangerous habits & attitudes don’t overtake the  hospital." Because, they will. Any other hospital needs to be cautious. That doesn't mean they don't hire people. It means they do so carefully and with consideration. For example, they might want to make sure that there are sufficient experienced employees to mentor the new employees on any given shift before they hire new employees for that shift. All new employees need to be mentored to one degree or another. It would be wise of those hiring the staff from the closed hospital to do so deliberately, with a great deal of attention.

 

Edited January 12, 2022 by TechWife

[TechWife]

31 minutes ago, Happy2BaMom said:

My cousin (hospital nurse) has a friend at a different hospital. Management there continues to open beds even with no additional staff. Her friend at one point was managing 14 patients herself in MedSurg with no tech (the standard ratio is anywhere from 1:5 to 1:8 *with* a FT tech or assistant). Every single room there is now doubled. Up to 40 people stacked in the ER. No. Additional. Staff. for any of that. Her friend said that they have to hope that no more than one patient codes (starts to die) at a time, because there is no way to attend to a second patient coding. I have no doubt people are dying who might have lived a few years ago. But how much is really the caregivers' fault(s)? Some, undoubtedly. But when caregivers are constantly put in untenable and unsafe situations by management, how much is management's fault?

Honestly, right now the system is breaking. It's the system that is at fault. Yes, there are a lot of bad managers making bad decisions, but there are also good managers doing the best they can with what they have, just like the rest of the staff is.

Not enough RN and MD slots in schools.

Not enough MD residencies.

Not enough specialists in many areas of the country.

Smaller community hospitals are no longer viable independently, so decision making isn't always done locally & it may not fit the situation

A lot of MD's employed by hospitals make far less than their peers in private practice, making hospital based practice less attractive, which affects continuity of care as turnover is high.

RN's are underpaid, resulting in the traveling nurse system we have going now. The $$ traveling nurses are pulling down is mind boggling right now. But, they could pay their staff better to retain them and in the end would need fewer traveling nurses. They wouldn't loose money doing it. Areas with multiple hospitals have nurses that work at different systems depending on what the system is offering in the way of sign on bonuses, compensation, placements and shifts. Stay bonuses can help, but that isn't a permanent solution, nor is it viable long term.

RN's are overworked. 'Nough said.

More people need the healthcare system than ever before.

There continue to be supply shortages - different supplies at different times. Right now it's COVID19 tests, at the very least.

Medication costs have skyrocketed.

Not enough hospital beds in the right areas of the country.

Not enough OR's in the right areas of the country.

Same story, different verse. You get the idea...