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Chicago Tribune | Section 1 | Wednesday, April 15, 2015
FOCUS HEALTH CARE
WHEN HOSPITALS
HIT THE ROAD
Poor communities are feeling deserted as more facilities move to wealthier areas
By Phil Galewitz |
BELLEVILLE, Ill. — Nearly as old as the railroad that slices through this southern
Illinois city just east of the Mississippi River, St. Elizabeth’s Hospital has been a downtown
bedrock since 1875.
Started by three nuns from a Franciscan order in Germany, the Catholic hospital still
seeks “to embody Christ’s healing love” to the sick, the aged and the poor, according to its
mission statement. It is so tied to the city that when the local economy slumped in 2009, the
Like a small but growing
number of hospitals around
the country, St. Elizabeth’s
is taking a radical step:
Hospital officials plan to
close the 303-bed hospital
and move elsewhere. They
are seeking state approval to
build a $300 million facility
7 miles northeast, in O’Fallon, a wealthier city that is
one of the fastest-growing
communities in the St. Louis region — with new subdivisions, proximity to a
regional mall and quick
access to Interstate 64.
Describing plans to leave
behind some services, such
as a walk-in clinic, St. Elizabeth’s Chief Executive Officer Maryann Reese insists
the hospital is not abandoning the city or the poor.
But that’s exactly how
many residents, community
leaders and clergy see it. If
St. Elizabeth’s leaves downtown, they say, it will limit
care for many poorer residents, especially those dependent on public transportation, and lead to overcrowding at the city’s one
other hospital, which is
downsizing. Many also
worry about the loss of jobs
and of the daily visitors to
the hospital who patronize
local shops and eateries.
“This ... only serves the
narrow interest of St. Elizabeth’s profit picture,” Belleville police Capt. John
Moody II wrote in a scathing letter about the plan to a
state review board. “There
is too much at stake and the
loss will be catastrophic,
and I fear unrecoverable.”
Hospitals have moved to
follow population migrations before, but such relocations are becoming more
common. That’s partly due
to the aging of facilities built
in the 1950s and 1960s and
partly to the need to attract
better-paying patients. A
2012 Health Affairs study
found that hospitals in 12
markets used geographic
expansion strategies, including building new hospitals or adding free-standing
emergency departments, to
“capture” well-insured patients.
“Where you choose to
place new facilities almost
always involves moving to
an area where there is a
substantial privately insured population,” said Paul
Ginsburg, chairman of medicine and public policy at
the University of Southern
California.
Hospital relocations are
planned or underway in
South and Central Florida,
eastern Tennessee, central
Georgia, Birmingham, Ala.,
and northeast Ohio. Some
have stirred controversy, as
in Belleville:
■ Just west of Fort Lauderdale, Fla., HCA, a forprofit hospital chain, plans
to close Plantation General
Hospital and open a new
hospital 7 miles away in
wealthier Davie, near a
medical school.
“It’s all about greed,” said
Plantation Mayor Diane
Bendekovic. When HCA offered to keep some outpatient services in town, she
told them: “Don’t throw
Plantation any crumbs.”
■ Tennova Healthcare is
moving its flagship Physicians Regional Medical
Center near downtown
Knoxville, Tenn., closer to
higher-income suburbs 8
miles west.
“Clearly ... they want to
be near the better zip
codes,” said Tony Spezia,
CEO of Covenant Health,
owner of Fort Sanders Regional Medical Center,
which will become the last
general hospital downtown.
Tennova is owned by forprofit Community Health
Systems.
Kaiser Health News
nonprofit St. Elizabeth’s gave $20 to every employee to spend on Main Street, sending
hundreds of shoppers out to the mostly mom and pop-owned stores.
But St. E’s, as locals call it, now faces its own financial troubles, partly due to the costs of
maintaining an obsolete facility and also to the growing numbers of low-income and
uninsured patients from Belleville and neighboring East St. Louis, one of the poorest cities
in the Midwest.
DERIK HOLTMANN/BELLEVILLE NEWS-DEMOCRAT
Like a small but growing number of hospitals, St. Elizabeth’s in Belleville, Ill., is planning to move to a wealthier location to ease financial troubles.
ZIA NIZAMI/BELLEVILLE NEWS-DEMOCRAT 2014
Describing plans to leave behind some services, such as a walk-in clinic, St. Elizabeth’s
CEO Maryann Reese insists the hospital is not abandoning the city or the poor.
■ Just outside Cleveland,
Lakewood Hospital in
Lakewood, Ohio, which is
managed by the Cleveland
Clinic, is slated to close in
2016, and patients will be
directed to the Clinic’s
newer Fairview Hospital 3
miles away or to another
facility being built in Avon,
13 miles away. Fairview and
Avon are in higher-income
areas. Lakewood officials
say losing the hospital and
its 1,000 employees could
have a prolonged impact.
Hospital officials point to
their aging, landlocked facilities and argue it is cheaper to build rather than
renovate.
What they don’t say publicly is how geography is
often economic destiny for a
hospital, especially at a time
of increasing financial pressure as a result of Medicare
funding cuts, including penalties that may result from
new pay-for-performance
measures in the Affordable
Care Act.
By moving to wealthier
areas, hospitals can reduce
the percent of uninsured
and lower-paying Medicaid
patients, while increasing
the privately insured —
what hospitals refer to as
attracting better “payer
mix.” That’s also why they
locate outpatient centers
and medical offices in affluent suburbs. But relocations
DERIK HOLTMANN/BELLEVILLE NEWS-DEMOCRAT 2014
Belleville Mayor Mark Eckert, right, believes St. Elizabeth’s
officials “are definitely running from the poor.”
often spark anger from
those left behind, who
worry about loss of jobs and
of access to care.
When the hospitals are
nonprofits, like St. Elizabeth’s, questions loom larger because they are ex-
empted from taxes in exchange for providing benefits to the community.
“Hospitals were established in inner cities where
the greatest needs were and
now, essentially, that charity
obligation has gone by the
wayside as they are looking
at their bottom line,” said
Gerard Anderson, director
of the Center for Hospital
Finance and Management
at the Johns Hopkins
Bloomberg School of Public
Health.
Even nonprofit hospitals
want to be near wealthier
residents. “You move to
where the money is,” he
said.
That doesn’t sit well with
Belleville Mayor Mark Eckert, who was born at the
hospital, drove an ambulance there when he was a
teenager and now lives
three blocks away. He fears
the move will devastate the
downtown economy and
make it more difficult for
some people to get care.
“They are definitely running from the poor,” he said.
St. Elizabeth’s officials
deny that, noting that only a
quarter of their patients
come from Belleville and
the new site will be closer to
the majority who live in
other communities, including eight of the 10 poorest
zip codes.
“Being more centrally located will also make care
more accessible for everyone, regardless of income,”
the hospital said in a statement.
Rival Memorial Hospital,
located a few miles from
downtown Belleville, challenges those assertions, saying the plans don’t consider
the impact on people who
depend on public transportation. Memorial,
though, is also targeting the
more affluent population
east of the city — building a
second, 94-bed hospital in
Shiloh, also just off the
interstate and a five-minute
drive from the proposed site
for St. Elizabeth’s. State
officials approved that facility in 2011 over the objection of St. Elizabeth’s,
which contended there was
no need for it.
Today, most of St. Elizabeth’s operates out of a
60-year-old building that
they say is difficult for many
people to get to because of
one-way roads. In addition,
patient rooms are too small,
and the waiting area for the
emergency room is
cramped. Though the hospital considered locations in
Belleville, it settled on 114
acres of farmland it bought
in O’Fallon in 2011 as a site
to build a facility with 144
beds.
St. Elizabeth’s lost $10.5
million on $148 million in
revenue in 2013, according
to its latest audited financial
statement. That same year,
Springfield-based Hospital
Sisters Health System,
which owns St. Elizabeth’s
and 13 other hospitals in
Illinois and Wisconsin,
made $168 million on nearly
$2 billion in revenue.
“Where you
choose to place
new facilities
almost always
involves moving
to an area where
there is a substantial privately
insured population.”
— Paul Ginsburg, chairman
of medicine and public
policy at the University of
Southern California
None of these arguments
have convinced Monsignor
John Myler, rector of St.
Peter’s Cathedral, across
from the hospital.
“It is contrary to Francis
to ask those in need to travel
to him,” he wrote in opposition to the plan. “Rather
Franciscans are — and have
been for centuries — right
among the people, not in a
well-to-do place asking the
people instead to come to
them.”
A state commission is
expected to hold a hearing
and a vote on the proposed
move April 21.
Kaiser Health News is an
editorially independent program of the Kaiser Family
Foundation.