Debate: 02/13

Running out of patients

Good Sam is closing;
what can Dayton do about it?

Q: Should Dayton government get involved and possibly challenge the closing of Good Samaritan Hospital?

By Sarah Sidlow

The federal government isn’t the only thing shutting down in 2018. Good Samaritan Hospital, part of the Premier Health family based on the northwest side of Dayton, will close its doors by the end of the year. And unlike the government’s, this shut down looks permanent.

Premier says it’s no longer sustainable to operate two hospitals—Good Samaritan and Miami Valley Hospital—within five miles of one another. No doubt, changes in the national landscape of health care have also played a role in the health network’s decision.

Premier Health, which employs a whopping 14,000 people in the Dayton region, has said it is committed to finding new jobs in the Premier network for approximately 1,600 of the Good Sam workers who will be affected.

So what will the site become? That’s still up for discussion: over the next few months, Premier will welcome community input about what will become of the Good Sam site.

Some of that community input is coming in the form of political involvement. The topic has become a central point of debate in the Ohio gubernatorial race.

Last week, Ohio congressman, former presidential candidate and democratic gubernatorial hopeful Dennis Kucinich joined the crowd of protesters outside Premier Health headquarters to rally against the hospital’s closure. Kucinich has also pledged to consult with attorneys in both Ohio and Washington, D.C. to see if there are ways to keep the hospital open.

At the heart of the issue for protesters like Kucinich is the notion that access to healthcare is being taken out of an area that desperately needs it. To argue that another hospital is just five miles away, they say, is to ignore the fact that five miles makes a huge difference to folks who don’t own a vehicle and instead must walk or catch a bus. Moreover, they claim, this is just the latest example of disinvestment in Dayton’s west side, a historically African-American area which for years has been marked by higher crime and financial turmoil.

Their point: access to health care should be a universal right not determined by financial status. And that, many argue, makes it an issue for lawmakers.

Yet for others, business is business—and its course shouldn’t be subject to the meddling of lawmakers or political hopefuls.

Mary Boosalis, Premier Health president and CEO, has said in local interviews that she both respects and understands the range of opinions that result from a decision like this one. But, she says, closing the hospital was the only reasonable option. In an exclusive interview with the Dayton Business Journal, Boosalis cited overbedding (that is, more beds than patients) and infrastructure costs as two major factors in Good Sam’s closing.

And what can Dayton lawmakers do about that? Unless the City is capable of ponying up the funds to keep Good Sam’s doors open, many argue they don’t really have a place at the table in these sorts of business conversations.


A Not So Free Market

We have an obligation to save
Good Samaritan Hospital

By Dave Westbrock, MD

Regarding the closing of Good Samaritan hospital, I will at the outset admit a bias. Not only was I born there, but my mother, Mary trained as a nurse with many of the Sisters of Charity religious order who later were in the administration of Good Sam.  She was head of the delivery room very early in the history of the hospital and later founded the women’s auxiliary and in 1961 became the first director of volunteers.  I had two jobs there as well as surgeries.  That having been said, it is true that Good Samaritan hospital is different and in a different era than when I spent many formative years in lower Dayton view.  The population is far different now than then, but it was and is now an integral resource for the community. Many Americans look at communities as having essential anchors to the identity and needs of its members.  Every community requires basic services such as police stations, fire stations, churches and, yes, a hospital.  Communities large and small have anchors that give them identity and safety.  In upper Dayton View, Good Samaritan hospital is one of those few anchors upon which locals can depend. 

It is true that private hospitals, even those designated as non-profit, need to make business decisions to ensure their future ability to serve their patients and their community as a whole.  I have been a member of the active medical staff and now emeritus of Miami Valley hospital for 40 years.  In that time I have seen a change in the culture and attitudes of hospital administrators.  When I began my practice, Dr. Sutton knew his obligation was to serve the citizens of the community and the medical staff in the delivery of quality health care.  Hospitals have now become empires, aspiring for ever larger numbers of hospital beds spreading to ever expanding demographics.  What used to be extensions of religious bodies, Good Samaritan and St. Elizabeth (Catholic), Miami Valley (Methodist), Kettering Memorial (Seventh Day Adventist) whose mission was to serve both rich and poor have now become profit centers without community shareholders. 

Most physicians who previously regarded themselves as clients of the hospital now serve as employees and most administrators command multi-million dollar salaries and bonuses for ever expanding building projects.  If both Miami Valley and Good Samaritan have only 50% occupancy, where does the fault lie?  Was Premier Health Partners forced to build a 12 story tower when nationally hospital bed utilization is declining?  The greater Dayton area is experiencing a building boom in emergency room facilities to compete with the trend of a gas station on every corner in the 1950’s. The simple answer is money.  Hospitals are subsidized by taxpayer dollars and local tax levies that result in as much as 5-10 fold higher prices for services that could be performed in a private physician office practice.  Insurers generally follow Medicare pricing and accept these higher prices and no demonstrable greater quality.  Ask yourself what it costs for an MRI at the local hospital facility when a private facility in Cincinnati charges $600.

Over the past several weeks many groups and political figures have weighed in on this matter, myself included.  You need to know that citizen business groups (The Salem Avenue Peace Corridor), local citizen groups and churches are actively challenging this decision.  One gubernatorial candidate threatened a lawsuit and citizen rallies are happening.  What most citizens of this great valley will find out is that there is more to closing a hospital than they realize in regard to charters and covenants.  Closing the doors involves not only local decisions, but those made both nationally and, in this case, internationally.   

A hospital, then, is an essential resource of a community and now, in most cases highly sustained by Medicare and Medicaid.  The hospital is then a contractor involved in a public-private arrangement.  This is unlike most businesses, even those highly involved in government contracting. As a free market capitalist, I am opposed to government interfering in lawful legal arrangements in business.  Health care has not been a free market for many years.  Government funds two-thirds of the health care economy and controls virtually every aspect of medical practice, and costs rise quickly with the advent of Obamacare and Medicaid expansion.  Medicaid now consumes 50% of Ohio’s budget. In that regard, as quasi-governmental agencies, hospitals are tax-free non-profits who have an obligation to their communities as corporate citizens which extends to more than just sponsoring sports stadia and the arts.  Their mission is to address the health needs of the community and when they fail by disappearing from a neighborhood in need, they have lost their sense of mission.  “We will improve the health of the communities we serve with others who share our commitment to provide high quality, cost-competitive health services.”(Premier Health’s Mission, Vison and Values).  I only ask, where is the commitment and at what cost?


Stop the Financial Bleeding

Government interference would risk
more hospital closures

By Don Hurst

Ohio governor wannabe Dennis Kucinich’s misguided plea to Dayton city officials to sue Premier Health over the closure of Good Samaritan Hospital strengthens my view that politicians need to stay out of health care. Not only does the government not have the right to force a private company to keep its doors open, but the government doesn’t possess the requisite expertise to dictate how a hospital should conduct business. 

Even though Premier Health is a non-profit that provides a needed service, at the end of the day it is a company that requires revenue to survive. Medical staff salaries cost money. Building operations cost money. Providing that legally mandated free emergency room care to everyone who comes through the door costs money. Without adequate income, a hospital cannot remain open.

I’m sorry if that sounds basic, but Kucinich seems to have slept through Economics 101. This notion that if only Premier cared enough about the community somehow Good Sam wouldn’t have to close is completely divorced from reality.

Politicians and the NAACP have framed the decision as an attack against minorities, but the truth is Premier has operated Good Sam at an unsustainable financial deficit for at least two years. The facility is over 80 years old and requires more than $90 million annually to keep the hospital up to building codes, according to Premier’s CEO Mary Boosalis. Add in operating costs and salaries, and it takes over $100 million a year to keep Good Sam’s doors open. I’m not an economist, but that seems like a lot of cash.

Where does that money come from? It doesn’t come from the City of Dayton, the State of Ohio or the NAACP. It comes from hospital stays and keeping the beds filled to near maximum capacity. According to the Dayton Business Journal, Good Sam has operated at half census since 2016. Half the hospital beds are empty on a regular basis.

Earning $100 million just to break even seems difficult. Losing half of your customers makes it just about impossible.

Bad things start to happen to staffing when bed counts fall too low. Nurses float to unfamiliar hospitals where they are too busy learning where this unit keeps its blood pressure cuffs to provide their best care to patients. That’s if they’re lucky. Census drops enough and medical staff have to stay home, earning drastically reduced paychecks. 

The math doesn’t support keeping Good Sam open, especially since Premier operates Miami Valley Hospital, which is just five miles away. Miami Valley can easily absorb Good Sam’s load since it is also running at half capacity. For those keeping track at home, that means Premier owns two hospitals within a ten-minute drive of each other but only enough patients to fill one of them.

Despite both hospitals hemorrhaging money, Kucinich’s solution is to force Good Sam and Miami Valley to remain open. Keep to that course and Dayton will lose two hospitals instead of one. Running them both into bankruptcy, and sacrificing both facilities and their employees for the sake of political correctness defies logic. 

The claim that local residents will lack medical treatment is disingenuous at best, and deliberately misleading to gain free publicity at worst. To those who say that the five-mile trek between Good Sam and Miami Valley is too daunting, don’t worry. Kettering Health Network’s Grandview Hospital is just 2.4 miles away according to Google. For more routine medical issues the Five Rivers Health Center will remain open at the Good Sam campus. So there are options. People are not going to lose access to health care.

Some in the media and government have cast Premier Health as a racist villain callously sentencing minorities to die in the pursuit of profits. However, the company seems committed to alleviating the pain the closure could cause. Premier plans to level the vacant buildings so the lot is shovel-ready for new owners. They are also donating $10 million for redeveloping the lot into something more beneficial to residents than a half-empty hospital.

Premier Health is only responding to the realities of its environment. Patients don’t stay in the hospital as much as they did 80 years ago. Advances in technology have reduced major surgeries to same day outpatient procedures. High deductible health insurance plans encourage patients to opt for less expensive treatment options than bear the weight of the hefty hospital stay price tag. 

Specifically in Good Sam’s situation, nearby population numbers have decreased, meaning they have less customers. People are fleeing the area. That’s not a Premier Health problem. That’s a Dayton problem.

Politicians and community leaders are shoving each other out of the way to get their faces on the news cameras to show the world how their hearts bleed for the poor people affected by the closure. Overblown hysterics do not solve the underlying problem of a depressed economic area. Instead, they should examine the causes of disinvestment from northwest Dayton. Closing Good Sam is not the disease – it’s a symptom. 

Premier Health is not a racist company shrugging off the complaints of minorities. Math is color-blind. No amount of social justice warrioring can close the gap between 50 percent capacity and $100 million a year. Residents will understandably feel uneasy watching a community fixture close, but I’m sure the staffs at Grandview and Miami Valley Hospitals will welcome them with open arms.

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Reach DCP editor Sarah Sidlow at SarahSidlow@DaytonCityPaper.com.

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