Where Do Hospitals Go To Die?

Medicine was always my first love/passion. I adored learning about how the body worked, and what happened when it did not. This, however, was much to my mother’s dismay because I would rattle on about something I had just observed, read, or seen at the supper table which she found to be unsettling or “gross” and highly inappropriate for her daughter to be discussing probably at all, but certainly not at the table. She never quite got used to this tomboy daughter of hers.

I did wind up in medicine although not as the large animal vet that I had envisioned growing up. (Didn’t have the grades for that.) I became a Medical Technologist and subsequently a Laboratory Manager. I’ve worked for large urban hospitals, small town hospitals, one itty bitty rural hospital, and several physician practices. It’s all been challenging and educational. No two places are exactly the same, but they all share a lot of things in common.

Things they share:

• They all operate on the brink of disaster, and no, they are not kidding. It sounds like a lot of money coming into the place when you get your invoices, but they have tremendous amounts going out, too. Astounding what it costs to run a business in healthcare.
• Personnel costs are their main issue. I’m not talking about the physicians, per se, because as a rule, they bill out separately. I’m talking primarily nursing staff, but also the “ancillary staff” (pulmonary techs, radiology techs, laboratory, physical therapy, occupational therapy, social workers, various patient advocates, chaplains, psych workers if they have them, etc.), facility staff (housekeeping, maintenance, security, kitchen, laundry, materials and purchasing) as well as administrative (C-suite, financial, admissions, medical records, human resources, etc.) For each patient bed, there are anywhere from 20 to 150 people working to keep the place open and functioning. It’s an army. And it runs 24/7/365.
• Ever since Medicare, and later Medicaid, came into being, the reimbursements have been steadily DECREASING. That means less money coming in for those patients. Here’s the catch with that: PRIVATE insurance bases their reimbursements on whatever Medicare is doing. So if Medicare reduces their reimbursement from say $15 to $12.50, they will, too. Here’s another catch: MediCAID never pays as much as MediCARE does. So if they’re paying $12.50, they will only pay $10. (I’m making these figures up. Don’t think they are real.)
• Because of the steadily shrinking reimbursement rates, hospitals started shrinking the number of beds they maintained. For example, one of the hospitals I worked in closed down an entire floor of beds. That meant they could reduce expensive nursing staff all the way down to the janitors. Nobody seemed to miss the bed numbers. Then it merged with another hospital. That merger meant that a new building was built, but the number of beds total of the two shrank yet again. Nobody noticed. Until the pandemic hit. Then the entire county woke up and wondered where nearly 300 beds had gone. I’ll tell you where they went. Reimbursement cut backs and they are not coming back.

This is the hard economic truth of Kemp’s policy of not expanding Medicaid to very low income people. If they do not have the means to pay the high cost of healthcare, then they have to resort to staying home and “making do” on their own. Their chances of dying go way up. The hospitals simply cannot AFFORD to offer care to that many people who cannot pay their bills. There is some money for ‘indigent’ care, but it usually runs out by June. After that, the hospitals and doctors provide care out of their own pockets. Sooner or later, those pockets are emptied out.

Kemp seems to think that the healthcare system has bottomless resources. It doesn’t.

Kemp is a very wealthy man who doesn’t worry about how to pay his bills. But these people do, and they need to have hospitals there to take care of them. Does he care at all? Certainly doesn’t seem to. Stacey Abrams does.

Medicaid money is already available. All he would have to do is sign the paperwork. It is MILLIONS of dollars and would bring new jobs to Georgia as well as save rural hospitals. Why won’t Kemp do it? Hard-hearted? Doesn’t care? Maybe even cruel? He certainly doesn’t have Georgia’s interest at heart.

I want Wellstar West Georgia Medical Center to remain open and serving the people of west Georgia. I want the hospitals in Columbus to continue to operate. But most of all, I want the hospitals in Warm Springs to continue to offer community service and to be able to upgrade their abilities. Rehabilitation is a tremendous asset to all in this area. But so is the ability to provide urgent medical attention.