One in three hospitals will close by 2020
By John Graham
April 3rd, 2012
I just read a disturbing article on KevinMD.com written by David Houle and Jonathan Fleece and entitled, Why One Third of Hospitals Will Close by 2020. My assumption was the loss of hospital would be due to the enactment of the Affordable Care Act (ACA). In part, that was the case but the substance of the article says that, because hospitals will be forced to publish their rates of infections and outcomes of care, people will choose the hospital with the best care and bankrupt the remaining institutions. These hospitals will close their doors because people have gone elsewhere.
I must say as a physician I understand the reality of what the report is saying — that entering a hospital can be dangerous to your health. The statistics they quote are devastating — over 100,000 deaths a year in hospitals due to errors of one kind or another. What is amazing to me is why all hospitals don’t make changes in care to prevent the errors from happening. If airlines had this kind of death rate, they would be shut down by our government.
Yet, some hospitals do make a great effort to put safety at the forefront. They have checks and balances in place to minimize the chance of injury to patients. The major hospitals in Hoston that I have visited all make great efforts for safe care with zero tolerance as their goal. For many smaller hospitals that is not true. And, I have actually shuttered when I witnessed the potential for errors on my visits to such institutions. The article says we are not to worry, the poorer institutions will soon be out the door.
But, there is a chavet the authors do not mention, a red-Herring, a fly in the ointment. The catch is that the finest Tier-One Trauma/medical centers in our nation are sent the worse cases. Their outcome rates may be lower than other institutions simply because they are treating the sickest patients. Often, patients are referred to the finest institutions when the patient is near death. The referring hospital doesn’t want the patient to die in their institution, so they refer the sickest patients out. This has been going on for decades — the best hospitals treat the sickest patients.
Which makes me wonder if the statistics are going to be truly helpful. And, it is possible our finest hospitals will be forced to refuse to accept patients from other institutions. Knowing a patient is critically ill and that he or she may die, they may refuse to accept the patient who will adversely affect their statistics. I can see that happening — hospitals doing whatever is necessary in order to keep their success rates up and to keep their doors open.
When you are critically ill you need the best facility. But, what if the ambulance takes you to a nearby outlying hospital and that hospital decides they need to transfer you to the larger facility — and what if that hospital refuses to accept you (because you didn’t come through their door first). This likely will be happening more and more in the future. Hosptials will be closing their doors to the sickest patients so their statistics will be acceptable to the federal government (for reimbursement purposes) and acceptable to patients, as well.
Then, will we be any better off? I doubt it.