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Traffic dips at Stroger Hospital
Hospital closes wing as admissions fall, putting revenue at risk

Monday, June 18, 2007
Crain's Chicago Business
by Mike Colias


A striking decline in the number of patients admitted to John H. Stroger Jr. Hospital prompted the closing of an entire wing at Cook County's flagship health care facility for the first time since it opened five years ago.

Last month's closure of a 26-bed ward would have been unthinkable as recently as last year at the city's busiest hospital, where patients lying on gurneys clog the bustling emergency room, awaiting an open room upstairs.

The decline means the loss of vital revenue and complicates efforts to turn around the financially ailing county health system. It also raises public health concerns: Patients who normally fill those beds could be forgoing medical treatment for ailments that could later morph into more severe health problems that cost more to treat.

"This is the first time we're not bursting at the seams," says Robert Simon, interim chief of the county's Bureau of Health Services. "It's a major concern because I don't think these patients are getting access to care elsewhere."

Dr. Simon admits that the county's efforts to cut costs may have played a part in reducing the number of patients at Stroger. He says a torrent of bad publicity from the recent closure of about a dozen walk-in clinics around the county and layoffs of more than 1,000 doctors, nurses and other staffers across the three-hospital system has made patients leery. Others may have been scared off after the health bureau, in a bid to bring in cash, recently began mailing tens of thousands of past-due medical bills, Dr. Simon says.

The closure of those clinics, which refer patients to Stroger, hasn't impeded traffic to the Near West Side hospital, Dr. Simon says, noting that most of those facilities were lightly used and accounted for just 5% of all 25 clinics' total volume.

Regardless, the county is losing revenue on empty beds. Dr. Simon says the hospital is trimming labor costs by shifting staff to other wards. But that must be weighed against the money those services could generate, says Stephen Skinner, a Boston-based consultant who works with large public health systems.

"The risk is that you save a little money, but you sacrifice longer-term revenue," Mr. Skinner says.

TRAILING FORECAST

The health bureau already is running millions of dollars behind its revenue forecast for this fiscal year (Crain's, June 4), which ends Nov. 30. Coming up short could force more service cuts or firings to meet next year's budget, barring an infusion of cash from the state or federal government. The health system accounts for almost a quarter of Cook County's $3-billion budget this year.
 
The empty wing holds 11% of Stroger's 228 beds in its medical-surgical wards, its core service. (Counting intensive care, pediatric and birthing, Stroger has a total of 438 beds.) The wing could be quickly staffed again should demand snap back, Dr. Simon says, though he won't predict how long that would take.

The average number of patients on a given day at Stroger for the four months ended May 31 was 316 — off considerably from the 353 average from 2003 to 2006, according to state and county data.

Several high-ranking members of Stroger's medical staff also express concern over the effect on patients who have received the past-due bills. The vast majority of those mostly uninsured patients should qualify for steep discounts or waivers based on income. But Stroger is woefully short of staff to process the patients' forms, so they keep getting collection notices.

Dr. Simon says he hopes to borrow $25 million or to get that amount from state or federal agencies to hire more staff and buy software to fix the billing problem. He also plans to freeze billing to uninsured patients until it's straightened out.

In the meantime, it's hard to say where patients are going or whether they're seeking care at all. Officials at several nearby hospitals say they've seen no noticeable effect.

But Mount Sinai Hospital, less than two miles from the Stroger campus, has seen "some patients migrate away from county and come here to use our emergency department" in recent months, CEO Alan Channing says.

"They were scared and didn't think they'd be able to get services over there," Mr. Channing says. "They've started voting with their feet."



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