'A hospital may not be able to care for emergency patients if it is restricted to constructing the facilities needed for its Monday through Friday occupancy' Emergencies aren't restricted to weekends'
struction and bed additions, yet according to the American Hospital Association Guide, the greatest cost increases in hospital care have been in New York.
"The assertion that spiralling hospital costs are caused by too many buildings and an excess of hospital beds is a lie," is the flat statement of Wendell Cherry, president of Humana, Inc., a "for profit" hospital company. Cherry's company has built 34 hospitals in the nation since 1968 and now has one under construction in Springfield. "The real cost is not in bricks and mortar," Cherry said, "but in labor."
In sharp contrast to the notion that cutting back on labor expenditures could make significant changes in health care costs is the statement of Casper Weinberger, secretary of the U.S. Department of Health, Education and Welfare. He has said that it is the nation's surplus of 80, 000 hospital beds which contributes most heavily to high patient charges. But Weinberger has given no clear indication as to how this surplus bed count was determined. Some hospital beds, of course, just should not be used. They are housed in obsolescent quarters and are a hazard to the patient. Many more beds are just misplaced.
When is a hospital full?
A city of 100, 000 inhabitants may be
short 125 beds in its metropolitan area,
yet the "regional" plan would list empty
beds in other facilities miles from the
town. Regionalization is of no help to a
patient living in Danville, for example,
who is informed that there is an empty
bed in a hospital in Hoopeston. A Danville physician is not likely to send his
patient to a Hoopeston hospital. It is of
no advantage to an indigent patient in
Chicago to have access to 10 empty
beds in a suburban hospital if the Cook
County facility is full.
Weinberger did not explain that a hospital with 80 per cent of its beds occupied is considered full. Beds that are used Monday through Friday are often empty on weekends, giving a hospital an 80 per cent occupancy rate. A hospital may not be able to care for emergency patients if it is restricted to constructing the facilities needed for its Monday through Friday occupancy. Emergencies aren't restricted to weekends. "The whole situation," Lindsley said, "depends on how many empty beds the community is willing to support." This is one of the thorny problems — among a host of others — which will confront the new board of the CHPA which was created by last summer's legislation.
One section of the new law which may help clarify the surplus bed dispute is the power granted to this board to rule on permits for new health care facilities as well as determining whether existing facilities should remain open or not. In effect, the CHPA Board has the responsibility of getting or keeping health care facilities in the most desirable geographic and demographic locations.
Although the function of the board will be regulatory in nature, it has the backing of professional groups usually opposed to any regulation. Among these are doctors' and nurses' organizations and the Department of Public Health. Where rate controls are concerned, however, the response from some of these organizations has not been favorable. The federal government ended its health cost controls last April. Since then only a subtle form of regulation, through licensing procedures, has been exercised. If a facility does not maintain required standards, a government agency or an insurance company can refuse to pay for patient care in it.
Realistically, it is conceded that the new legislation will not be a cure-all; further refining legislation may be necessary. Lindsley is aware that many problems remain unresolved, especially concerning the construction of new facilities. Here, he said, "It is a case where the 'ins' want to keep the 'outs' out and the 'outs' want in." Investor-owned hospitals, however, characterize the curbs on construction as devices whereby the "ins" can simply preserve the status quo. Private hospitals also argue that they must pay taxes on their income, a circumstance which does not apply to the not-for-profit institutions. These "for profit" hospitals cite their efficient management and use of labor as the instrument which enables them to pay taxes and still operate at a profit.
"The average per diem cost in all the hospitals in the nation," Cherry said, "is $115, while ours is $100. We are able to maintain that cost with no loss of care to the patient because we know how to run a business. Community hospitals employ 3.9 persons per day per patient while we employ only 2.1. On our gross income, we pay an average of seven dollars per patient per day in taxes. Remember," he admonished, "that money goes back into the community."
One of the greatest concerns of the CHPA is that burgeoning facilities will have a cost greater than the one measured in dollars — poor patient care. But the controls provided by the new legislation and the stringent State standards which both private and community hospitals are required to meet to be eligible for payment by third parties, could mean Illinois is heading towards a new era of excellence in health care.
Ultimately, Cherry concludes, "the final jury is the people who use the hospitals. If they don't get good care, they use another hospital."
They could also die.
42 /Illinois Issues/February 1975