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HOME > ABOUT > PRESS > HEALTH CARE LANDSCAPE STILL IN A FOG
Article published - March 16, 2008
Credit: PRESS DEMOCRAT
Health care landscape still in a fog
By Pete Golis
In the showdown between the Sonoma County Board of Supervisors and the Sutter Health system, this was the week in which Sutter blinked. In shelving plans to close Sutter Medical Center in Santa Rosa, Sutter offers a tacit admission that it is better to shoulder the costs associated with keeping the hospital open than to get its butt kicked in a court of law.
The decision means many of the 1,200 employees at Sutter Medical Center will keep their jobs for now. And the decision buys time to figure out a better way to care for uninsured patients, to guarantee emergency rooms are not stretched to the breaking point and to make sure that other services are maintained.
These are gains worth celebrating.
But the announcement doesn't solve the long-term, fundamental problem. It remains that Sutter's local hospital reported losses of $70 million over the last five years, and Sutter's managers will continue to seek ways to reduce those losses by reducing services.
It will be the job of the Board of Supervisors to continue to monitor those changes as it pushes Sutter to honor its contractual obligations.
As if there wasn't enough confusion, the principals now disagree about whether that obligation expires in 2016 or 2021.
As it was when Sutter last year announced plans to close the hospital, this decision leaves many important questions unanswered. In the tangle of legal and financial rivalries, this secrecy may be inevitable. But it isn't helpful for health care providers and consumers waiting to make decisions about their futures.
In the short term, what services will Sutter provide? In the longer term, will Sutter hospital exist? If it does, what kind of hospital will it be? If it remains only to provide for-profit services, perhaps in a surgery center, that arrangement would only increase the burden on other providers, left to manage the costs of uninsured and under-insured patients.
Presumably, Sutter now must decide how to comply with state earthquake safety laws, either retrofitting the existing hospital or building a new one on a site adjacent to the Wells Fargo Center for the Arts. Is Sutter prepared to spend $253 million on a new facility to maintain a business that loses $70 million over five years? That seems unlikely.
Unfortunately, Sutter has been less than forthcoming about what happens now. Officials insist they haven't had time to consider the options under Plan B.
For health care organizations, survival can mean concentrating on services that pay for themselves, hoping others will provide the services that lose money.
One way or another, the health care system in Sonoma County is in the process of reinventing itself. Three smaller hospitals face uncertain futures. As insurance premiums race higher, Kaiser Permanente Medical Center continues to accept more patients, reducing the number of people who seek services at other hospitals. Technology is reducing the number and duration of hospital visits.
In and out of government, local leaders are challenged to find ways to get out in front of these changes, hoping to make the best use of limited resources while reducing the negative impacts on the quality of care.
How can the costs of serving the uninsured and the under-insured be equitably shared? Can we agree to move resources to support community clinics that can provide better care for less money, while reducing the financial burden on hospital emergency rooms?
Fifteen months after Sutter announced plans to close by the end of 2007, these questions remain unanswered. But then, no one ever said the issue was uncomplicated.
"When you say, 'We need to look at the health care delivery system,' it's a very easy sentence with very few words," Supervisor Valerie Brown told me last year. "But the complexity of (the issue) is overwhelming."
In part, Sonoma County is struggling with these issues because President Bush and Congress, and Gov. Arnold Schwarzenegger and the state Legislature have failed to agree on solutions. Schwarzenegger and the Legislature at least made an effort. President Bush seems persuaded that the status quo is good enough.
With Democratic candidates Hillary Clinton and Barack Obama insisting Washington must enact health care reforms in 2009, it will be instructive to see if Republican nominee John McCain tries to separate himself from the Bush administration's stance on health care.
While the long-term future remains in doubt, the Board of Supervisors deserves praise for taking the hard-line approach that forced Sutter to back down, at least for now.
It was neither reasonable nor realistic for Sutter to give county officials and health care providers less than a year's notice to deal with the human impacts of closing a hospital that is more than a century old.
Going forward, the urgency remains, but at least there is more time to manage these changes in a humane way. Whatever happens at Sutter Medical Center, the conversations that begin with last year's announcement need to continue.
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