In 2008, Oak Forest Hospital’s emergency department saw an average of eight patients a day. Of its 213 beds, only 55 to 60 are in use.
The bed count at Provident Hospital has steadily shrunk to 85, and only 60 are in use.
It’s inefficiencies like these, which can mean high operating costs and hefty budgets, that are key in the debate of whether to close Oak Forest and Provident.
Health system CEO William Foley is weighing that move following the partial repeal of the sales tax.
The repeal of one-half percent of the county sales tax increase means the health system is poised to enter 2011 without an estimated $75 million in county funds. Coupled with the loss of $162 million in outside federal funds, officials are bracing for the loss of 1,250 more jobs and the potential loss of services.
They’re unsure what kind of benefits the health system will get from Medicare and Medicaid reimbursement, and the system has grappled with tens of thousands of out-of-county patients, costing it about $50 million a year.
The options are grim, but it would take a lot for county leaders to close two of the county’s three hospitals.
“I don’t see any will on the (county) board to shut down any hospital. Todd Stroger can’t do it on his own. Foley can’t do it on his own, and (health board chairman) Warren Batts can’t do it on his own,” says Commissioner Tony Peraica, a frequent critic of Stroger, the county board president.
Eight patients a day
The questions surrounding the two hospitals point to inefficiencies in staffing and patient loads. According to reports commissioned by the health system, Oak Forest admitted 31,559 patients in 2008, an average of 86 a day. Its emergency department treated 2,180 patients, an average of just eight a day.
Oak Forest takes in about $74.83 million a year, according to figures provided by the Illinois Department of Public Health, but it costs about $91 million to operate.
The the 85-bed Provident has better numbers. It sees more than 400,000 patients a year, about 28,000 of them in the ER. Provident pulls in $99 million, while costing more than $97 million to operate.
While statistically a money-maker, the hospital is often criticized as overstaffed and underused.
Statistics like these have some wondering if the hospitals are worth the cost.
“Granted, (Provident) has some symbolic significance, but I’m not sure it’s worthy of preserving,” says Quentin Young, a longtime fixture on the Chicago medical scene. “You don’t have a vigorous full-service hospital. They’ve failed to establish a vigorous medical presence.”
Even so, Young says, he wants to see the hospitals remain open.
If the hospitals close, it would create a void in the southern part of the county, where Oak Forest is located.
On Chicago’s South Side, where Provident sits, it would be a blow to the black community, which has long claimed the hospital as a point of pride.
Provident first opened in 1891, as the city’s first teaching hospital for blacks.
The hospital closed in the late 80s. It reopened in 1994.
Trimming the fat
Stroger controls the county budget and can propose cuts from any department. The hospital system is perhaps the county's most visible operation, and talk of closing facilities angers labor unions and prompts concerns over patient welfare.
But Laurence Msall, executive director of the nonpartisan Civic Federation says cuts can come from elsewhere in the county, rather than from the health system.
The threat to close hospitals, he says, don’t “seem to be based in any objective financial analyses that conclude the health system should be a top priority,” he says.
“Why would you pick on the health board and say what their cuts are going to be when you haven’t identified” other cuts? he asks.
A recent report supporting a tax rollback issued by the group touts a number of initiatives undertaken by the health board to decrease costs and increase revenue and efficiency, including entering into a money-saving group purchasing organization and eliminating more than 1,000 jobs.
Msall argues the county could stave off health care cuts by reducing tenure-based raises for county employees and privatizing some services, like janitorial work.
County could ‘rival’ rural areas
Despite that, many worry about the fate of the hospitals.
“I think we could see the closure of Oak Forest and Provident,” says Margie Schaps, executive director of the nonprofit Health & Medicine Policy Research Group. “Unless we find some money somewhere, there are going to have to be draconian cuts. They’re going to have to figure out what those cuts are.”
But closing hospitals is a dangerous proposition for the hundreds of thousands of poor and uninsured who use county facilities.
And should more closures happen, "You have a real void that rivals some of rural America,” Young says.
Health system board members are scrambling for answers, and it’s unlikely the fate of Oak Forest and Provident will be known until after the Feb. 2 primaries.
And even as health system leaders prepare for the half-percent rollback, the potential that the full tax could be repealed looms, as Stroger’s Democratic opponents support reducing the tax.
Windy Citizen 