Did the University of Chicago sacrifice patient care for profit?

The University of Chicago Medical Center is under the national microscope, with a recent death in their emergency department’s waiting room, and an alleged, inappropriate transfer of a patient needing surgical care.

Blogging over at MedPage Today, Shadowfax gives a more detailed look at their indiscretions.

With margins are already well above the national average, the hospital has decided to double down on profits, by limiting hospital beds available to the emergency department, and concentrating on revenue-generating services like oncology and surgical subspecialties.

I’m sure that if they could shut down the emergency department, a drain on most every hospital, they would.

It’s quite eye-opening how blatant they are in limiting care to the community, and now, federal regulations are taking a closer look. Repercussions, aside from the public relations hit they are taking, could be severe, including Medicare pulling its certification from the hospital.

So, in trying to stem the financial bleeding from emergency care, the University of Chicago is providing a template on how not to do it.

Comments

John
Can CMS “force” any providing hospital to expand inpatient facilities that aren’t captive to other missions of the hospital, like providing oncolgy and surgical support services, for the benefit of patients needing admission from the ER? Does any hospital have unlimited capacity to do so? And when you imply that the ER is being denied access to inpatient beds set aside for other purposes, are you saying that E.D. admissions are more important than an oncology admission? Or a post-surgery admission? (Are those not also missions of the hospital?) Are you saying that there should be some requirement of a ratio of annual visits to average number of inpatient beds? Are you implying that–since this is an average–that the number of beds lower than average relative to outpatient visits is bad and that a number greater is somehow good?
It sounds as if the problem isn’t the number of inpatient beds but rather the number of E.D. beds, not just in UCMC but in downtown Chicago, if what you say is true, that the patients are dropping dead in the E.D. waiting room. It sounds as if the triage efforts need revising, or that there aren’t enough stretcher-side services, and that the mid-level fast-track isn’t really the issue. And it sounds as if the problems of this E.D. aren’t all that much different from any other urban hospital where people come to the E.D. for non-emergent care. I guess it’s nice that the medical center can show a net operating gain in revenues; that is better than a loss, and even “non-profit” institutions cannot sustain net losses as a standard for ongoing operation. The urban landscape is littered with examples of hospitals that tried that; they end up in memories of grey-haired people and as sites for new condo buildings.
My take home isn’t that UCMC is bad because it doesn’t build the E.D. to suit the demands of the “community,” whatever those are, or that it doesn’t let their emergency department decide the operations strategy and staffing for the rest of the hospital over the needs and requirements of other departments or that it doesn’t forget that one of the requirements of ongoing operations is that you generate enough revenue to pay your bills, whether they be to pay for “missions of excellence” or not.
Beating the institution with the billy club of EMTALA because they aren’t a supply of unlimited hospital inpatient beds for patients presenting to an overtaxed E.D. is just profoundly stupid, but it is a typical regulators response of using sanctions while ignoring the global realities of financial limitations to any enterprise. This response smacks of typical toxic theater of outrage, played out in the media and resulting in the usual suspects being paraded before investigators. And the outcome will be predictable.
Is it any wonder that specialty hospitals have become so common?
David
John,
What an excellent series of questions and what a well-written comment overall.
I was wondering, are there a lot of speciality hospitals today? There don’t seem to be many in my region (Washington D.C.) but I know that there was a moratorium on opening them for a time. I think specialty hospitals are indeed the natural reaction to this problem and would, myself, want to work in one if it was available.
John
Well, in NYC, there are some well-known examples: Memorial Sloan-Kettering and the Hospital for Special Surgery. There are cardiology-specific hospitals in many other cities, specializing in interventional cardiology and cardiothoracic surgery.
Poor Washington. Gone is D.C. General. Gone is Capital Hill Hospital. Gone is Columbia Hospital for Women. Georgetown University Hospital was sold under distress to MedStar who have picked its bones, removing cardiology and cardiothoracic surgery to their own facility. Greater Southeast has been beaten senseless, passing through receivership after its receivables broker went bust and the city reneged on its obligations to pay for the public care dumped on that hospital after D.C. General closed. Providence Hospital, over in Brookland, a facility I admired for its commitment to its neighborhood and the city has been punished for its trouble.
Washington Adventist in Takoma Park has tried to carve out a cardiology specialization. Holy Cross Hospital in Silver Spring is trying to attract seniors to its E.D., wisely realizing that they have insurance and that the E.D. for the senior crowd is an important access point for paid admissions.
Anonymous
I am a physician. My in law was treated at U of C for cancer. The care was, hands down, the worst I have ever experienced. And when he died from iatrogenic causes? They didn’t have a chaplain, patient relations or even Kleenex in the room for the grieving family – and their chief concern was how quickly could we get his body out of the room so they could use it. Sickening. I am glad they are getting the shame they deserve.

Did the University of Chicago sacrifice patient care for profit?

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