Another reason for a broader approach to healthcare planning

Massachusetts. Steward Health Care, a private firm that owns hospitals and other care facilities in multiple states, and 9 in Massachusetts, is in danger of going out of business, putting thousands of people out of work, and making health services much harder to obtain ("Steward Health Care’s financial issues could spell catastrophe for the state" and "Steward’s medical devices were repossessed. Weeks later, a new mother died," Boston Globe).  Bills have been left unpaid for as much as one year.

One of the reasons the company is in financial distress is that the real estate ownership was separated from hospitals, so they have to pay big rent bills, on which they are behind.  When hospitals own their real estate they don't have to pay rent.

While various elected officials are talking receivership, they haven't already developed such powers, making quick action difficult.

Rural hospitals are going out of business at a high rate leaving many communities without close by medical care ("Saving Rural Hospitals - The Crisis in Rural Health Care," "Rural Hospitals Are Shuttering Their Maternity Units," New York Times), or getting bought up by private equity.  From the article:

More than 100 rural hospitals have closed over the past decade, and more than 600 additional rural hospitals — 30% of all rural hospitals in the country — are at risk of closing in the near future. Rural hospitals are at risk of closure because they lose money delivering services to patients. In the past, many hospitals have received grants, local tax revenues, or subsidies from other businesses that offset these losses, but there is no guarantee that these funds will continue to be available or sufficient to cover the higher costs hospitals are experiencing. Millions of people could be directly harmed if these hospitals close.

Although one issue with rural hospitals is that they perform fewer procedures, meaning their care may not be as good as busier hospitals.

Chicago.  There's a great article about Mercy Hospital in Chicago, which was owned by a private sector firm, which intended to close it ("The Left-for-Dead Hospital That Got a Second Chance for $1," Bloomberg).  It ended up getting bought by an innovative private health care firm based in Flint, Michigan, for $1.  But it was touch and go for awhile.  And has had a hard time recovering because a lot of staff left during the period when the original owner said the hospital was closing.  And even while it was negotiating the sale, it was closing programs, and the new owners are struggling to restore them.

Delaware County, Pennsylvania.  Crozer Health has been closing hospitals in Pennsylvania, and has failed to execute various attempts at being acquired by better funded entities (" Cash-strapped Crozer Health turns to Temple and Jefferson for help maintaining services," ). It's owned by private equity too.

Philadelphia.  A few years ago Hahnemann Hospital, which served the city's neediest closed, after being acquired by private equity ("Philly's tough hospital market - not greed - did in Hahnemann," Inquirer).  But like with Mercy Hospital in Chicago, it's hard to keep a hospital open when it serves low income patients who are either uninsured or on Medicaid and Medicare, which pay much less for care compared to private insurance.

A piece in the Guardian discusses the difference between working in a private hospital versus a public hospital with few private insurance patients ("‘At the private hospital, the disrespect was just more subtle’: a tale of America’s two healthcare systems").

Idaho News 2 ICBS) photo.

Idaho.  Intermountain Health, a multi-state nonprofit that has been acquiring or merging with other systems at a break neck pace, is closing a multi-location medical practice it bought.  At this point, the 11 location Saltzer Health set of clinics and facilities are likely to close without finding a buyer ("Intermountain Healthcare to close or sell Saltzer Health locations in the Treasure Valley," KTVB-TV).

Receivership is a way to take over hospitals in financial distress.  But you need procedures and potentially financing in place in order to pull it off.  But as the Mercy article points out, governments have been trying to get out of the hospital business because it is so costly.  Getting back in is the last thing they want to do.  Ideally, the federal government could step in as a backstop, but this is very difficult considering Republican opposition to public support of health care ("The Congressional Republican Agenda: Repealing the Affordable Care Act and Slashing Medicaid," White House).  Extending government involvement is the last thing they want to do.

Scenario planning and monitoring.  The provision of health care is extremely important to local, state and federal governments.  Given the precarious state of so many health care institutions, the rising participation of private equity ("What Happens When Private Equity Takes Over a Hospital," Harvard, "Private Equity Investments in Health Care May Increase Costs and Degrade Quality," Columbia), to be ahead of the problem, governments need to engage in much closer monitoring and developing contingency plans to be able to step in as needed.

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Interestingly, while I go to a privately owned hospital, another hospital owned by the same company faces closure over quality of care issues ("Conditions at Asheville’s Mission Hospital pose ‘immediate jeopardy to patients’ health and safety,’ state investigators report," North Carolina Health News).

There are some interesting journal articles suggesting private hospitals could do more community-related programming that they don't typically do, but is done by nonprofit hospitals.