The South Florida Hospital & Healthcare Association (SFHHA) is 69 years old. And, no, I haven’t worked here the whole time.But I have perused the minutes for meetings of the Boards of Directors and found that problems, issues and challenges come and go; rise and fall in the list of day to day priorities. Some are universal and repetitive. One current item, however, is at an unprecedented level of acuity. Declining use rates for inpatient care are actually jeopardizing the financial stability of hospitals nationwide, including here in South Florida. It’s a tough story to tell, and understandably doesn’t get a lot of sympathy from patients, payers or the government that funds so much of the health care continuum.
You see, the good news is we as a population are doing a good, or at least better, job at staying out of hospitals. We wear seat belts and helmets. We watch what we eat. We go to the gym. Even those of us boomers with chronic conditions religiously take our medication. And then there’s technology. The miracles of modern medicine mean that we can test for almost every medical condition. Early identification means less drastic treatment, which itself usually means some other computer assisted technological device or procedure, or some regimen of newly discovered pharmacology on an outpatient basis. In other words, most medical care today doesn’t require an overnight stay in an acute care hospital. In fact, a decade or more ago, doctors started doing a lot of what had been hospital outpatient procedures in their own offices, or independently owned free standing facilities. Since what goes around, comes around, now the hospital members of SFHHA are all building and running these facilities in satellite locations; affiliating them with the hospitals and employing the physicians and other health professionals it takes to staff them. A goal, of course, is another source of revenue to make up for the decline in inpatient days.
So just like our member hospitals, SFHHA has competing goals. While the hospitals are expanding their outpatient portfolios, they are also aggressively marketing those services and departments that treat the remaining patients who really do need to stay in a bed. Cardiac Care, Cancer Centers, Orthopedic Practices, Stroke Centers, Trauma Programs, and Transplant Services have become the focus of fierce competition. While this Association wouldn’t contemplate ever supporting one facility over another, certain risks to proficiency and quality are related to excess capacity and underutilization. Not to mention that unit price goes up when volume goes down. Telling this story is a double-edged sword for any organization that wants to maintain its integrity and its membership. These trends, lower utilization and duplication of service, are unavoidable realities, and the right sizing of the health system isn’t likely to happen any time soon. As the hospitals’ association, we must help them prepare for a sustainable future. As their community advocate, we must educate the policy makers and the public. These roles and goals are occasionally in conflict. To remain another 69 years, balance becomes the imperative. It’s why we’re here to stay. Please let us know what we can do better.
