Evolve or shut down. That’s the harsh reality for community hospitals as they face an ever-changing health care environment, threatening their bottom lines. It’s a national crisis from which the North Bay is not immune.
“There’s a host of challenges that all hospitals face but particularly these small, independent hospitals,” said Jan Emerson-Shea, vice president, external affairs at the California Hospital Association. “Some of these hospitals file bankruptcy, some shut altogether, some are able to go to local voters, and some affiliate with larger health care systems that have the ability to keep them open and provide them access to capital.”
The financial picture for small hospitals is “precarious at best,” she said. “Our state MediCal program is one of the worst payers in the nation—hospitals only receive 60 cents on the dollar for care provided to the patient.” Medicare is a little better at roughly 80 to 85 cents on the dollar for those patients, she said.
Rethinking, reinventing: Sonoma Valley Hospital
So far this year, 75-bed Sonoma Valley Hospital, in Sonoma, has closed its obstetrics unit and transferred ownership of its home health care facility. It is currently in the process of evaluating the future of its skilled nursing facility, according to Kelly Mather, president and CEO at Sonoma Valley Hospital.
“It’s become clear that a community hospital can no longer try to be all things to all people, but must refocus on essential community needs,” Mather said. “We’re all facing the same issues.”
The challenge now is to find new ways to evolve, as well as strengthen the services traditionally most in demand from community hospitals—robust emergency room services and expanded outpatient care services, she said.
One of SVH’s moves this year was finalizing an affiliation agreement with the University of California San Francisco Health to create an integrated health network. The two entities have long had a working relationship. Under the new agreement, UCSF is providing its expertise, resources, and a new medical director for SVH, according to Mather.
“We plan to be the Diagnostic Center for UCSF patients in the North Bay with our new affiliation, and already attract patients from outside the district for pain management and other procedures,” Mather said.
In September, SVH transferred ownership of its home-health care service, Healing at Home, to Hospice by the Bay, a regional not-for-profit organization and UCSF affiliate. The transfer took effect Oct. 1, according to SVH.
The hospital is currently in the process of determining the future of its skilled nursing unit, which cares for patients who need less than acute care. The skilled nursing unit has a projected $880,000 operational loss for fiscal year 2019. The hospital’s board in August approved a task force to evaluate the facility’s future.
Options on the table include transferring the service to a nearby standalone skilled nursing facility, outsourcing clinical staff or closing it altogether, said Jane Hirsch, chair of the task force. There have been several public meetings and there will be another one in the near future before a decision is made next year, she said.
There are no further moves planned for the foreseeable future, Mather said. “These are the only service lines that are losing money.”
“Every hospital makes those types of determinations and they’re tough,” Emerson-Shea said. “It’s very hard when you’ve offered a service such as OB for a long time. It feels like a loss to the community when those business decisions have to be made.”