Honolulu based Hawaii Medical Center East in Liliha and Hawaii Medical Center West in Ewa on the Island of Oahu have officially closed their doors after a deal to sell their assets in bankruptcy court to California based Prime Healthcare Services fell through last month. Prime Healthcare's 25 million dollar offer was rejected. In mid December the hospitals abruptly closed their emergency rooms leading to a rapid chain reaction of overloaded emergency rooms in surrounding local hospitals.
The closing left nearly 1000 people without a job. The final patients were transferred out of the facility late Wednesday January 4th, 2012. HMC East had been the state's only transplant center. Another local hospital, Queen's Medical Center, is trying to get certification. These hospitals have apparently lead a troubled past involving previous bankruptcy proceedings. I suppose, like any business, if it can't survive on its own two feet, it doesn't deserve to survive. I'm sure there are many details regarding their failure that remain outside the public realm. In the end, they couldn't pay their bills. Unless you are the federal government, that means you disappear.
I would drop to my knees and cry out loud if I was a hospitalist at any of the other local hospitals in the surrounding community. Those hundreds of beds that disappeared overnight will get absorbed by higher patient census and higher ER volumes in surrounding community hospitals. I can tolerate higher census, for a while. The hospitalist medicine census can be unpredictable. However, to suddenly be responsible for dozens of additional daily patients on an ongoing basis would rapidly lead to increased physician burn out, increased medical errors, decreased efficiency, lower doctor satisfaction, lower nurse satisfaction and lower patient satisfaction.
It's the classic inner city hospital dynamics of too many patients and not enough resources to care for them. And because Medicare is going to start paying hospitals based on patient satisfaction scores, the losers are the hospitals that are most desperately needed by the poorest in our country. CMS is going to destroy access to care by our poor. Their mandates are unfunded. Their expectations are noble but unreasonable realities of the Medicare and Medicaid National Banks failed economics. It can be very difficult for surrounding hospital systems to rapidly absorb the census of two large community hospitals. Heck, these centers were big enough to support a transplant program. We aren't talking about a small critical access hospital here. These were big time programs.
If you need more hospitalists and emergency room physicians to help out at surrounding hospitals, physician credentialing takes time. It just doesn't happen over night. It is a pretty rigorous multi-step process. I'm glad I'm not a hospitalist in Honolulu these days. I'm glad I'm not a resident physician either because I'm either out of a job or I'm struggling to stay compliant with my new intern work hour restrictions as I get bombarded with a much higher daily census.
Ah, so many rules. So many unintended consequences of the regulations. The question I have is how many Hawaii Medical Center hospitals are lurking in the wind just waiting for the opportunity to throw in the towel. With hospital Medicare profit margins razor thin already, it won't take much for hospitals lacking alternative sources of revenue to die a rapid death. No matter how you try and sugar coat patient care, it is a business and it will always be a big business.
