FORT SCOTT, Kan. — A slight drizzle had begun within the grey December sky outdoors Community Christian Church as Reta Baker, president of the native hospital, stepped by way of the doorways to hitch a weekly morning espresso organized by Fort Scott’s chamber of commerce.
The city supervisor was there, together with the franchisee of the native McDonald’s, an insurance coverage company proprietor and the receptionist from the massive auto gross sales lot. Baker, who grew up on a farm south of city, knew all of them.
About ‘No Mercy’
KHN’s year-long collection, No Mercy, follows how the closure of 1 beloved rural hospital disrupts a group’s well being care, financial system and equilibrium.
Still, she paused within the doorway along with her chin up to absorb the scene. Then, reducing her voice, she admitted: “Nobody talked to me after the announcement.”
Just a number of months earlier than, Baker — becoming a member of with the hospital’s proprietor, St. Louis-based Mercy — introduced the 132-year-old hospital would shut. Baker rigorously orchestrated face-to-face conferences with docs, nurses, metropolis leaders and workers members within the last days of September and on Oct. 1. Afterward, she despatched written notices to the workers and native newspaper.
For the 7,800 individuals of Fort Scott, about 90 miles south of Kansas City, the hospital’s closure was a loss they by no means imagined doable, sparking anger and concern.
“Babies are going to be dying,” mentioned longtime resident Darlene Doherty, who was on the espresso. “This is a disaster.”
Bourbon County Sheriff Bill Martin stopped earlier than leaving the gathering to say the closure has “a dark side.” And Dusty Drake, the lead minister at Community Christian Church, diplomatically mentioned individuals have “lots of questions,” including that members of his congregation will lose their jobs.
Yet, at the same time as this city offers with the trauma of dropping a beloved establishment, deeper nationwide questions underlie the battle: Do small communities like this one want a conventional hospital in any respect? And, if not, what well being care do they want?
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Sisters of Mercy nuns first opened Fort Scott’s 10-bed frontier hospital in 1886 — a time when touring 30 miles to see a physician was unfathomable and when most medical remedies had been so primitive they might be allotted nearly wherever.
Now, driving the four-lane freeway north to Kansas City or crossing the state line to Joplin, Mo., is a day journey that features procuring and a cease at your favourite restaurant. The larger hospitals there supply the newest subtle remedies and tools.
And when sufferers right here get sick, many merely go elsewhere. An common of 9 sufferers stayed in Mercy Hospital Fort Scott’s greater than 40 beds every day from July 2017 by way of June 2018. And these numbers usually are not unusual: Forty-five Kansas hospitals report a mean every day census of fewer than two sufferers.
James Cosgrove, who directed a latest U.S. Government Accountability Office study about rural hospital closures, mentioned the nation wants a greater understanding of what the closures imply to the well being of individuals in rural America, the place the burden of disease — from diabetes to most cancers — is commonly higher than in city areas.
What occurs when a 70-year-old grandfather falls on ice and should select between staying residence and driving to the closest emergency division, 30 miles away? Where does the sheriff’s deputy who picks up an injured suspect take his cost for medical clearance earlier than going to jail? And how does a younger mom whose toddler fell in opposition to the espresso desk and now has a gaping head wound cope?
There can also be the financial query of how the hospital closure will have an effect on the city’s demographic make-up since, as is commonly the case in rural America, Fort Scott’s hospital is a main supply of well-paying jobs and attracts professionals to the group.
As Fort Scott offers with the trauma of dropping a beloved establishment, deeper nationwide questions underlie the battle: Do small, rural communities want a conventional hospital in any respect? And if not, how will they get the well being care they want?
The GAO plans to finish a follow-up research later this yr on the fallout from rural hospital closures. “We want to know more,” Cosgrove mentioned. The report was originally requested in 2017 by then-Sen. Claire McCaskill (D-Mo.) and then-Rep. Tim Walz (D-Minn.), and has been picked up by Sen. Gary Peters (D-Mich.). Here in Fort Scott, the questions are being answered — painfully — in actual time.
At the top of December, Mercy closed Fort Scott’s hospital however determined to maintain the constructing open to lease parts to accommodate an emergency division, outpatient clinic and different providers.
Mercy Hospital Fort Scott joined a rising listing of greater than 100 rural hospitals that have closed nationwide since 2010, in accordance with information from the University of North Carolina’s Cecil G. Sheps Center for Health Services Research. How the city copes is a window into what comes subsequent.
‘We Were Naive’
Over time, Mercy turned a lot part of the group that folks anticipated to see the hospital’s ambulance standing guard at the highschool’s Friday night time soccer video games.
Mercy’s title was seemingly in every single place, actively selling inhabitants well being initiatives by working with the varsity district to decrease youngsters’s weight problems charges in addition to native employers on diabetes prevention and wholesome consuming applications — worthy however, typically, not income turbines for the hospital.
“You cannot take for granted that your hospital is as committed to your community as you are,” mentioned Fort Scott City Manager Dave Martin. “We were naive.”
Indeed, in 2002 when Mercy determined to construct the then-69-bed hospital, residents raised $1 million out of their very own pockets for building. Another million was given by residents to the hospital’s basis for upgrading and changing the hospital’s tools.
“Nobody donated to Mercy just for it to be Mercy’s,” mentioned Bill Brittain, a former metropolis and county commissioner. The level was to have a hospital for Fort Scott.
Today Mercy is a significant well being care conglomerate, with greater than 40 acute care and specialty hospitals, in addition to 900 doctor practices and outpatient services. Fort Scott is the second Kansas hospital Mercy has closed.
Tom Mathews, vice chairman of finance for Mercy’s southwestern Missouri and Kansas area, mentioned Fort Scott’s regular decline in sufferers, mixed with lack of reimbursement — in addition to the rising value of bills resembling medicine and salaries — “created an unsustainable situation for the ministry.”
But Fort Scott is a spot that wants well being care: One out of each 4 youngsters in Bourbon County dwell in poverty. People die a lot youthful right here than the remainder of the state and charges for teen births, grownup smoking, unemployment and violent crime are all larger in Bourbon County than the state common, in accordance with data collected by the Kansas Health Institute and the Robert Wood Johnson Foundation. Ten p.c of Bourbon County’s greater than 14,000 residents, about half of whom dwell in Fort Scott, lack medical health insurance. Kansas is one in all 14 states that have not expanded Medicaid beneath the Affordable Care Act and, whereas many components trigger a rural closing, the GAO report discovered states that had expanded Medicaid had fewer closures.
The GAO report additionally discovered that residents of rural areas typically have decrease family incomes than their counterparts in larger cities, and usually tend to have limitations due to power well being situations, like hypertension, diabetes or weight problems, that have an effect on their every day actions.
The county’s untimely start price can also be higher than the 9.9% nationwide, a quantity that worries Dr. Katrina Burke, an area household care physician who additionally delivers infants. “Some of my patients don’t have cars,” she mentioned, “or they have one car and their husband or boyfriend is out working with the car.”
By practically any social and financial measure, southeastern Kansas is “arguably the most troubled part of the entire state,” mentioned Dr. Gianfranco Pezzino, senior fellow on the Kansas Health Institute. While the well being wants are nice, it’s not clear the best way to pay for them.
Health Care’s ‘Very Startling’ Evolution
Reta Baker describes the farm she grew up on, south of city, as “a little wide place in the road.” She utilized to the Mercy college of nursing in 1974, left after getting married and got here again in 1981 to take a job as workers nurse on the hospital. She has “been here ever since,” 37 years — the previous decade because the hospital president.
It has been “very startling” to look at the way in which well being care has developed, Baker mentioned. Patients as soon as stayed within the hospital for weeks after surgical procedure and now, she mentioned, “they come in and they have their gallbladder out and go home the same day.”
With that, funds and reimbursement practices from authorities and well being insurers modified too, valuing procedures moderately than time spent within the hospital. Rural hospitals nationwide have struggled beneath that components, the GAO report discovered.
Acknowledging the problem, the federal authorities established some applications to assist hospitals that serve poorer populations survive: Through a program known as 340B, some hospitals get diminished costs on costly medicine. Rural hospitals that certified for a “critical access” designation due to their distant areas bought larger funds for some lengthy stays. About 3,000 hospitals nationwide get federal “disproportionate share payments” to replicate the truth that their sufferers are likely to have poor or no insurance coverage.
Fort Scott took half within the 340B low cost drug program in addition to the disproportionate share funds. But, although Baker tried, it couldn’t acquire important entry standing.
When Medicare reimbursement dropped 2% due to sequestration after the Budget Control Act of 2011, it proved traumatic, for the reason that federal insurer was a significant supply of revenue and, for a lot of rural hospitals, the perfect payer.
Then, in 2013, when the federal authorities started financially penalizing most hospitals for having too many sufferers returning inside 30 days, hospitals like Fort Scott’s misplaced hundreds of in a single yr. It contributed to Fort Scott’s “financial fall,” Baker mentioned.
Baker did her finest to set issues proper. To scale back the variety of bounce-back admissions, sufferers would get a name from the doctor’s workplace inside 72 hours of their hospital keep to schedule an workplace go to inside two weeks. “We worked really, really hard,” Baker mentioned. Five years in the past, the variety of sufferers returning to Fort Scott’s hospital was 21%; in 2018 it was 5.5%.
Meanwhile, sufferers had been additionally “out-migrating” and selecting to go to Ascension Via Christi in Pittsburg — which is 2 occasions bigger than Fort Scott — as a result of it supplied cardiology and orthopedic providers, Baker mentioned. Patients additionally ceaselessly drove 90 miles north to the Kansas City space for specialty care and the kids’s hospital.
“Anybody who is having a big surgery done, a bowel resection or a mastectomy, they want to go where people do it all the time,” Baker mentioned. Mercy’s Fort Scott hospital had no cardiologists and solely two surgeons doing easier procedures, resembling hernia restore or eradicating an appendix.
Last yr, solely 13% of the individuals in Bourbon County and the encircling space who wanted hospital care selected to remain in Fort Scott, in accordance with trade information shared by Baker.
There had been no sufferers within the hospital’s beds throughout one weekend in December, Baker mentioned, including: “I look at the report every day. It bounces between zero and seven.” The hospital employed 500 to 600 individuals a decade in the past, however by the point the closure was introduced fewer than 300 had been left.
That logic — the monetary want — for the closing didn’t sit properly with residents, and Mercy executives knew it. They knew in June they might be closing Fort Scott however waited till October to announce it to the workers and town. City Manager Martin responded by shortly assembling a well being activity power, insisting it was “critical” to ship the precise message concerning the closure.
Relations between Mercy and town grew so tense that attorneys had been wanted simply to speak to Mercy. In all, Fort Scott had spent greater than $7,500 on Mercy Closure Project authorized charges by the top of 2018, in accordance with city records.
Will Fort Scott Sink With No Mercy?
When Darlene Doherty graduated from Fort Scott High School in 1962, there have been two issues to do on the town: “Work at Mercy or work at Western Insurance.” The insurance coverage firm, although, was offered within the 1980s, and the employer disappeared, together with practically a thousand jobs.
Yet, even because the group’s inhabitants slowly declined, Martin and different group leaders have stored Fort Scott vibrant. There’s the brand new Smallville CrossFit studio, which Martin attends; a brand new microbrewery; two new gasoline stations; a Sleep Inn lodge, an assisted dwelling heart; and a Dairy Queen franchise. And the McDonald’s that opened in 2012 simply accomplished renovation.
The city’s largest employer, Peerless Architectural Windows and Doors, which supplies about 400 jobs, purchased 25 extra acres and plans to increase. There’s state money promised to increase native highways, and Fort Scott has utilized for federal grants to increase its airport.
Roxine Poznich, proprietor of Books & Grannies in Fort Scott, Kan., was a 27-year worker of Mercy Hospital in Fort Scott. She misplaced her job when the hospital closed and now manages her bookstore full time. She was additionally a most cancers affected person on the hospital and now should drive about 50 miles to Chanute for chemotherapy remedies. (Christopher Smith for KHN) Fort Scott fills up on weekday afternoons as locals seize pizza, go to a coffeehouse or browse vintage outlets and a bookstore. Like different rural communities, the industrial areas embody empty storefronts. (Christopher Smith for KHN) An empty Price Chopper grocery store sits lower than a mile from the now closed Mercy Hospital in Fort Scott, Kan. The Price Chopper, which had a preferred salad bar and employed practically 50 individuals, introduced its closure seven days after the hospital closed. (Sarah Jane Tribble/KHN) The Fort Scott National Historic Site was one of many first navy outposts constructed because the U.S. frontier expanded westward. It is a key vacationer attraction in Fort Scott, Kan. (Christopher Smith for KHN) Fort Scott fills up on weekday afternoons as locals seize pizza, go to a coffeehouse or browse vintage outlets and a bookstore. Like different rural communities, the industrial areas embody empty storefronts. (Christopher Smith for KHN)
Baker and among the physicians on Mercy’s workers have been busy making an attempt to make sure that important well being care providers survive, too.
Baker discovered consumers for the hospital’s hospice, residence well being providers and first care clinics so they might proceed working.
Burke, the household care physician, signed on to be a part of the Community Health Center of Southeast Kansas, a federally certified nonprofit that’s taking on 4 well being clinics operated by Mercy Hospital Fort Scott. She must ship infants in Pittsburg, which is sort of 30 miles away on a largely two-lane freeway that has building employees slowing visitors as they work to increase it to 4 lanes.
Burke mentioned her observe is full, and she or he desires her sufferers to be taken care of: “If we don’t do it, who’s going to?”
Mercy donated its ambulances and transferred emergency medical workers to the county and metropolis.
And, in a tense, last-minute save, Baker negotiated a two-year take care of Ascension Via Christi hospital in Pittsburg to function the emergency division — which was closed for 2 weeks in February earlier than reopening beneath the brand new administration.
But she is aware of that too could also be only a patch. If no purchaser is discovered, Mercy will shut the constructing by 2021.
This is the primary installment in KHN’s year-long collection, No Mercy, which follows how the closure of 1 beloved rural hospital disrupts a group’s well being care, financial system and equilibrium.
Sarah Jane Tribble: firstname.lastname@example.org”>email@example.com, @SJTribble