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Fewer Patients Visiting Hospitals, Clinics

May 06, 2009
BCBR Article Fewer patients visiting hospitals, clinics By Ryan Dionne April 17, 2009 -- BOULDER -- Personal computers will remain slow, carpets won't be replaced and expansion projects won't begin, but administrators of hospitals in the Boulder Valley said they won't skimp on quality of care. Like many businesses throughout the country, hospitals here are feeling the effects of the economy. The main difference: They have to take care of their customers whether the customers can pay or not. "When they need health care, we're still there for them," said John Sackett, president and chief executive officer of Avista Adventist Hospital in Louisville. And while health-care providers have uncollected charges every year from people who can't pay their bills, this year is different. Most area hospitals have either seen an increase in the number of people who can't pay their bills, or they have treated fewer patients. And many of the patients they see have more severe problems. "The fact of the matter is we're seeing sicker patients," said Neil Bertrand, Longmont United Hospital's chief financial officer. "I think people are putting things off until they absolutely have to." As companies shed workers many people lose their health insurance, which means higher out-of-pocket expenses. Some are then forced to choose between putting food on the table and negating their pain. Many choose food. That leaves hospitals struggling with providing the best quality care to patients while coping with less revenue, which in turn affects employees, equipment, renovations and more. "It's certainly a balancing act," said Boulder Community Hospital spokesman Rich Sheehan. Compared to previous years, Boulder Community, Avista Adventist and Longmont United hospitals in addition to Exempla Good Samaritan Medical Center have experienced weaker revenue than was originally projected. While none would release exact figures, each has seen the number of patients decline. To cope, the four area hospitals have made many changes to help stretch funds. Carson said he and his staff have made various changes that are expected to save $2.8 million this year. The hospital has reduced employee retirement savings account contributions, longevity bonuses, cut back on travel and meeting expenses, cancelled some employee events, put capital expenditures on hold and held off on renovation projects. They're not alone. Exempla Good Samaritan is working to decrease its utility bills, Boulder Community is renegotiating supply contracts and Avista Adventist temporarily cancelled administrative raises to have money for other employee raises. All four hospitals are delaying certain equipment purchases that won't drastically impact patient care. Whether it's a digital mammogram machine, an intravenous fluid pump or an X-ray machine, hospitals are delaying large purchases as long as the equipment still works well. "We want our hospital to be state-of-the-art no doubt about it," Sackett said. But he added that state-of-the-art doesn't always make financial sense. However, every medical facility is committed to patient care regardless of price. So surgical equipment and other imperative expenditures are not being sacrificed. "Patient safety is No. 1," Sackett said. Every day hospital executives are reviewing expenses to find ways to cut costs, and many have turned to their employees for suggestions. "The list of suggestions is just pages and pages," said Dave Hamm, Exempla Good Samaritan Medical Center's chief executive officer. And all executives said the majority of their staffs are willing to make some changes in order to keep their jobs or prevent co-workers from losing theirs. Though the executives are optimistic the economy will take a turn for the better, they're not yet out from under the dark cloud. Boulder Community Hospital has seen the number of inpatients decline for 10 consecutive months through February. Longmont United Hospital has seen the number of indigent patients increase starting last September. Exempla Good Samaritan Medical Center has also seen indigent care increase. Avista Adventist Hospital has seen a 10 percent drop from average in number of patients. However, a local specialty hospital, The Children's Hospital in Broomfield, hasn't been hit as hard as many general hospitals. "We're just starting to feel the effects of the economy," said Len Dryer, The Children's Hospital's senior vice president and chief financial officer. In a recession, parents often take their children to the hospital more frequently than they do themselves, so economic conditions typically impact children's hospitals later than other medical facilities, he said. Also, kids don't have as many elective procedures, such as knee replacements. Typically, they are either sick or they're not. However, like the other area hospitals, Dryer said The Children's Hospital has drastically decreased travel and training budgets, decreased employees' annual raises, put renovations on hold and examined where staff can be more efficient. Even insurance companies are examining budgets, despite some, like Kaiser Permanente Colorado and Anthem Blue Cross and Blue Shield of Colorado, experiencing growth. One insurance trend is that more people are obtaining individual coverage plans, said Lew Emanuelson, Anthem's vice president of large group sales in Colorado. Those individual coverage plans often cost less, but they cover less, have higher deductibles and lower maximum payments than other plans. And they have to be renewed every six months. With the recession more widespread than many in the past, more industries and more workers are impacted making it harder to pay for health care. But unlike many other industries, health care has one major advantage, Dryer said. "The one thing we have is people still get sick," he said. "You've got to be there for them when that happens." Contact writer Ryan Dionne at 303-440-4950 or e-mail rdionne@bcbr.com.