Critical Issues Facing Hospitals

California's community hospitals provide vital health care and emergency services 24/7.  They also act as a safety net in times of public health concerns like the H1N1 swine flu virus or during times of natural disasters like earthquakes.

While hospitals continue to put their patients and communities first, the growing H1N1 flu pandemic, the recession, the growing uninsured population, and the consistent underfunding of government programs are limiting hospitals' ability to provide care.

Access to vital health care services, including emergency room services, are being jeoparized at a time when we all need it most. Here's a look at some of the critical issues.

This year’s flu season is bound to be severe with both the seasonal flu and the H1N1 Swine Flu virus. In fact, California could be one of 15 states that run out of hospital beds at the height of the H1NI swine flu epidemic, according to a new report titled, “H1N1 Challenges Ahead ,“  released by Trust for America’s Health. According to the report, as many as 180,025 Californians could be hospitalized if 35% of the population contract the novel flu virus and experience serious reactions and other high-risk complications.

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• California’s community hospitals and emergency rooms provide life-saving care to anyone needing it, despite their ability to pay for the health care services received. Last year, California's community hospitals provided more than $11.3 billion of uncompensated care.
   
• California's hospitals are not unique to the negative impacts of the current economic recession. Hospitals are struggling with deteriorating revenues and increases in bad debt and charity care. As a result, hospitals are having to make very difficult choices to reduce services, make staff reductions, or close services altogther.
   
• California's unemployment rate now stands above 11.9 percent, one of the highest unemploment rates in the nation. As more Californians lose their jobs and health insurance, they are relying more and more on California’s ERs for basic health care services.
   
• A new report from Moody's Investors Service says that eighteen months into the recession, the signs of recovery are mixed for certain sectors, including hospitals, that will continue to "face significant polituical, economic financial and capital market uncertainties."

• California has lost more than 70 hospitals and emergency rooms during the past 10 years. As our population continues to grow and age, our emergency rooms are under ever increasing pressure trying to care for all patients who enter their doors.

• According to an August 2009 policy brief published by the Kaiser Commission, hospital emergency rooms across the country and in California are "operating at or over capacity" with an increasing number of patiants seeking care. According to the report, several emergency rooms studied were described as "overwhelmed" or "close to the breaking point."
   
• In 2008, California’s hospitals had nearly 11 million patient visits. Every person entering an emergency room must be seen, despite their health issue or their ability to pay for services. This number is only expected to increase as the regular seasonal flu and H1N1 flu virus affects more Californians, and cutbacks in county mental health services drive more people to the emergency room.

• Every four seconds, someone enters an emergency room in California. The average wait time now is about 4 hours and getting longer. In one large metropolitan area, the wait time in ERs now exceeds 11.5 hours on average.

• California’s Medi-Cal program has been chronically under-funded by the state for many years and continues to rank dead-last in the nation in reimbursement to doctors and hospitals.

• In 2008, California hospitals provided more than $11.3 billion in care that was provided but not paid for. Included in that figure is $3.8 billion in direct losses from inadequate Medi-Cal payments.

• The Medi-Cal program provides vital health care services to our state’s most vulnerable populations. Further cuts will leave more seniors, children and the disabled without adequate coverage and access to care. California’s hospital emergency rooms are becoming the medical office of last resort.

• Hospitals across the state are making good progress in retrofitting and rebuilding efforts to meet the state’s seismic compliance requirements. However, a majority of hospitals (64%) will not be able to meet the looming 2013/2015 deadline. The current national economic crisis and tight credit markets have made it impossible for hospitals to access the necessary capital to make these facility improvements.
   
• More than half of the state’s 430 hospitals are currently operating in the red, with several hospitals on the brink of bankruptcy. In light of these financial challenges and inability for hospitals to access capital, hospitals must be given more time and other reasonable solutions to meet the intent of the seismic safety law. The cost for complying with this unfunded mandate by the state is $110 billion without financing costs.
   
• If hospitals cannot meet the 2013/2015 deadlines, the state will be forced to close these facilities. Closures will likely occur in communities that can least afford to lose another emergency room or inpatient bed. Despite the current tightening of the job market, hospitals and health care providers will need thousands of new workers within the next three to five years. Critical shortages are forecast for clinical laboratory scientists, medical laboratory technicians and nearly 200 other medical professions. These shortages will impact hospitals’ ability to provide patient care.