This message is paid for by Healthy Hospital, Healthy Community PAC
Putting aside the appropriateness of the sign in front of Teton Orthopedics urging members of our community to obtain their MRIs at St. John’s Medical Center, several issues are raised by Krista Novak’s Aug. 29 Guest Shot.
Across America independent community hospitals are in crisis. A recent report documents more than 70 closures over a six-year period, with almost 700 hospitals at risk for closure. The most powerful predictor of closure is profitability, as reimbursements have declined, particularly in states that have not expanded Medicaid. The problem is particularly acute in Wyoming, which has the second highest cost of health care per capita in the US. We in Jackson are fortunate that St. John’s Medical Center has remained independent, maintaining financial stability while receiving high ratings nationally for the quality of its service.
St. John’s and other hospitals are able to achieve financial stability only by a complicated balancing act, as both public and private insurance programs reimburse some medical services at much lower rates than other.
Thus income from services that operate at a profit (such as imaging, surgery, laboratory) is used to fund other services (nursing homes, obstetrics, family medicine and pediatrics) that are essential to the health of the community but operate at a loss.
That strategy is put at risk when profiteers, aligned with local physicians, come into a community to set up high-reimbursement, free-standing private services. These clinics siphon off dollars from the hospital that would be otherwise used to support unprofitable but much-needed care for the community.
Faced with this “healthy competition,” hospitals are forced to cut back services or buy out the competitor under terms that profit the investors and increase the hospital’s expenses even further. Just such an outcome has occurred in both Casper and Rock Springs, where the introduction of unnecessary but profitable specialty facilities have significantly hurt the ability of the hospitals to meet community needs.
Numerous studies show that excess imaging capacity in a community leads to more scans and more profit without necessarily improving health care. That is particularly true when physicians with a financial interest in the clinic order the testing. This problem has led many states to adopt laws that require the demonstration of medical need in the community before the introduction of new and expensive imaging equipment through private clinics. Unfortunately, Wyoming legislators have not passed similar laws.
To justify the need for additional MRI capacity in the Jackson community, much has been made of the fact that Teton Sports and Spine Imaging has a 3.0 Tesla MRI (St. John’s is a 1.5) and that this is a quality issue. However, research has shown that higher power, more expensive MRI scanners are rarely needed for optimal medical care. Indeed, equipment manufacturers have said the need for higher-powered MRIs is very limited. Their routine use thus only raises costs (and profits), rather than improve medical outcomes.
Quality of imaging is based upon many factors. MRIs are complex machines that are difficult to set up and maintain. A critical issue in obtaining quality images is having radiologists on-site to oversee the development and maintenance of the necessary complex inputs for each type of scan. Although the Teton Sports and Spine Imaging radiologists are well trained and capable, they are not on-site. Moreover, to get the most accurate interpretation of the images it is almost imperative for the ordering doctor and radiologist to review the pictures together to add the patient’s history and physical finding to the discussion. At St. John’s, that’s easy; the radiologists are on site and local.
Machines take the pictures, but it is the radiologist and ordering physician talking to each other that makes the difference in quality. At St. John’s the local doctors and radiologists work together every day and learn each other’s style, thus enhancing communication. Patients who have their MRI done at St. John’s get a significant benefit: They can meet with the radiologist, look at the images together and discuss their MRI. That’s incredibly valuable and reassuring.
Fortunately, one does not have to wait days to get an MRI scheduled at St. John’s. In fact, the availability is remarkable compared with other communities.
I have the utmost respect for Krista Novak as a clinician and all that she has brought to our community over the years. So too, as she stated, we are very fortunate to have highly skilled physicians in this community. Those who choose to compete with the hospital, even though they derive a significant part of their income from work they do at St. John’s, are doing our whole community a disservice.
It is time, as Krista points out, that the medical community comes together, to plan for the inevitable difficult future and work collaboratively for the people of Teton County.
