By Polly Keary, Editor
If the levy fails, will the hospital close?
That’s a question that’s arisen more than once on social media pages in recent weeks.
The answer, according to new Valley General Hospital CEO Eric Jensen, is that failure of the levy could mean long term financial woes that might jeopardize the future of the hospital.
That is not a given, just a possibility, but there are other implications of the levy failure that are more certain, and that is that some services will have to be reduced or eliminated. What those are isn’t yet clear, said Jensen.
“If the levy fails we will cut some service; cutting inpatient services is a possibility, but which exact cuts is a whole different topic,” he said. “We’d have to look at a variety of things. We’d need to look at imaging, what would happen if we cut that, and we’d have to look at inpatient surgery.”
The problem with reducing inpatient surgery is that it could challenge the hospital’s ability to maintain its trauma service designation.
“There are five levels of designation,” said Jensen. “Level 1 is Harborview. There are only a couple of Level 2s in the state. Providence is level 3. We are level 4, and a lot of that depends on physician coverage.”
In order to be a Level 4 trauma center, a hospital has to have 24/7 surgery coverage. And that requires at least two surgeons, as one person can’t be on call 24 hours per day. But if the hospital doesn’t have inpatient surgery that is non-emergency, it would be difficult to keep two surgeons around, said Jensen.
“We have to have surgeons that can maintain a practice,” he said. “If they can’t keep inpatient surgery here, they may not have enough business to do any surgery here, and they may not be on call for us.”
But without a Level 4 trauma service designation, and without 24 hour surgery available, ambulances would sometimes take some patients out of the area that otherwise could have been seen in Monroe.
“Level 4 trauma is where we take patients that need to be stabilized before they go somewhere else, because they have more resources than an ambulance,” said Kurt Schneider of Fire District 3 in Monroe. “If they aren’t there, say you are coming from the pass or even Monroe, generally a more significant goes to Harborview. Say they need critical things like blood and Valley isn’t there, that patient just does without.”
That’s not the worst of it, said Jensen. He remembers a case in the remote Olympic Peninsula town of Forks, where he was CEO of the hospital, in which the availability of emergency surgery saved a young man’s life.
“We had a couple teenagers shooting at a shed with explosives in it and it blew up. One kid was killed and the other kid had most of his leg severed, and if we hadn’t had a general surgeon he would have died. But we clamped it and the kid survived,” Jensen said.
Having a hospital nearby that can perform some surgeries can be important, said Merlin Halverson, Chief of Fire District 5 in Sultan.
“Obviously, the more quickly we can get a patient to a surgeon the better off that patient is going to be,” he said. “If they lose their ability to have surgeons there, in many cases that’s not going to be good.”
Trauma patients have what is called a “golden hour,” said Halverson.
“It’s a theory that people who need emergency surgery for trauma need to get that within an hour in order to preserve their lives,” he said.
When emergency workers prepare to take an injury victim to medical care, they call the on-call doctor at Valley General, Halverson explained. That doctor considers the severity of the injury and the resources available at the various hospitals in the area and makes a recommendation about where that patient should go.
If it is a cardiac patient that needs a specific kind of care called a cath lab, the doctor typically directs the patient to Providence. If the patient needs surgery that can be done at Valley, then the patient goes to Monroe. If the patient is very seriously injured, that patient may need to go to Harborview. But sometimes that patient needs to stop at Valley on the way to get stabilized.
“Losing any of Valley would be bad for us,” said Halverson. “It would extend transport time for patients.”
Determining exactly how to deal with the failure of the levy would require some thorough studies, said Jensen. But it doesn’t make sense to invest the time and money into those studies unless the hospital knows they are needed, he explained.
The money from the levy, which would equal about $2.2 million per year, would go directly into Maintenance and Operations, which is basically the checking account for the hospital. It would go to pay salaries and bills, buy supplies and address the other expenses of day-to-day operations.
Currently all but $60,000 of what the hospital collects in taxes goes to pay off improvements to the hospital, including the emergency department. The hospital has more than 10 years to go on those payments.
EvergreenHealth is not going to back out of the affiliation should the levy fail, said Bob Malte, CEO of EvergreenHealth, which affiliated with VGH at the start of the year.
“Our partnership with Valley General Hospital was not based or predicated on the levy consideration,” he said.
But the levy outcome will affect what the affiliation can accomplish, he elaborated.
EvergreenHealth is a public, taxpayer-supported hospital, as well, which means it can’t just give Valley General money. But it did pay $1 million up front for five years’ rent for space in the Sky River Medical Center in which Evergreen doctors, including primary care doctors, could practice.
Also, Evergreen and VGH can more easily refer patients back and forth, streamline service offerings and avoid duplications, share the cost of medical supplies, share staff and expertise and more. Currently VGH is leasing from EvergreenHealth the services of a chief nursing officer, among other lead staff.
Ultimately, some specialists and an increase in primary care doctors are expected to come to Monroe from EvergreenHealth, which is in Kirkland. It is the services that VGH can offer that will be impacted by the levy, Malte said.
“The results of the levy vote will have implications on the current services available at the hospital and new expanded services that would support the community’s needs,” he said. “The role of the Valley General Hospital’s Board of Commissioners and their leadership team will guide the organization’s decisions in the future. EvergreenHealth will partner with them on strategic initiatives to support patients receiving the safest and most satisfying experience at the best value.”
The worst case scenario, should the levy fail, is that the hospital could eventually fold, Jensen said.
Cutting inpatient care entirely isn’t feasible, he said.
“There’s no such thing as an outpatient hospital,” he said. “A hospital is defined by Medicare, and Medicare defines a hospital as a medical facility that accepts inpatients, and if you aren’t a hospital you don’t get provider-based payment.”
What that essentially means is that all insurance providers, not just the government ones, determine what they pay based on whether the entity providing services is a hospital or not.
Outpatient facilities like those operated by hospitals such as Evergreen and Swedish are only able to bill as hospitals because they are wholly owned and operated by inpatient hospitals, said Jensen. The affiliation with Evergreen doesn’t count, as that isn’t an ownership deal.
So if it becomes financially impossible to provide inpatient services, it may be impossible to maintain a hospital at all.
That would leave the Sky Valley without an emergency room or inpatient beds, as Providence’s new $20 medical clinic, under construction at North Kelsey, won’t include those things.
Last year the hospital lost $4.6 million. The levy would pump $2.2 million in; Jensen, who took over the helm of the hospital Jan. 31, believes the rest of the shortfall can be addressed through efficiencies resulting from the affiliation, improved billing and other internal processes, and streamlining operations at the hospital, among other things. A turnaround plan is in the works.
Ballots are due on the levy Tuesday, April 23. The levy would cost the average homeowner an additional $54 per year.