Cleveland’s MetroHealth will thrive (not die) amid healthcare reform

Mark Twain’s quip that “news of my death was an exaggeration” sums up my reaction to the article on MetroHealth: “Healthcare reform’s impact: Farewell to public hospitals like MetroHealth.” The speculation that it’s all over for MetroHealth is wrong for three reasons.

First, MetroHealth’s Board and management team have demonstrated an ability to manage the organization to deliver the mission at break-even or better financial results. MetroHealth has run in the black since 2008 after a decade with seven years of losses. More importantly, MetroHealth delivered 200,000 uncompensated visits in 2010, up 25 percent since 2008, demonstrating our commitment to mission. We use margin to do mission!

Second, MetroHealth’s mission will never make an attractive acquisition target. As a public safety net hospital almost 20 percent of our care is uncompensated. The coverage expansion in health reform may give half of those patients insurance, but Medicaid rates will probably decline, as you report. So medical care for lower income patients will continue to be a money losing proposition. The County subsidy only pays for one third of the cost of our uncompensated care, so that cannot be the rationale for acquisition. Therefore MetroHealth can only be an attractive target if the acquirer can jettison the mission. We who are committed to provide access to all will fight that prospect zealously.

Third, your view that no one with alternatives will come to a safety net hospital is belied by the data. In Massachusetts ambulatory care visits to safety net providers grew at over twice the rate as visits to non-safety net providers once uninsured patients were covered. (Arch Intern Med/Vol 17/Aug 8/22 2011: Safety Net Providers After Health Care Reform). Assuming that MetroHealth is not attractive to patients with choice is a leap too far. We are planning to serve the influx of newly insured patients with the same convenient, high quality medical services we provide today.

MetroHealth’s elimination is not inevitable! Our Boards, physicians, staff and management come to work every day with a commitment to deliver outstanding care to all. The future is uncertain but we have shown the determination to take our destiny in our own hands and build for it.