A state well being board’s determination to disclaim a Chicago hospital the fitting to shut raises a thorny query: Can the federal government drive a financially struggling non-public hospital to maintain its doorways open?
It is difficult, legal professionals say.
The Illinois Well being Services & Companies Overview Board, which decides the destiny of well being care tasks within the state, voted unanimously yesterday to not approve Mercy Hospital & Medical Middle’s utility to shut early subsequent yr. Catholic large Trinity Well being, which owns the South Facet facility, plans to problem the discovering on the board’s Jan. 26 assembly.
If the board affirms its denial, how does the state compel Mercy—which Trinity mentioned is posting month-to-month working losses of $four million—to stay open?
Closing a well being care facility with out approval may end up in a effective of as much as $10,000, plus an extra $10,000 a month whereas the violation continues. Moreover, a facility may lose the flexibility to gather funds from the state, resembling excellent hospital evaluation funds and Medicaid reimbursements.
Low-income sufferers on Medicaid account for almost half of Mercy’s inpatient income and 35 % of its outpatient income, in keeping with the most recent Illinois Division of Public Well being knowledge.
Nonetheless, as business observers level out, such fines is perhaps preferable to the thousands and thousands of the hospital mentioned it’s already dropping every month.
Trinity has mentioned that since shopping for Mercy in 2012, it’s offered tons of of thousands and thousands of to fund infrastructure enhancements and meet working wants. Trinity additionally beforehand mentioned the getting old facility would require no less than $100 million of extra capital investments within the subsequent 5 years.
However sources say it’s unlikely that Trinity will outright shutter Mercy with out approval, falling out of favor with the board, contemplating it nonetheless owns three hospitals within the state: Loyola College Medical Middle, Gottlieb Memorial Hospital and MacNeal Hospital.
“What I feel will occur over the subsequent couple weeks is what we noticed occur at” lately shuttered Westlake Hospital in Melrose Park and MetroSouth Medical Middle in Blue Island, mentioned Juan Morado Jr., a accomplice at legislation agency Benesch Friedlander Coplan & Aronoff. “We’ll see workers of the ability start to search for employment elsewhere and, because the variety of workers begins to dwindle, (Mercy’s) means to offer care on the stage they want to will diminish. You could possibly see the hospital system submit notices of non permanent suspension for explicit classes of service.”
In different phrases: If it is thought-about unsafe to take action, the state will not demand it proceed working.
A Trinity consultant didn’t reply to questions on whether or not Mercy has began winding down sure companies or whether or not employees have already got began taking positions elsewhere.
“We stay centered on caring for our sufferers and can proceed to work with surrounding well being care suppliers inside the regulatory construction of the Illinois Well being Services Act and the Illinois Hospital Licensing Act,” Trinity mentioned in an emailed assertion.
Trinity’s state of affairs just isn’t unprecedented.
Prepare dinner County’s utility to shut Oak Forest Hospital in 2011 was rejected by the state’s well being amenities board. The hospital ultimately obtained approval to remodel its massive inpatient facility into an outpatient middle.
The Oak Forest case “mirrors precisely what Mercy is speaking about doing,” Morado mentioned. “The roadmap is there. . . .In a way, we’ve been having the identical dialog for a decade.”
Trinity lately utilized with the state to open Mercy Care Middle, a $13 million outpatient clinic that will be lower than 2 miles from the hospital. The board is scheduled to vote on the outpatient venture at its Jan. 26 assembly—the identical assembly the place it is anticipated to revisit the hospital’s closure utility.
Sources say Trinity may come again to the board at that assembly with a compromise that will entice members to vote to approve Mercy’s closure. For instance, they mentioned, it may supply to maintain the hospital open till the outpatient middle is operational, scheduled for Sept. 30.
Trinity’s plan to shut Mercy between Feb. 1 and Might 31—throughout a public well being disaster—has prompted outrage from elected officers and neighborhood members. The well being amenities board yesterday echoed issues about the potential for having roughly 400 fewer beds on Chicago’s South Facet, the place individuals of colour have lengthy been disproportionately affected by persistent situations and, now, COVID-19.
However the board’s means to disclaim Mercy’s closure, in all probability, has much less to do with the pandemic than it does with a latest Illinois Well being Services Planning Act change that restored some energy to appointed members. The change adopted the board’s controversial April 2019 determination to approve the closure of Westlake Hospital.
Within the case of Westlake and different lately closed hospitals, the board basically was required to approve any request to discontinue companies if a hospital operator submitted a complete utility.