MAJOR CHANGES TO HEALTHCARE DELIVERY IN DICKINSON COUNTY APPEAR
INEVITABLE AS HOSPITAL SYSTEM SLIDES TOWARD POSSIBLE BANKRUPTCY
(Iron Mountain - March 01, 2018) - As the financial condition of the
Dickinson County Healthcare System approaches crisis stage, with bankruptcy a
real option, talks are continuing between officials of Dickinson County, the
Dickinson County Healthcare System and Bellin Health.
Bellin operates a
flagship hospital in Green Bay and a number of clinics and other health care
facilities in the Northeastern Wisconsin region. In 2017, DCHS and Bellin agreed
to a "letter of intent," under which operation of the facility would be handed
to Bellin. Bellin is a privately owned, non-profit organization. Unlike the
current hospital board of directors, the Bellin board is not open to public
While many are applauding this proposed change, there may be
implications which haven't been thoroughly considered.
Any thoughts that
the County was in a position to SELL the facility to Bellin evaporated long ago.
At this point, the question appears to be: Is Bellin willing to take over the
operation and assume it's debt. The fact is that neither the County Board of
Commissioners or the DCHS Board of Directors has any real leverage in these
negotiations. There is also the possibility that some sort of arrangement
could be agreed upon whereby Bellin would not assume direct ownership, or
participate in the accrued debt (which currently exceeds twenty million
There is no doubt that Dickinson County Memorial's finances are
in a state of near crisis. But before we're too quick to criticize the DCHS,
let's consider a couple of facts:
According to Bloomberg Reports, 22
similar hospitals have already filed for bankruptcy protection this year, and
dozens of others are facing the same fate.
According to that same
Bloomberg Report, hospitals, including private rural ones, may be among the
hardest hit by changing levels of Federal funding. The Affordable Care Act,
known as Obamacare, reduced payments to hospitals that serve a large number of
poor and uninsured patients, known as "disproportionate share hospitals," on the
theory that more patients would be insured under the law. Congress delayed those
cuts several times, but didnít do so for the current fiscal year, which may
"single-handedly" throw hospitals into immediate financial distress. Many of
these small institutions operate on less than one dayís cash on hand.
"Smaller hospitals have already been struggling for years,Ē said Kristin Going,
a partner in the New York office of Drinker, Biddle & Reath LLP. "Since 2010, a
growing number of patients have enrolled in high-deductible health plans that
force them to shoulder more of costs when they get treatment, according to the
U.S. Centers for Disease Control and Prevention. That has translated into more
bad debt from customers for hospitals and other providers."
At the same
time, as part of the Presidents tax cut package, the Congress removed the
penalty for not purchasing insurance, dealing another financial blow to
hospitals as more uninsured patients show up at their doors.
always be areas where a facility can improve. But most of the complaints that
one hears about the hospital have little to do with patient care.
the area that generates the largest number of criticisms is the Emergency
Department. This is the first contact that many have with the facility, and a
bad experience there can cause them to seek providers elsewhere. It's not enough
to say that these problems and complaints exist in many emergency departments.
There is no doubt that hospital officials could and should have done more to
address these complaints.
The second most common complaint deals with the
DCHS billing system, which virtually everyone seems displeased with. The major
complaint is that people receive bills with no explanation of what they're
paying for and get very little help if they call the hospital for explanations.
While this has little to do with the care provided, it frustrates many to the
point of seeking providers elsewhere. The hospital board has been aware of these
complaints for years, but has chosen not to address them.
complaints such as this are certainly not entirely responsible for the
hospital's precarious financial condition, they certainly have not helped,
especially not with a convenient and arguably aggressive alternative in the same
Which brings us to the subject of Bellin Health. There is no
doubt that the Bellin Clinic, developed on the site of the former Dickinson
County Memorial Hospital, has had a major impact on the hospital's finances, not
just in numbers, but in the type of patient.
Bellin does not have an
emergency room, thus they are not required to absorb the costs associated with
that operation. Most of those who use the Bellin facility have the family
support to travel to and from Green Bay; but more importantly they generally
have better quality insurance and the ability to pay their bills. Bellin claims
to have handled more than 13,000 procedures at that facility last year.
This has left Dickinson County Memorial with a disproportionate number of poorly
insured or uninsured, and many who are not able to pay at all.
lies the problem and the only possible solution; action by Congress.
Medicare cuts have had a disproportionate effect on Dickinson County Memorial,
due to demographics. With a median age nearly ten years above the national
average, Dickinson County is more dependent on those Medicare dollars than are
most other hospitals.
Anyone who believes that Bellin will come riding in as a "Knight in
shining armor," solving all of these problems, is likely to be very
There is no doubt that the hospital could do better in some
areas. But the conditions that have caused the financial crisis have been
primarily out of its control, and would be out of Bellin's control as well.
Without Congressional action restoring (or increasing) previous levels of
Medicare and Medicaid funding, the hospital's financial condition will continue
Without that funding, Bellin will be in no better
position to maintain the current level of care than is the current board.
Without that funding, services will have to be reduced, regardless of who is in
DCHS officials are already doing everything possible to cut
expenses without reducing services, but that can only go so far. At some point
patients will begin to notice these changes, likely in the form of less local
access to medical specialties.
The problem is acute and immediate.
Sources at the hospital have told us that every day is a "dash for cash," trying
to put together the funds necessary to pay bills and meet payroll.
years ago the hospital was in the black, and the future looked bright. Two
things have changed since then. The first, and by far the most damaging, has
been the Federal funding cuts. The other major change has been the rapid
expansion of the Bellin facility on Woodward Avenue.
Far from being the
"Knight in shining armor," many may find their access to health care diminished
by a Bellin takeover. Different ownership will not improve the hospital's
profitability, and it's not likely that Bellin will feel the same commitment to
the local community that the current administration feels. Furthermore, there's
no assurance that Bellin would keep all of the current services in place at DCHS
since many of them duplicate services available at the Bellin Clinic, which is
still undergoing expansion. Will Bellin keep in place very expensive hardware
such as CT and MRI scanners? How about the very expensive emergency department?
One must, in fact, question whether Bellin has actually exacerbated the
financial problems at DCHS.
While the County and DCHS officials may
attempt to seek assurances on some of these issues during negotiations, the fact
is that long-term, Bellin will make decisions based on finances, not on dreams
On the other hand, without a Bellin takeover, DCHS will likely
have to seek bankruptcy protection. Any bankruptcy reorganization will
necessarily result in major health care delivery changes.
Congress could resolve this problem very quickly by restoring the waiver
on the Medicare and Medicaid cuts. Without such action, there are no good
options; things will change, and not necessarily for the better.