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More answers to the questions that have been asked by our readers. See the past two days’ posts for more discussion.

Is the St. Joseph Hospital Burn Center verified or not verified?

NICHE has spoken with the Chicago headquarters of the American Burn Association several times. The St. Joe Burn Center remains a member of the association with its verification currently expired (6/16/2017) and renewal pending. The loss of qualified personnel and the date of ABA verification expiration date can be seen on this website:
http://ameriburn.site-ym.com/members/….
St. Joe is no longer listed as a verified site on the ABA page dedicated to finding a burn center. An ABA inspection found a number of deficiencies, not merely physician turnover, and so until records are reviewed and deficiencies corrected, verification will remain pending. Deficiencies may include increased infection rate, inadequate staffing and training levels, and inadequate timeliness of care, among others. There is little reason to be optimistic about St. Joe’s hopes for renewed verification, and a second inspection is expected soon. If a “floating staff” is used to answer questions about staffing levels, they will have not received burn unit training. And unless nurse/patient ratios measure up to intensive care levels. NICHE expects that verification will be achieved only if additional investment is made in the burn unit–something that appears unlikely at best under CHS ownership.

So many good doctors are leaving LHN. You would think they would rectify the situation and try to keep them.

NICHE measures quality first by personnel and second by facility. “Dingy” is comparatively easy to repair and new equipment can be purchased to replaced that which is outdated, but it is very difficult to reverse the type of organizational brain drain we’re seeing at LHN. For example, the latest physician to leave, Dr. Rich Cardillo, is a pulmonary physician who led the Lutheran Medical Group and was on the Lutheran board. His name is just the latest in a long line of defections, including Drs. Randolph, Rumsey, Sutter, and Orlow. Medical staff like these are invaluable due to their knowledge of the community, their colleagues, and the facilities in which they work.

These are not isolated cases, Just last week we saw the hasty dismissal of pediatric cancer doctor Scott Myers, who was surprised that no arrangements had been made for him to say goodbye to each patient with whom he had a personal relationship. (“Why was Dr. Myers terminated?,” we have also been asked. We can only speculate, but we do know this: Indiana is an “at will” employment state, meaning your dismissal requires no statement of cause. The termination of Dr. Myers, therefore, could have been purely about money, therefore.) In addition, it’s hard to understand why CHS would not renew the contract of a top cardiovascular transplant surgeon. This specialty, and many others, are in short supply in the United States. The American College of Cardiology expects a shortage of 1500 cardiovascular-thoracic surgeons by 2020–over a third of those now in practice (see http://www.acc.org/…/…/04/29/09/41/minimizing-and-maximizing
). Altogether, there is a long list of physicians who have departed, often quietly, or those who intend to leave Lutheran after making personal arrangements.

Bluntly stated, these physicians cannot easily be replaced in this market. There is a shortage of specialists and a greater shortage of experienced specialists. NICHE wonders, therefore, why sought-after physicians would choose to connect themselves to a CHS facility. Is the same true for those physicians who are less sought-after?

We know CHS has a “secret” plan is to reduce FTE’s under the direction of Brad Cash, VP of finance for the division. Are we to anticipate that CHS will replace St. Joe with a newer, smaller facility with fewer employees and reduced overhead to accommodate the current payer mix?

NICHE is only aware that an FTE reduction plan continues across all of CHS (including Dupont Hospital), with the possible exception of Lutheran Hospital–for now. The CHS earnings crunch is real, and we’d guess that everything is on the table to ensure the company’s survival. We will await more details, but–as we have said previously–when you add up land remediation and preparation, doctors’ offices, outpatient clinics, a parking lot, and 100 beds that include a burn unit and intensive care unit $100 million is not enough at $800,000 per bed: unless the facility is significantly scaled back. Of course there is always the “Bates Hotel” model of hospital-lite, and that is why a full financial commitment and details from CHS would be helpful in clarifying what exactly is planned.