Climbing into the black at Dayton General Hospital
Dayton General is a "critical access hospital," according to the
With this designation, Medicare and Medicaid reimbursements to
Before it started investing more in technology and treatments, Dayton General was bleeding, said
The late 2000s and early 2010s were an especially tumultuous time for the hospital as it struggled to attract and retain staff. A nurse shortage, workplace culture and conditions spurred resignations, a nurse said in a 2010 Union-Bulletin article.
But now, the health system's investment in self-improvement has turned this around, Skiffington said. Major renovations were made in 2016-2017 thanks to a
These new treatments and services are a benefit to patients, who would otherwise likely have to travel hours to get them elsewhere, and are a benefit to the health system because the reimbursements are better, too.
"I think that's what's really been turning things around for us," Skiffington said.
Other changes have further improved morale and the bottom line. In 2015, the hospital started contracting with a company to provide emergency room physicians for one weekend a month, to relieve stress on the clinic staff who were covering the ER in addition to their regular work, according to Skiffington.
The health system also worked to grow its swing-bed program, providing rehabilitation following severe injury or illness treatment. Therapies are expanding too, with the addition of acupuncture treatment, speech therapy and aquatic therapy. August was the hospital's biggest month for ultrasounds since they became available in
The health system took on more debt to purchase the necessary equipment, she said, but the costs are manageable. Now, the hospital has been able to attract more staff with competitive salaries.
"I think the morale is very good compared to what it was," Skiffington said, "and I think we're fortunate to have all the great people we have working here."
After years of running deficits, the health system had about
However,
Part of the problem is that health care -- and how it is paid for -- has become too complex, said
Many incorrectly point to the cost of inpatient care as the cause for hospitals' financial woes, Miller said, but Medicare, Medicaid and commercial health insurance systems are stacked against rural health care providers.
"Everyone who pays them is underpaying," he said.
State and federal governments theoretically reimburse providers for the entire cost of caring for the country's 67.2 million Medicaid enrollees, who commonly have lower income and more demand for medical attention.
However, Miller said, those reimbursement rates could be based on years-old calculations, possibly leading to inaccurate payouts.
And commercial insurers, who mostly cover workers through their employers, pay based on rates that are often geared more toward cities, where there are more customers.
"We have a payment system for them that is not designed at all to support what they do," Miller said.
Medicare complicates things further. The federal government program covering over 56 million people is supposed to reimburse providers to the tune of 101 percent, but with government spending cuts of two percent, they actually only get 99 percent.
"These hospitals, by definition, can't even break even," Miller said. "
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