Last month it announced plans to build yet another one: a 200-bed hospital in
AdventHealth leaders said they were responding to demand from a growing part of the metro.
But there's another reason to build on the far edge of the area's wealthiest county.
"By putting your hospitals beyond the outside of the ongoing growth or sprawl within a metro area, you have eliminated most of the poor people," said
And while residents of lower-income areas must do without, he said,
The announcements by AdventHealth, the nonprofit formerly known as
Meanwhile, large sections of
In other industries, it wouldn't necessarily make sense to expand in a part of town that's already saturated, while ignoring areas that have little to no competition. But it makes sense for hospitals because in general, the amount of money they make for a given procedure depends on who is paying.
AdventHealth plans to break ground this fall on its 85-bed hospital at
Dockins said that means a lot of working-age high earners with private health insurance, which pays better than Medicare (a government program for older Americans) and much better than Medicaid or treating the uninsured.
It's not an equitable health care system, he said, but it's like that almost all over the country and it's not the hospitals' fault.
"I think they're doing what the business structure drives them to do," Sallee said. "In general I wish the structure was different. The structure incentivizes the behavior, and the behavior is to compete like hell for commercial patients."
That's worsening the inequality of health care access between the haves and have-nots in
There are now at least 15 emergency rooms in
It's not all rosy for
There is one place where the system is different:
Individual hospitals are paid different amounts to encourage competition, but patients don't pay different amounts based on who insures them, and the system also tries to account for the amount of uncompensated care each hospital provides to the uninsured.
"By having Medicare and Medicaid pay essentially the same as commercial payers ... hospitals are not, if you will, disadvantaged by being in a community with what we in the field would call 'a challenging payer mix,'" Atlas said.
Some states have dabbled in similar models, but the amount of money in the health care industry has changed dramatically since the 1970s and many hospitals now oppose all-payer models because they like the freedom to negotiate with smaller groups of payers.
There's been no buzz about bringing all-payer to
Which means that at a time when several hospital systems in
"Transportation is an issue, and at the moment right now I am borrowing my mother's car in order to even get back and forth" to doctor appointments, Brantley said when The Star interviewed him last month for another story. "I lost my car when I was sick and I haven't been able to make enough money to get another car."
If he has a car, Brantley can continue driving 20 minutes from his house near the Quindaro neighborhood to the
If he's forced to take the bus to his chemotherapy treatments, the ride is one to two hours each way and requires at least one transfer. He has no options closer to home.
"There's nothing around here," Brantley said.
Within the last five years, medical building projects in
-- A half-dozen "micro-hospitals" and freestanding emergency rooms opened throughout
-- AdventHealth's BluHawk medical clinic in south
-- Smaller scale projects like a
-- More expansions still in the works, like the AdventHealth hospital in
The hospital systems say they're simply trying to bring medical care closer to home.
"We've been building our physician network in south
"I don't begrudge the hospitals opening new facilities," Sharpe said. "I just wish they would open up new clinics too in areas of town that are perpetually underserved."
The federal government's
Not one square mile of
For the most part, the only medical organizations building in those places are safety net clinics that are subsidized by donations and tax dollars.
The HCA Midwest hospitals, which include
Sharpe, whose organization works to improve health care access in underserved areas, said the nonprofit hospitals "are doing good work in their communities," but some parts of the metro are being left behind.
Many factors create those disparities, and experts generally agree that things like poverty and lifestyle weigh heavier than the number of nearby doctors and hospitals. But Sharpe said it would still make sense for the area's leading medical providers to build where people are least healthy.
"In an ideal world, if we were really looking at population health outcomes, we'd be locating primary care and specialty care resources in communities that have the highest rates of poverty and the lowest rates of access to those services," Sharpe said.
Instead, much of the new building is in
New medical facilities would also bring a financial boost to underserved areas that would help with some of the socioeconomic factors contributing to poor health, Sharpe said. The new AdventHealth hospital in south
Advocates say expanding Medicaid would make underserved communities more attractive health care markets. Medicaid payment rates are low compared to other insurance, but still usually a better return on investment than treating uninsured patients.
In the absence of expansion,
But when an uninsured adult who's not pregnant needs an MRI or surgery, "that gets a bit complicated."
His organization has a partnership with
"The folks at Truman really are committed to making this work and they do make every effort to take care of everybody we send over," Khan said.
Truman also provides an on-demand transportation system for some of its patients.
There's nothing like that for low-income people who need hospital care in
Sallee said his clinics' patients could benefit from having things like medical imaging or surgical centers closer to home, but "there's not the resources to make that happen."
That's despite having the region's largest medical center, the
But academic medical centers run on thin margins, he said, and none of those investments would be possible if KU weren't also joining the competition for suburbia.
"When you try to do good work in an underserved area, you've got to balance it against an area that's got mostly insured patients," Stites said. "For us, on the
"You can't have a strategy of only existing in a relatively poor county," Stites said, "because you're not going to be able to keep the doors open unless you have tremendous support from the county or the state, a la
Unless someone challenges their tax-exempt status, though, there's nothing legally binding KU or any of the other hospitals to use the money they make treating commercially insured patients to ensure everyone else has access. And there is no clear path to medical care for patients who can't afford it, like there is in
An organization called WyJo Care recruits doctors to donate some of their time to treating uninsured people in
Sallee said KU and St. Luke's both step up to treat
But other advocates for low-income residents said they've talked to people who have been turned away.
"There have been places, like KU, where if someone needs to have surgery or get something serious done, they just won't accept them," said
Having lower percentages of uninsured people has helped make
Hospitals have to pay for staff, electricity, janitorial services and other costs even if they're not full. And with the exception of times like last year's bad flu season, they're not usually full.
The new AdventHealth hospital in
Meanwhile, government programs and private sector health insurers are slowly trying to move away from the traditional model of paying by the test, procedure or night's stay and instead bundle payments to reward providers who keep people out of the hospital.
"Why would you build inpatient beds, when we see annually, ongoing migration toward outpatient services and away from inpatient?" Dockins said. "It seems to me to be a pretty nonsensical approach to health care strategic planning to be building out all these beds so close to each other."
But Dockins said AdventHealth had a compelling reason to expand: competitors building around its main campus on
Those small facilities don't offer all the services AdventHealth does. But Dockins said they're located on major traffic arteries to divert high-value patients who are having emergencies. Those patients can get stabilized at the small facility, then referred to the "mother ship" hospital like St. Luke's on the
It's more infrastructure, but not more efficiency.
"What this typically leads to is a significant increase in overall costs for a particular population, but not necessarily an increase in overall quality of care," Dockins said.
In a normal market, more competition in a geographic area should drive down prices for consumers.
But hospital care is not a normal market, Dockins said. People don't shop around during medical emergencies, and even when it's not an emergency, hospital pricing is so opaque, shopping around is nearly impossible.
The federal government recently required all hospitals that participate in Medicare to post price lists on their websites. But the lists can be hard to find, and they're technical enough that it's hard for non-medical people to decode them. They also break down some procedures into many separate components, each with their own price listing, and they don't account for the different prices each insurance company has negotiated.
"We still don't have any clue when we go into any of these hospitals in
So hospital prices are set more by what they need to charge to maintain and expand their operations and what insurance companies will allow.
There's evidence nationally that insurance companies are allowing higher costs and just passing them on to their customers.
A study by the
Meanwhile, the average deductible for private health insurance plans rose from
In short, Dockins said, people in
The proliferation of emergency rooms -- freestanding and otherwise -- in
Levinson had private insurance through
Levinson also said that last year he took his son to Children's Mercy's Blue Valley Urgent Care clinic and was unexpectedly charged extra because the clinic used something called "provider-based billing" that allows hospitals to charge facility fees even for care that was provided outside of the hospital itself.
Medicare stopped paying those fees by federal law in 2015, but the Children's Mercy clinic was grandfathered in.
"Certainly I'm very appreciative of the access to good health care," Levinson said. "I just think the health care providers, particularly nonprofit systems that are asking the community for support, should be transparent about their costs and should be charging reasonable amounts for the services they provide."
St. Luke's and Children's Mercy didn't respond to requests for comment.
Levinson said he's glad he doesn't live in rural areas where hospitals are closing, but with three hospitals already within a few miles of his house he wishes more health systems in
The federal government used to require states to make hospitals prove a need for a major expansion in a given area to prevent inflated prices due to excess capacity. That mandate was repealed in the 1980s, leaving it up to the states whether to keep their so-called "certificate of need" laws.
But Khan of the
Until the health care system changes at a national level, he said, hospitals will keep ignoring low-income neighborhoods to seek out the areas with the most commercially insured patients.
"Everybody's sort of trying to feed from the same trough, as it were."
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