Bon Secours Seeks Aid to Avoid Shutdown

Bon Secours seeks aid to avoid shutdown

West Baltimore hospital asks state for $5 million

By Kelly Brewington | Baltimore Sun

April 9, 2009

Officials at BonSecoursHospital are asking the state for $5 million to keep the struggling hospital afloat for a year while they devise a new strategy to offer health care to a troubled West Baltimore community.
The company and the religious order that oversee Bon Secours have not ordered its closure. But executives say the hospital needs an infusion of cash and a new vision to avoid shutting its doors.
"We are losing millions to an old system that cannot be sustained in the future," said Richard J. Statuto, CEO of the hospital's parent company, Marriottsville-based Bon Secours Health System Inc.

The hospital lost $22 million last year - the largest loss in a decade, according to the state agency that sets the rates that hospitals can charge. But Bon Secours has had problems for many years sustaining a profit in a community where most of its patients are poor, very sick and without insurance.
Dr. Samuel L. Ross, the hospital's CEO, took over two years ago and pledged to confront inefficiencies. He replaced senior management, got more stringent about billing, and last year laid off 80 people from a staff of 900. But the losses continued.
"The reality is if the hospital is not able to achieve the financial turnaround - and get the support to do that - there has to be an honest look at whether or not there is closure," Ross said.
House and Senate budget conferees in Annapolis are considering the hospital's request, among many other issues. The full General Assembly must adopt a budget before the session ends Monday.
Ross said that even if the hospital has to close, officials hope Bon Secours can continue to deliver outpatient health care and social services in West Baltimore.
An institution where senior executives open meetings with prayer, leaders say they are committed to the same ministry established by the Sisters of Bon Secours when they opened the hospital in 1919. But they say they cannot continue to sink millions more into a health care model that is broken.
Bon Secours suffers from a downward spiral that has small inner-city hospitals fighting to survive nationwide: Poor patients, high costs and low reimbursement rates.
Most patients have Medicare or Medicaid, government insurance programs which reimburse at lower rates than private companies, while some patients have no insurance at all. The hospital's uncompensated care equals 18 percent of its gross revenue - more than twice the state average.
Hospital officials say that with so many poor patients, doctors earn very little from insurers' payments for the services they provide. So Bon Secours, like many other hospitals, pays them more just to keep them on staff. That subsidy - which cost the hospital $13 million last year - makes up the biggest portion of the hospital's losses, hospital officials say.
At the same time, the neighborhood around Bon Secours has virtually no primary care practices. Patients clog the emergency room as if it's their private doctor's office.
"If we want to stop the madness, we need to come up with a more effective model that people want to embrace," Ross said. "There is no easy fix."
This month, Bon Secours officials will start meeting with neighboring hospitals, health care leaders and community advocates to discuss a new health care model for the community. Ross said he doesn't know what a new Bon Secours might look like, but it needs to focus on the community's biggest needs: primary care and helping patients with chronic medical problems manage their diseases.
Ross says the process will be similar to an effort the hospital launched a decade ago, when it established a foundation that provides a web of social services to the community. In addition to the 125-bed hospital on West Baltimore Street, Bon Secours runs community centers that offer parenting and GED classes, and it operates a bank called Our Money Place. In addition, the foundation rehabbed crumbling rowhouses into solid low-income rentals.
The hospital itself has deep roots in a community whose institutions have vanished. Bon Secours took over West Baltimore's failing LibertyMedicalCenter in 1996. Liberty was the outgrowth of what used to be ProvidentHospital, an institution in black Baltimore and once the only city hospital that trained black nurses and doctors.
Located on a desolate corner, Bon Secours lies in the midst of Baltimore's most vexing urban problems. Its residents include some of the city's sickest, with high rates of heart disease, diabetes, AIDS and infant mortality.
In the emergency room, doctors see it all - from people with chronic diabetes, renal failure and asthma to drug addicts, psychiatric patients and the homeless, who flood the waiting room seeking a warm, safe place to escape the winter. The staff knows many of them by name.
On a recent afternoon, the ER is full, mostly with elderly patients reclining in beds, hooked up to various beeping machines. The scene is orderly, as charge nurse JoAnn Behounek makes rounds.
She visits Mary Bishop, 66, a Bon Secours regular. Today, she's complaining of a toothache. But after more prodding, Behounek discovers Bishop has had a heart valve infection. She was likely told to visit the emergency room in the event of any serious pain.
Bishop lives in East Baltimore, but she took a taxi out of her way to Bon Secours. "I like it here," she says.
Two beds down, Kenneth Jackson, 45, is hooked up to oxygen. His lifelong asthma was so severe that morning that his girlfriend called an ambulance. Doctors concluded he had pneumonia. Jackson, who takes medication for schizophrenia, said he was treated for asthma at a health clinic for the homeless until a few months ago when his doctor left the organization.
Behounek, who has worked at Bon Secours for 25 years, says Jackson is like many patients whose health care history is murky. "They are all God's children, just like me," said Behounek, who wears a silver cross around her neck.
If Bon Secours converts to an outpatient model, no one knows where Bishop and Jackson will go for emergency care. The closest hospitals are the University of Maryland Medical Center, St. Agnes Hospital and Maryland GeneralHospital.
But patients will bring their financial problems with them to hospitals that are already strained, said Alan Sager of BostonUniversity's School of Public Health, who has studied urban hospital closings. And some patients may stop seeking medical care, he said.
The state's rate-setting commission has tried to help Bon Secours by building a 3 percent cushion into its rates, which translates to roughly an extra $3 million a year for the hospital. But the commission cannot do more, said Robert Murray, its executive director. "The commission has tried to recognize the additional cost of operating in a very indigent neighborhood," he said.
Ross pointed out that beyond health care, Bon Secours is the primary economic engine in a depressed area. "It's not just us," he said. "There are vendors, small businesses and people we employ."
Brother Arthur R. Caliman, a senior executive, said the hospital cannot turn its back on a neighborhood with such great needs.
"There is no question that we want to continue some level of health care ministry," he said. "I think the problem is so great that the hospital may not be the best solution."

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