BY JULIE IRWIN
The Cincinnati Enquirer
Franciscan priest Dominic Wachtel gives Communion to Walter Moster at Franciscan Hospital-Mount Airy Campus.
(Michael Keating photo)
|
ZOOM |
|
Like all hospitals, Catholic institutions are struggling with the uncertainties wrought by managed care. Unlike others, they are facing an identity crisis that asks how Catholic health care is different and whether those distinctions will survive.
The answers affect more than simply the theologians and administrators posing the questions. The U.S. Catholic health-care system cares for about 70 million people in 542 hospitals and numerous other institutions, including 11 Cincinnati-area hospitals. Founded as an extension of the healing mission of Jesus, they have long placed an emphasis on serving the poor of their communities.
But the religious orders that started most of the nation's Catholic hospitals could not have imagined the issues their successors would grapple with: bitter debates over reproductive services; declining numbers of nuns; mergers, consolidations and closings; market-driven pressures in a field that has long been more ministry than industry.
As Catholic hospitals across the country struggle with how to preserve their mission, local institutions are finding strength in alliances among themselves. They are coming up with new programs -- parish nurses, wellness programs, insurance for the poor -- that combine faith and service. And they are balancing margin and mission, hoping a distinctly Catholic presence will continue in a rapidly changing industry.
"Is it harder today? Yes," said Sister Beverly McGuire, senior vice president for mission and culture at Cincinnati-based Catholic Healthcare Partners. "I think everybody right now is kind of scurrying, and what our organization is trying to do is to stay focused. Everybody can't be everything to everybody. What is it that we want to be and do, and with whom do we want to do that in service to the people?"
On one level, the challenges facing Catholic and non-Catholic hospitals alike are economic, a response to increased competition in the rapidly evolving world of managed care. Institutions are teaming up to create affiliations, hoping that shared services will save money and keep their buildings afloat. In just five years, the Greater Cincinnati hospital scene has shifted from 30 mostly independent hospitals to three major groups with a handful left over.
Catholic hospitals are in the midst of that process, particularly this summer. Catholic Healthcare Partners (CHP), a multistate network based in Cincinnati that includes four local Mercy hospitals, is adding St. Elizabeth Medical Center's three hospitals in a deal that could close this month.
CHP is also negotiating with Franciscan Health Partnership, which operates hospitals in Mount Airy, Westwood and Dayton, Ohio. If they reach an agreement, 10 of the region's 11 Catholic hospitals would be affiliated -- the lone exception being Good Samaritan, which belongs to TriHealth -- in a suburban ring around Cincinnati. To administrators, financial health is indivisible from religious mission.
"If we don't have a good bottom line and we're losing a lot of money, then we're not protecting the mission," said Sister Arlene McGowan, vice president of mission and support services for Franciscan of Ohio Valley. Officials there conducted a study two years ago that showed changes in Medicare would result in a $50 million drop in five years. They responded by combining food preparation, consolidating products to give greater buying power, combining some positions and introducing other cost-cutting measures.
"(Under)a new managed-care contract, our revenues are a lot less than they used to be, where we used to get 70 cents on the dollar, and we thought that reimbursement was poor. Well, now we think that reimbursement is like it's from heaven, (because now) we're getting 30 cents on the dollar," Sister McGowan said. "And so it's important that we look at the resources of the organization to make sure we're being cost-effective and efficient in providing our care and we do things that keep our organization solvent."
But the changes confronting Catholic health care go deeper than the economics driving them. In some instances, the results are welcome innovations that fit nicely with the institutions' founding missions; in others, they divide communities:
Mergers between Catholic and non-Catholic hospitals have created tension in communities over issues of reproductive health. Catholic hospitals are prohibited from performing abortions, dispensing contraceptives, sterilizing patients and conducting some fertilization techniques.
When a Baptist and a Catholic hospital in Enid, Okla., merged recently, some residents were angry to learn women could no longer receive tubal ligations after giving birth. Other controversies have erupted, especially in rural regions with few hospitals. Two Tristate counties -- Clermont and Grant -- have a Catholic hospital as the sole provider, but there have been no complaints about reproductive services there yet.
Shorter stays mean it is harder for chaplains to reach patients while they are in the hospital. As a result, spiritual-care workers are trying to reach patients in their doctors' offices beforehand or at home after.
"If we're really going to be thinking of the spiritual care of patients, it's not going to be in the hospital, because when they're in the hospital, by and large they're comatose or out so fast that you don't know they're there yet," Sister McGuire said. "You've got to be creative in the way you do that so that you start that spiritual care maybe as far back as the doctor's office."
The dwindling number of religious women, who have traditionally run many Catholic hospitals, raises questions about the continuation of mission.
"Theoretically, if we're doing our job correctly, when all the sisters and brothers and priests are gone, the Catholic laity should be able to carry it on, because it's their ministry," Sister McGowan said. "That's one of the things we try to get across to our employees when we talk about orientation, that this is not another job for you, this is a ministry."
A renewed emphasis on prevention as a way to cut costs is combining churches and health care in ways unthinkable 15 years ago. Parish nurses coordinate health-care screenings after services, while Mercy Hospital Anderson runs an outreach clinic and Franciscan established an insurance program so patients can seek help before the emergency room.
"If we wait until the poor get sick, I don't know what that says about our concern for their dignity, their ability to care for their own lives, their ability to work, take care of their families," Sister McGuire said.
Increased interest in the connection between mind, body and spirit has health groups pushing alternative medicines and wellness, hoping to keep people healthy and save money on disease treatment. The Mercy hospitals in Fairfield and Anderson Township this year opened centers for health and wellness, enormous complexes that combine exercise equipment with biofeedback, cardiac rehab with meditation, Western science with alternative therapies. They also this year hired a regional director of human and spiritual development to attend to employees' needs.
"From a Christian perspective, we have a responsibility, I believe, to care for our bodies, to stay healthy," said Sister Kathy Green, vice president of mission for Mercy Health Partners. "We've done these centers because of our belief in this holistic approach to care. . . . It's also, we believe, going to eventually be a sound business practice."
Is it enough to save Catholic health care? The Rev. Richard McCormick, a respected voice on Catholic medical ethics, warned in the Jesuit magazine America last month that Catholic hospitals are in danger of losing their founding mission.
"So what do we have here?" he wrote. "A context dominated by managed care with the following characteristics: medicine as business, depersonalized care, cuts in Medicare and Medicaid, impoverished public hospitals, mergermania and competition, obsolescence of the hospital and threatened pastoral care." The alliances in places such as Cincinnati are useful because they allow a continuity of culture while shoring up financial outlooks, he said in a recent interview. And an increased emphasis on prevention and parish-based services support meshes well with a Catholic philosophy of care.
"I think (the partnerships between Catholic hospitals) are hopeful because they share so much of the same culture," he said. But, "I don't think we can expect such a direction can solve the contemporary hospital problem."
Franciscan priest Dominic Wachtel gives Communion to Walter Moster at Franciscan Hospital-Mount Airy Campus. Some think Catholic hospitals are facing a crisis now.
