By Carla Stayboldt, MD and James Santiago Grisolía, MD
The City of Chula Vista´s rapid expansion makes it the seventh fastest growing city in the United States. This creates heavy demands on all civic infrastructure, including health care: physician offices, outpatient therapy and diagnostic services, and inpatient hospital services. East CV has the greatest need for new facilities and services, while West CV has the greatest population density, where increasing diversity and an aging population create changing needs for new health services.
Decades ago, hospitals and physicians could easily build new facilities, trusting that insurance reimbursements would cover the costs. Today, rock-bottom payments from managed care payors, Medicare and Medi-Cal not only make it harder to borrow money for new facilities, they threaten existing programs and services as well. Increasing numbers of uninsured patients, rising costs and unfunded mandates also impact any hospital´s bottom line. Some unfunded mandates include laws requiring retrofitting for earthquake preparedness, inflexible nursing: patient ratios, and nurse unionization, which typically adds 30% to hospital costs in administrative inefficiencies.
In this new environment, Scripps Memorial Hospital Chula Vista has been consistently losing money. Improvements such as a new Intensive Care Unit, a new Emergency Department, and an upcoming Cardiac Catheterization Lab were painfully slow to arrive, as local cash flow did not permit timely expansion to meet local needs.
ScrippsHealth plans to borrow $100 million to upgrade or open programs and facilities at all 5 hospitals. But Wall Street demands optimum performance and Scripps Chula Vista´s losses stand out on the balance sheet. Downsizing or even closing Scripps Chula Vista would deprive South County of needed outpatient and inpatient services, as well as an Emergency Department that treats 36,000 South County residents annually.
The most favorable alternative for the community would be to combine Scripps Mercy and Chula Vista hospitals into a single entity with one license and two campuses (Metro and South). This keeps the existing “4th and H Street” hospital open and under local control by its own physicians to meet the needs of South County residents.
Under the merger, both governmental and private reimbursements to the hospitals will improve. The superb physicians at Scripps Chula Vista will be supported by stronger, combined hospital services in many areas. Increased access to capital will allow physicians in South County to design new programs to better meet community needs, in partnership with ScrippsHealth.
Outpatient imaging, surgical services, gerontology, rehabilitation and other services will be considered and designed locally to meet local needs. We doctors in South County will have the option of partnering with our Metro colleagues to obtain more fair outpatient contracts from health plans. The Scripps Chula Vista Family Medicine Residency will be preserved, with access to new resources.
So far, each hospital´s medical leadership has approved the general principles for the hospital consolidation to one license. The physicians at each hospital will meet with their leadership in town hall meetings this month. When a detailed set of joint by-laws are completed, each medical staff will have a chance to approve the revised by-laws in July.
After putting aside our normal fear of change, physicians at each hospital are realizing this new structure offers the best alternative for meeting the changing needs of both South County and Metropolitan San Diego communities.
Scripps-Mercy Hospital, consistently ranked among the nation´s top 50-100 hospitals, was founded by the Sisters of Mercy in the 1890´s. Scripps-Mercy doctors have long supported the Sisters´ historic mission to care for all, including the most unfortunate. Both hospitals and medical staffs offer nationally competitive programs for training residents. Each medical staff has its own proud tradition of self-governance, community service and commitment to excellence. Going forward as partners, the united staff of Scripps-Mercy, both Metro and South campuses, will be among the largest medical staffs in California. This will enable us to speak with a strong, united voice for the needs of our community.
Dr Stayboldt is Chief of Pathology and a past Chief of the Medical Staff at Scripps Chula Vista. Dr Grisolía is Chief of Medicine at Scripps Mercy Hospital. Both doctors are bilingual in English and Spanish.