After more than two years of being up for sale, the future of Louisville's Jewish Hospital is unclear. If the downtown hospital closes, it will leave countless patients looking for care elsewhere. But nearby facilities don't necessarily have capacity, and they can't begin to hire more staff to address the needs until a decision is made about Jewish.
In 2017, parent company Catholic Health Initiatives announced Jewish Hospital, the Frazier Rehab Institute, Sts. Mary’s and Elizabeth and Jewish Hospital Shelbyville were up for sale following financial troubles. University of Louisville Hospital explored finding a partner to buy the hospital with, but earlier this month said the effort failed.
Even if CHI finds a buyer, the new owner could still close Jewish Hospital; Jewish and St. Mary lost$135 million between 2012 and 2017. And if the hospital closes, a large number of city residents will have to go elsewhere for care. In 2018, the downtown hospital had 462 beds. That same year, the hospital had 33,926 emergency room visits, 57,242 outpatient visits and 15,778 acute care admissions, according to the U of L request for proposals it sent to potential buyers.
Data from another city — New York — where an urban hospital closed suggests the obvious: patients will move to the next-nearest hospital. A 2015 study analyzed the aftermath of the 2012 closure of New York City’s St. Vincent’s Hospital. The majority of emergency room patients ended up at the next closest hospital, according to Nupur Garg, co-author of the study and an emergency room physician.
“The emergency medicine population that went to St. Vincent primarily ended up going to the next closest hospital and created a surge there,” Garg said.
That surge came in the form of almost twice the patients the closest hospital usually saw. And that surge in patients didn’t wait until St. Vincent’s closed, but began immediately after the 30-day notice of closure.
“Once it was announced, you could see St. Vincent’s emergency medicine [patients] dwindle,” Garg said.
Could Other Hospitals Handle Jewish's Patients?
The ability of Louisville’s other two downtown hospitals — University Hospital and Norton Downtown — to take patients largely depends on how busy these hospitals already are.
On average in 2017, U of L Hospital was 59.4 percent full at any given time, according toKentucky’s 2017 Hospital Report. Norton Downtown, meanwhile, was 53.6 percent full on average that year. This is the rate of available beds divided by the number of patients in a given time frame, and takes into account when the hospitals are less busy.
But University of Louisville Hospital Chief Medical Officer Jason Smith said U of L is often at full capacity and not taking any new patients.
The three downtown hospitals tend to draw patients from different areas of the city. The University of Louisville Hospital sees a lot of patients from areas around Smoketown and from western neighborhoods of Louisville. Jewish Hospital, meanwhile, sees patients from around Shively and in southwest and south Louisville. Patients from Norton Downtown come from a little farther away: Newburg, but also south and southwest Louisville, according todata from 2017.
Jewish Hospital also has the highest proportion of patients who have Medicare or Medicaid coverage compared to U of L Hospital and Norton Downtown, according tofederal data. Medicare and Medicaid tend to pay the least to hospitals compared to commercial insurance.
Mitchell Burmeister with Metro EMS said about 10 percent of their transports to hospitals are to Jewish Hospital. If Jewish were to close, they’d have to take those patients somewhere else, likely to the closest hospital.
“If Jewish were eliminated from our mix downtown, the effect would likely be busier ED’s at the remaining hospitals.”
Hospital Holding Pattern
University of Louisville Hospital Chief Medical Officer Jason Smith said they’ll only start planning for an additional influx of patients if Catholic Health Initiatives says Jewish Hospital will close. That would likely include U of L hiring new staff.
“So, should I hire more doctors and nurses is always a problem — they don’t grow on trees,” Smith said.
But Smith noted that staffing levels are usually based on what a hospital currently needs. Garg said hiring new staff is often hard to justify to hospital boards when those patients aren’t yet there. And that lag can hurt patients.
“It’s also really bad for patient care,” Garg said. “It’s not just the doctors, it’s nurses, it’s tech, it’s sanitation — they have to clean rooms more rapidly because there’s more patients coming in and out. We can’t see patients unless all these things are in place.”
Alan Sagar, a health policy and management professor at Boston University, said when urban hospitals close, sometimes non-emergency patients won't immediately seek care elsewhere.
“For some patients, they’re just more comfortable going to one place where they know the doctors and the nurses,” Sagar said. “Each hospital has its own separate, you can almost call it, ecology of care. So when you lose one, the disruption can be substantial.”
Smith with U of L said the closure wouldn’t be as detrimental to the community as the rural hospital closures happening across the country. In those situations, patients and emergency services have to drive much farther. But rural hospitals also tend to have fewer patients and do fewer advanced procedures.
“So a closure of an urban hospital from a capacity standpoint is a little easier to mitigate, but you’re required to do a lot more because you’ve got a lot more patients,” Smith said.
In response to questions on the potential effect of a Jewish Hospital closure on Norton Downtown, a spokesperson for Norton said speculation would be "irresponsible on our part."
