Questions That Need Answers

From the Lakewood Observer:

The Lakewood City Council needs to answer certain specific questions in order make a valid judgement regarding our future health care, specifically the CCF Letter of Intent to close Lakewood Hospital. These answers need to be based on accurate, unbiased and comprehensive data derived from impartial and independent sources rather than those released only by the Cleveland Clinic.

First, what are the hospital needs of the citizens of Lakewood and our service area (Zip codes 44107, 44102, 44111, 44116 and 44135)? The average need in Ohio is 2.6 acute care beds per 1000 population. This indicates a need for 135 beds (2.6/1000 x 52,000) for our citizens and a total of 400 beds for our service area. We need to know four things regarding our current needs: 1) What are the hospitalized medical diagnoses (ICD-9 codes) and surgical procedures (CPT codes) that led to current hospitalizations? 2) Which hospitals were utilized by these patients and with what distribution? 3) What is the trend over the past 10 years for these numbers? 4) What is the reimbursement for each of these diagnoses and procedures?

Once we know this, we can ask a second question. Does the spectrum of service lines at Lakewood Hospital match the above defined requirements of our population? What services have been previously available at Lakewood Hospital and which are currently available? If the services lines match our need, then the question for the current administration revolves around why the patients chose other institutions and why the administrative strategy failed to adequately compete for these patients. If the service lines are not currently available, then the question becomes whether there has been a material breach of the Definitive Agreement from 1996 and its revision in 2010 which states that the CCF will maintain service lines similar to other community hospitals and specifically per the 2010 agreement for Centers of Excellence in Neurology/Neurosurgery and Acute Rehabilitation Services.

The third question concerns economic viability. If you add up the reimbursements for all the admissions for the above ICD-9 and CPT codes, does the amount of money generated justify an acute care hospital? If the answer is no, then the city needs to act in its own economic interest to convert the hospital assets in real estate, bed licenses and equipment into maximal city assets which the City of Lakewood will directly control in a transparent and accountable manner. If the answer to the economic question is yes, then the city needs to seek a new partner, who will adequately develop and continue hospital services to meet the needs of our citizens. This would require replacement of the Cleveland Clinic which has not been capable of developing a successful business plan that reflects our citizen’s needs rather than the Clinic’s agenda.

Terence Kilroy, MD