Health care reimbursement has become a very complex and costly proposition for hospitals and providers. With the recent layoffs at LRGH in Laconia and Franklin, some have seen this as an opportunity to blame it all on Obamacare, mostly for political gain. Case in point is NH Congressman Tony Guinta who is running for re-election. There is always a cause and effect for most things in life, and in this instance and in my opinion, LRGH leadership did not steer the ship in the right direction. It is bit personal for me in that I know and worked with some of the individuals that were let go. Michael Kitch has a good article in today's Laconia Daily Sun with another perspective on this topic, based upon facts and not politics.
Aside from the points made in the LDS article, changing leadership at LRGH and incorrect assumptions on where health care was going, led to a business model that in today's reality was not viable. They have seen four CEO's in the past two years with the recent announcement of an interim CEO and may see a fifth one when a search is completed. It is difficult to manage a business and make long term strategic plans with so much flux at the top of the ladder. Employees get mixed messages when the strategic direction changes every time a new leader steps in to right the ship. In addition, senior management also sees change as the new CEO wants to put people in positions that are on board with his or her way of thinking. Confusing and worrisome for front line employees. Morale drops, productivity drops and it leads to an environment of uncertainty. The layoffs have been rumored for months at LRGH, especially as a company was brought in to find ways to cut costs and increase reimbursement. Is my job safe? Where will I find work? Impending doom is not a good motivator for a workforce. A new rumor is that another round of cuts would come in 30 days.
Presumably, the recommendations of the experts that LRGH hired were executed this past week. Among the many changes ( this is information by the way I received first hand from two LRGH employees) are that the the entire ICU nursing staff at Franklin was let go and that most of the outpatient services at Franklin would be relocated to Laconia. The Franklin emergency room would remain open, but it is unclear yet what will become of the remainder of the hospital which is a 25 bed critical access hospital. There is also very important unit at Franklin that opened a few years ago to house on an interim basis, patients that need inpatient mental health service and are awaiting bed placement. This unit helps alleviate the pressure on emergency rooms that have to hold these patients in the ER until a bed is available. No word on the future of that unit.
As more and more procedures and testing are done as outpatients,there is less and less need for inpatient care. Couple that with the use of a network of hospital that function as centers of excellence for things like cardiac issues and other specialties, the need for inpatient care further dwindles. Lastly, long gone are the days of " lets keep him another day." Today, the payors rule and patients are discharged to home or lower level of care based upon their criteria or the hospital doesn't get reimbursed.
I feel for the employees at LRGH who do a great job in fulfilling it's mission, and I am sure that despite all the changes, LRGH will continue to provide the same excellent care it always has. I also feel very strongly that the pressures on health care providers stem from a multitude of causes and simply yelling " Obamacare " will not address the root causes. Politics as usual is not the answer. It's the problem.