In a leafy suburb of Cleveland, 108-year-old Lakewood Hospital is expected to close in the next two years. Mike Summers points to the fourth floor windows on the far left side of the historic brick building. He recalls spending three weeks in one of those rooms. It was Christmas 1965 and Summers had a broken hip.

“I remember hearing Christmas bells from the church across the street,” he says.

Summers was born at this hospital. His sister was born here. This hospital has a special place in his heart. But then he became mayor of Lakewood four years ago and realized the hospital was a financial liability for the small city, which has seen a sharp increase in poverty levels in the past two decades.

“I’ve grown to understand the situation we are in is not unique. There are considerable forces at play and we are in the middle of all of them and a lot of communities are just like us,” Summers says.

Lakewood Hospital is this community’s biggest employer, with 1,000 workers. It has been a rich source of municipal revenues even as manufacturing jobs left the region.

But the hospital, operated for the city by the large nonprofit Cleveland Clinic system, has lost money since 2005. Executives say they need to close it and replace it with a smaller outpatient health center and emergency room.

Residents who need to be admitted could go instead to another hospital that the Cleveland Clinic is building in nearby Avon, a more affluent suburb, says Dr. Toby Cosgrove, the chief executive officer of the Cleveland Clinic.

For generations, the hospital has been a source of pride for residents. Nearly everybody has a connection to it – they were born there, worked there, or spent time healing there when they were ill.

And hundreds turned out for a community meeting in January, heckling city leaders and hospital executives making a case for the closure.

“It is our intent to keep Lakewood Hospital fully functioning until Avon Hospital opens in September 2016,” Cosgrove said at the meeting.

Still, residents are pursuing legal action. The city has responded to the residents’ action, and Lakewood’s leaders say they’d like the community to focus on how to overcome the loss of the hospital, rather than a legal battle.

Lakewood is experiencing something that is increasingly common across the country.

The hospital, like others, has fewer patients and they aren’t staying as long – which can cut into revenues.

Who is using the hospital is also a factor, says Paul Ginsburg, chairman of medicine and public policy at the University of Southern California.

“Unfortunately as a society we’ve created some powerful incentives,” Ginsburg says. “Hospitals are paid much better to treat privately insured patients than anyone else. After that comes Medicare, and the least payment is for Medicaid patients and, of course, the uninsured. That’s virtually no payments.”

Lakewood has become a poster child for the challenges of inner-ring suburbs.

A Brookings Institution report in 2012 on the nation’s growing suburban poverty includes Lakewood. It notes that free and reduced price lunches for high school students shot up from 9 to 46 percent between 1999 to 2010.

Mayor Summers says that there is no question Lakewood Hospital’s percentage of privately insured patients has dropped in recent years.

“In 2000, we were about maybe four or five percent of residents were at the poverty level. Today, we’re pushing 16 percent,” he says. “It’s been fairly dramatic.”

This story is part of a reporting partnership with NPR, WCPN and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Florida Gov. Rick Scott’s high-stakes visit to Washington D.C. Wednesday to persuade the Obama administration to keep the federal government’s $2.2 billion in annual funding for hospital care of the poor produced no breakthrough.

“We had a good conversation … but we don’t have a resolution,” the Republican governor told reporters after an hour-long meeting with U.S. Health and Human Services Secretary Sylvia Burwell.

Burwell said in a statement that Florida’s request for the $2.2 billion in federal funding “falls short of the key principles HHS will use in considering proposals regarding uncompensated care pool programs, and the size of the proposed LIP [Low Income Pool] appears larger than what matches the principles.”

Burwell added the decision on whether to extend funding for what’s known as the Low Income Pool beyond the program’s June 30 expiration does not depend on the state’s decision to expand Medicaid.

A letter HHS sent the state last month appeared to tie the two together and spurred Scott to file suit against HHS, alleging it was trying to coerce the state to expand Medicaid. The governors of Texas and Kansas, which receive similar funding to help their hospitals, have said they support Florida’s lawsuit.

But after meeting with Scott, Burwell insisted that “whether a state receives federal funding for an uncompensated care pool is not dependent on whether it expands Medicaid, and that the decision to expand Medicaid, or not, is a state decision.”

That seemed to leave open the question of whether some funding might still be available for the program, albeit at a lower level, if a state does not expand.

Scott said he needs an immediate answer from HHS on how much money, if any, the administration might provide so he and the state Legislature can complete their budget deliberations. “We need our answer right now,” he said.

Burwell indicated he might have to wait a while longer.

“HHS heard the Governor’s request for a timely response to help the state meet its budget timeline,” her statement said. “HHS believes completion of the public comment period, on-going discussions with the state, and the state’s submission of its proposal to CMS are the next steps in the process.”

The 30-day comment period has about two weeks remaining.

Florida is one of 21 states that chose not to expand Medicaid under the Affordable Care Act. That left about 800,000 Floridians without coverage.  Burwell has said HHS prefers the state expand coverage rather than continue full federal funding of the low-income pool.

The bitter dispute over Medicaid expansion between Republicans who control the state House and those who control the Senate led the Florida Legislature to adjourn last week without passing a state budget for the fiscal year that begins July 1. Lawmakers are expected to return to Tallahassee in June to resume budget deliberations.

The state House has adamantly opposed expanding Medicaid, with House Speaker Steve Crisafulli last week calling it a “broken system with poor health outcomes, high inflation, inseverable federal strings, and no incentive for personal responsibility for those who are able to provide for themselves.”

But on Wednesday, Scott had good things to say about how well Medicaid was working in Florida. In the past two years, the state has turned over most of the Medicaid program’s operations to private Medicaid health plans. “We now have a program that works,” Scott said.  “We know what it’s going to cost us. We have insurance companies responsible for taking care of Medicaid recipients and we have Medicaid recipients who know who is responsible for their care…and we now have a budget surplus.”

Nonetheless, Scott said he doesn’t trust the federal government’s promise to fund Medicaid expansion under the health law and the state will be on the hook to pick up too much of the cost. The federal government is paying all the costs through 2016 and then nothing less than 90 percent of the costs.

A year ago, federal officials warned Florida leaders the low-income program would end this year but Scott included the money in his proposed state budget anyway.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

The week of May 6 -12 has been “National Nurses Week” for over twenty years now, and this year too it will be a unique occasion to celebrate the role nurses play in delivering the highest level of quality care to their patients. To kick off the week, we’d like to highlight just a handful Continue Reading

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A hospital closure can send tremors through a city or town, leaving residents fearful about how they will be cared for in emergencies and serious illnesses. A study released Monday offers some comfort, finding that when hospitals shut down, death rates and other markers of quality generally do not worsen.

Researchers at the Harvard School of Public Health examined 195 hospital closures between 2003 and 2011, looking at health experiences in the year before and the year after the hospital went out of business. Their paper, published in the journal Health Affairs, found that changes in death rates of people on Medicare — both those who had been in the hospital and among the broader populace — were no different than those for people in similar places where no hospital had closed.

While the researchers noted that some people might be inconvenienced by having to travel further for care, they found no significant changes in how often Medicare beneficiaries were admitted to hospitals, how long they stayed or how much their care cost.

The closed hospitals tended to be financially troubled, with revenues averaging 13 percent less than the cost of running the institutions. “It’s possible that we didn’t see any change in outcomes because patients instead went to nearby hospitals that had better finances and may have had more resources to provide care,” said Dr. Karen Joynt, the lead researcher on the study.

She cautioned that the study looked at the average experience of a hospital closure and should not be interpreted to mean that every hospital loss is harmless. “I would be shocked if you couldn’t find an example where access is really threatened,” she said.

One of the study’s surprises was that 70 percent of the hospital closures were in urban areas rather than in rural regions, where hospitals have had trouble staying afloat for decades. Rural closures can be devastating when the hospital is the only one in the region. Medicare pays isolated hospitals more generously to help them keep going. Since 2010, 50 rural hospitals have closed, 16 of them last year, according to the N.C. Rural Health Research Program.

A less surprising finding from the study was that a third of the closed institutions were safety net hospitals that treated large numbers of the poor and uninsured. Joynt said the researchers had no way of examining whether the health of low-income and uninsured people suffered from the closures, so it was possible those closures did have deleterious effects. The paper looked at Medicare patients because their records are easiest to analyze and compare.

Nancy Foster, a quality expert at the American Hospital Association, called the paper “an important first indication that nothing untoward has befallen patients thus far, but we’ve got to continue to monitor this.”

She said that with hospital admissions declining overall, many are building outpatient clinics and stand-alone emergency rooms, to ensure patients aren’t abandoned.

The Harvard study did find a few changes when hospitals closed. Readmission rates dropped by more than 6 percent, and patients were more likely to go out of their health care market when they needed to be admitted to hospital. On average in places where hospitals closed, the percentage of Medicare patients leaving the area for inpatient hospital care increased from 43 percent before the hospital closed to 54 percent afterward.

“On average, people are going a little further, but it clearly has no negative effect on their outcomes and on their health,” said Dr. Ashish Jha, another author of the study.

He said that while hospitals are often coveted because they are large employers, from a health perspective, fewer admissions can be a good sign. “If we do our job well and keep people healthy, many hospitals will become unnecessary,” Jha said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.