“Does it cause me any concern? Not really,” said Wendell Dirks, chairman of the HCMC board of directors. “I don’t know that it will or won’t affect us. I don’t know how it would.”
The board of directors of Marion County Hospital District No. 1 voted Jan. 22 to authorize Jeremy Armstrong, chief executive officer at St. Luke, to solicit bids for the development of a master building plan.
“I don’t know what it’s going to look like at this point,” Armstrong said. “That’s why we’re having…the master facility plan done, to tell us basically what we need, based on volumes and new services we may offer.”
The cost for developing a master plan was estimated between $50,000 and $100,000. Armstrong said he doesn’t expect the plan, which includes input from hospital personnel and the community, to be completed until June or July.
Until the plan is completed and reviewed, Armstrong said the board won’t know what kind of project it would need or how much it would cost. The board has projected the hospital tax district could afford to raise up to $8 million; the likelihood of additional costs would need to be met through contributions.
Armstrong said any new construction would occur on the existing site.
“With the two clinics and the two nursing homes being here, if we were to move the hospital somewhere else we would be duplicating services, like laundry and dietary, and it would drive up our costs,” he said.
“The feasibility goes out the window when you talk about moving off site.”
The St. Luke decision is the latest development in a long-standing, on-and-off discussion about cooperation between, and possible merger of, the two hospitals in Marion County.
The issue had resurfaced this past September when Hillsboro physician Randall Claassen challenged the Marion County Board of Commissioners to take the lead in building a new hospital that would join the existing ones at a central location.
In late October, the commissioners announced there was no need to discuss the idea after receiving a letter from the HCMC board stating it was not interested in pursuing the topic. (See sidebar.)
The response by HCMC added momentum to St. Luke’s decision last month to commission a master plan, according to Armstrong.
“In the discussions that I’ve had with my board, it’s kind of like, well, then why would we want to sit down and discuss it?” Armstrong said about possible merger.
“If we were going to do something jointly, then there would have to be some compromises on both side. From our standpoint, it seemed they weren’t willing to compromise anything once we read that (letter).”
HCMC officials said they understand St. Luke’s desire to plan for its own future—even as HCMC does regarding its own operation.
“It’s really not up to HCMC or Hillsboro to say what St. Luke does or doesn’t do in regard to their building,” said Mike Ryan, HCMC chief executive officer. “I don’t think (St. Luke’s initiative) would have a substantial impact at all on the operations of HCMC.
“In the final analysis they have to do what’s right for them.”
Can two survive?
That raises the broader question: Can two hospitals continue to operate successfully in Marion County over the long term?
Armstrong said it will be challenging.
“Whenever you talk to outside consultants and look at the population studies of Marion County and see the trend that we’re increasingly an older county having a difficult time keeping the younger generation—yeah, it’s going to be increasingly difficult to sustain two facilities in Marion County. There’s no doubt about that.
“How long down the road it’s going to be, I don’t think anybody knows that,” Armstrong added.
“Unless there’s an awful lot of support from the two communities to subsidize what (the hospitals are) not able to support from a patient standpoint, I don’t see that there’s going to be a long-term ability to sustain two hospitals in Marion County.”
Dirks said his mind has changed on that issue.
“We’ve made some major strides in the last couple of years,” he said of HCMC’s financial viability. “If you had asked me that question two years ago, I was wondering if one hospital in Hillsboro was going to survive. But we’re very, very healthy right now, and I think the two hospitals can survive.
“They’re both Critical Access Hospitals for one thing, and that makes a big difference. If one or the other wasn’t, the one that wasn’t would be suffering greatly. Under the set of circumstances we’re dealing with, I think (survival is) very possible.”
“Critical Access Hospital” is a designation of the federal Centers for Medicare and Medicaid Services, which provide such hospitals with cost-based reimbursement for many services, relaxed staffing requirements in comparison to full-service hospitals and federal grant assistance for designated network partners.
How to best meet needs
Ryan agreed with Dirks’ assessment of the future. He said having two hospitals ultimately is a better way to serve the needs of both communities.
“It just increases your access to health care if you have one closer to you,” Ryan said. “The thoughts of having one built halfway in between (the two towns), or in one community or the other, it puts the other community at a disadvantage in terms of accessing health care. That’s not a good sign for the future economic development of that community.
“(St. Luke will) have to do what’s right for them and we’ll have to do what’s right for us,” he added. “I’m firmly committed to the continuance of providing quality health care here in this community, for this community.”
Both parties agree the two hospitals are not really in competition with each other for survival.
“In all honesty I don’t see my competition being Hillsboro,” Armstrong said. “My competition is Newton (Medical Center).
“We’re dividing and conquering ourselves here in this county,” he added.
“I can understand both cities’ point of view—this is jobs and nobody wants to lose their hospital. That’s a huge factor. But Newton has got their stuff together over there and their sucking our patients away.
“There are issues we are struggling with to best meet the patient’s needs here,” Armstrong said. “If you don’t, we understand that they’re going to go elsewhere. Quite frankly, that’s what they’re doing.
“We’re trying to best tailor our facility to the needs of the communities in our (tax) district.”
Said Dirks: “We wish them well in their endeavors, and I’d like to think they do the same for us. We don’t see this as a competitive issue between Marion and Hillsboro, but I know some people in the community do.”