San Diego Business Journal

Local health care leaders are worried the upcoming closure of Mission Bay Hospital will put a greater strain on local hospitals already plagued by their own financial woes.

Mission Bay's owner Triad Hospitals Inc. announced Oct. 16 the hospital will shut down Jan. 24 as a result of low insurance reimbursements, low number of admissions and anticipated high costs to comply with earthquake safety retrofitting.

Mission Bay is the second acute-care hospital in San Diego to close within four months.

When Scripps Memorial Hospital East County closed June 4, community hospitals and Grossmont Hospital geared up to boost emergency services for diverted East County residents.

Gwen Jones, chief of emergency medical services for San Diego County, is evaluating how Mission Bay's closure will affect community hospitals.

The report is due to the state Department of Health Services by Dec. 15, she said.

Jones didn't want to speculate on the impact, but predicted numerous community hospitals will need to pick up the slack.

Gary Stephany, president and CEO of the Healthcare Association of San Diego and Imperial Counties, expects Scripps Memorial Hospital, UCSD's medical centers in La Jolla and Hillcrest, and Sharp Memorial Hospital will see emergency room care soaring as a result of Mission Bay's closure.

"When you add 10,000 more visits (Mission Bay handled about 900 emergency room visits a month) to other hospitals it will affect them," Stephany said.

Financial Impact

For most hospitals, increase in emergency room business won't equal more money. To the contrary, said Stephany.

"More business generally effects them negatively, because most emergency rooms lose money these days," he said.

That's especially true in San Diego County, where 26 percent of the total population has no health care insurance. Uninsure people typically wait until they are the sickest, then seek treatment at the emergency room where care is the most expensive.

Officials at Scripps, Sharp Healthcare and UCSD said they are all preparing for the increase in emergency room visits at their facilities. Patients seeking emergency care can expect to wait even longer in the already overcrowded facilities in town.

Chris Van Gorder, Scripps' president and CEO, said while Scripps created a task force to evaluate the impact, he'll await the county's report before making decisions.

Randy Larsson, Sharp Memorial Hospitals' vice president of ambulatory and post-acute services, predicts some 200 additional monthly emergency room visits at Sharp Memorial Hospital in Kearny Mesa.

Situation Worsened

Sharp is already bolstering its staff and number of beds in the Kearny Mesa emergency area. Both Van Gorder and Larsson declined to speculate on additional costs.

Dr. David Guss, UCSD's director of the department of emergency medicine, said the closure will worsen the existing problem of overcrowded emergency rooms.

He added, "Fortunately it (Mission Bay) wasn't a terribly busy hospital."

He predicted Downtown-based Scripps Mercy Hospital, UCSD's hospitals in La Jolla and Hillcrest, and Scripps Memorial Hospital in La Jolla will take care of diverted patients.

But Stephany foresees worse times ahead.

The loss of another 120 beds in the county could be devastating, especially during flu season, he said.

Dr. Robert Hertzka, the former president of the San Diego County Medical Society, is also worried.

"If we have a difficult flu season like the last two out of three years we will (see some) deaths related to our lack of capacity this January," Hertzka said.

Stephany said local hospitals are already operating on a shoestring budget.

He reiterated a long-lamented problem , insurers aren't paying hospitals enough to care for their patients. Medicare reimbursements to care for the elderly, and medical reimbursements to care for the poor, have been insufficient to cover the costs for health care.

At Mission Bay the struggle to keep afloat ended with last week's news.

Deborah Brehe, Mission Bay's CEO, said the Friday the 13th news by Triad, the Dallas-based for-profit-company owner, didn't come as a surprise.

"It's become more difficult with the low reimbursements and low market share to compete," Brehe said. She declined to give a figure on the hospital's loss.

Medical Staff Shortage

Brehe, however, has already begun to work with local hospitals to find new jobs for her 127 full-time health care staff.

Luckily for Mission Bay's employees, there is a shortage of highly trained medical staff and nurses in San Diego.

"It gives me great comfort to know they will be OK," Brehe said. She hasn't had time to contemplate her own future.

Hertzka said he's sad to see Brehe go.

"Mission Bay has a reputation for being one of the best managed hospitals in the county," he said. "Deborah led a lot of innovation."

Triad officials are discussing Mission Bay's fate once it shuts down, said Triad's vice president Patricia Ball. She offered no details.

Stephany said San Diego's climate with its strict regulations isn't exactly hospital friendly.

"It's hard to close one and too hard to build one," he said.

On Nov. 17, Mission Bay will announce the last day for inpatient and outpatient admission.