jonetta rose barras: Health care in flight

Executives at Ascension, which owns Providence Health System and more than 150 hospitals across the country, want District of Columbia residents and others to believe their prime motivation for phasing out a host of critical medical services during the past year has been a desire to improve overall local health care delivery. That’s all propaganda.

When a corporation — even one that is nonprofit and faith-based — decides to consolidate, it’s driven mostly by the bottom line. Connect the dots in this recently released statement by Health System president and chief executive officer Keith Vander Kolk.

“We know that 15 percent of a person’s life is spent in actual healthcare, which means the remaining 85 percent is spent in other areas that either positively or negatively impact their overall well-being,” said Kolk. “That is where the greatest opportunity to make meaningful change lies, and we must put our focus and energy on advancing a model of transformation that will serve the District in new and lasting ways.”

The decision to eliminate acute care at Providence Hospital follows the 2017 termination of obstetrics and inpatient psychiatric services. Ascension also announced on July 11 the merger of Providence with Baltimore’s St. Agnes Healthcare to create Health System.

Kolk, who once worked for Johns Hopkins in Saudi Arabia, took over at St. Agnes in 2015. With the merger, he is now the head of Health System for Washington/Baltimore Ministry Market. The company also has reasserted its intention to establish a “health village.”

What does that mean? Follow that 85 percent mentioned by Kolk.

Apparently the company has recognized that it has been missing out on potential revenue. So it’s time to cash in. Providence is located on 30 acres of prime real estate in a market where land value seems to know no ceiling.

Ascension has decided to reduce health care expenses by relying, at least in part, on technology. Health System will focus on “telehealth” while jumping into so-called “care coordination,” which does not necessarily mean providing direct services.

“In addition, Providence will look at non-healthcare-related services that impact an individual’s well-being,” company officials said in the announcement. “This new approach will allow Providence to take a leadership role in transforming healthcare delivery.”

That is corporate speak.

That “health village” is nothing more than a mixed-use development project. It may include a wellness center, but there also will be retail outlets and senior housing. The company already owns more than 50 senior citizen facilities, according to its website.

Did I mention that Ascension also provides, through its Solutions Division, “physician practice management, venture capital investing, investment management, biomedical engineering, facilities management, information services, and risk management”?

In other words, Ascension is no down-on-its-luck company.

Low-income residents are likely to take the hardest hit. Most District elected officials and other city leaders have lamented the closing of the acute care facilities at Providence: DC Council Chairman Pro Tempore Kenyan McDuffie, who represents Ward 5 where the hospital is located, said he was “deeply alarmed.”

Ward 7 Council member Vincent C. Gray, chair of the Committee on Health, said he was “deeply troubled.” At-large member Elissa Silverman told me it is “very worrisome.”

“We want to make sure people have access to health care facilities close to their homes,” she said, noting the inequity of the current delivery system. Residents in Northwest have their choice among some of DC’s best hospitals, including MedStar Georgetown University Hospital and George Washington University Hospital. However, “if you live anywhere on the eastern end of the city, you have fewer options,” Silverman said. A new hospital may be constructed on the St. Elizabeths campus in Ward 8, but that won’t happen in time to fully buffer the effect of Providence’s actions.

Oddly, in the Ascension announcement LaQuandra Nesbitt, director of the DC Department of Health and a medical doctor, praised Health System’s action. “Providence’s new approach is a positive step towards creating a comprehensive, accessible, equitable healthcare system capable of providing the highest quality services in a cost-effective manner to those who live and work in DC,” she said.

Talk about being out of touch.

When Providence closed its maternity ward in 2017, Howard University Hospital was pressed into service, according to Howard University President Wayne A.I. Frederick, who is also a doctor. In a statement reacting to Health System’s announcement, he said the hospital “answered the call to lend support to displaced patients and entered a partnership with Unity Health Care to expand obstetrics access to underserved areas across the District.”

Frederick said his hospital has “witnessed quantifiable growth in our patient base and emergency health,” ending its 2018 fiscal year with a $20.4 million balance.

The city was fortunate to have Howard University step in, especially considering the challenges around maternal mortality among African-American women. The New York Times described the scope of the crisis in a recent magazine article. The United States is one of only 13 countries in the world where maternal mortality is worse than it was 25 years ago. The U.S. Centers for Disease Control and Prevention has estimated that each year between 700 and 900 women die either during pregnancy or during delivery.

Howard University Hospital may have been in a position to pick up some of the slack. Can it absorb future acute-services needs? Will the move by Kolk and his colleagues at Ascension jeopardize the well-being of other facilities in DC? The current state of affairs portends a damaging domino effect for all District residents, despite cheerleading by Mayor Muriel Bowser’s health director.

jonetta rose barras is a DC-based author and freelance writer. She can be reached at thebarrasreport@gmail.com.