If You Can’t Believe Your Eyes……

Daily Observer

December 13, 1974

The Community Medical Hospital is planning to raise nine million dollars to put about 100 new beds into operation. The nature of the beds and the architectural configuration of the new wing, are important considerations, but the entire venture may be nothing more than a ‘pipe-dream’ because before the hospital can build its new wing it must get a certificate of need from the state.

That isn’t quite true. The fact is the hospital can build its new wing and put it in operation, but without a certificate of need the third parties, Blue Cross and Medicare, will not pay for patient care in the new beds. In addition, the word from Trenton is that probably after the computers stop whirring and the population feedbacks are calculated, only thirty two beds will be approved.

More alarming is that the annual cost for a hospital bed has risen to about $80,000 per bed, and are predicted to reach $90,000 by the time plans are completed, money is borrowed, certificates obtained, and the foundations laid.

If, however the state will approve only 32 beds of the 100 requested, there is no way the hospital can draw cogent plans or make realistic projections.

In addition, skilled nursing homes build on the national average at a cost of $20,000 per bed. Skilled nursing homes are apparently as safe as hospitals, otherwise they would be licensed as domiciles for the sick. What happened to the $60,000 dollars differential between the cost of a hospital bed and a nursing home bed?

If the difference is due to the operating suites for surgical procedures, then it would seem wise to construct some hospitals for $20,000 per bed to take care of non-surgical cases. These would be strictly medical hospitals. They would not have coronary care units. They would not have emergency rooms, they would not have operating rooms. They could siphon off from the general hospital about 50 percent of the patients who have no need of an $80,000 per bed facility.

But there is a catch. If someone wanted to build 1—non-surgical beds at $20,000 per adjacent to Community Hospital, then the Community Hospital wouldn’t be able to get a certificate of need for expansion. The management of Community Hospital might fight the approval at the B Agency, which is supposed to be the medium by which the community makes its needs known to the state agencies.

The above scenario is fantasy anyway, because it is unheard of in this country to build a hospital bed for $20,000 since $80,000 is the national average. Yet, a skilled nursing home could easily be turned into a chronic care hospital by simply adding the appropriate nursing staff and expanding its pharmacy.

Since skilled nursing homes are equipped to care for patients just a notch below the degree of illness required for hospitalization, then it would seem logical for physicians to use these institutions for patients in that category instead of flooding the hospitals with them. But there’s a catch. Blue Cross and Medicare will not pay for patients in such institutions unless they spend at least three days in a real hospital.

If all of this sounds confusing, try to straighten it out yourself by making a few telephone calls to the various agencies at local, state and federal levels. The confusion will mount. You will find, if you are fortunate enough to get past the secretary, that medical care in America has been confounded by the distant planners whose tardy computers pretend that they are plugged in to the contemporary scene.

If you know that there is a bed shortage because you continually pass stretchers in the hall, if you know that the coronary care units are filled to capacity because serious cases become hidden in private rooms, you are asked not to believe your eyes and ears, senses and memory, because they contradict the latest computations from IBM and Univac.

The administrative merry-go-round was built by the government in collusion with the insurers when they found that the cost of bringing the bonanza of the investment of billions of dollars of medical research to the public will be more billions.

But if we are to believe the founding fathers, the nation was established to provide life, liberty and the pursuit of happiness to its citizens. What better way to spend our wealth than on the health of our citizens? Penny-pinching on health and the fine tuning of available beds for community needs may look good on the drawing board, but it usually leaves some poor guy with a heart attack lying unmonitored on a stretcher in a darkened hall. Better ten unused beds than one patient suffering alone at home because of hospital overload.

The medical community of the nation is bound like Gulliver by the Lilliputions in fine skein of administrative codes and government laws, so exquisitely logical that they border on insane.

Waste is intrinsic to the delivery of medical care. They only question is whether the waste will be in money or lives.