NEWS BLOG (WSAU) Go big, or go home.

That’s the down-side of government regulation and shrinking margins.

From this outsider, that’s what’s happening with Ministry Health Care. There’s news today that Ministry’s hospitals will soon be managed by Ascension Health Alliance, which operates 70 others.

My family doctor when I was a boy was a family friend. Dr. White knew my mother and father. As a kid, he was the only doctor I’d ever seen until I went off to college. When I was in high school, Dr. White added a partner to his practice. Dr. Harlan was a nice man, a capable physician, but he wasn’t our doctor. I remember Dr. White saying that two successful doctors could operate more efficiently than one. There were cost-savings to sharing an office, equipment, nurses, and business-staff.

When my first child was born, Dr. White was still practicing medicine. He was part of a much larger pediatrician group – 15 doctors spread out over six offices. It was hard to get an appointment with him. And since he was nearing retirement, it was suggested we begin seeing another doctor in the group. The new medical group was large and impersonal – but it was the only way to process all the insurance and Medicaid paperwork that was critical to having cash-flow.

That was before the health care reform.

The Medicare and Medicaid payments that hospitals depend on are going to get squeezed even more. (You’ve heard about the $700-billion that are being taken out of those systems – as Mitt Romney and Paul Ryan are likely to remind us, repeatedly.) Obamacare will mean more people with insurance (potentially good for health care providers); there will be more paperwork and a greater likelihood of price controls (potentially bad). Modern hospitals are already anticipating these changes. For instance, St. Clare’s Hospital already has fewer patient-beds that many older hospitals. The fear is the long-term sick might be parked in hospital beds with low government reimbursements; the solution is to provide as much out-patient care as possible.

Now comes the next round of ‘lean and mean’ – a combined Ministry-Ascension means lower administrative costs. Marketing savings. One hospital lab can process the medical tests for multiple facilities. One medical center can focus on one area of expertise. Specialists can be shared. The costs of electronic-medical-records conversion can be spread out.

None of this is necessarily bad, just different. Our health care delivery system is expensive. Costs have to be wrung out. There are still many unanswered questions, both about this change and what the overall healthcare landscape will look like. This is clear: as big is Ministry was – 15 hospitals, 46 clinics, 12,000 employees – isn’t big enough to go it alone.

Chris Conley
9/5