Ascension faces criticism over cuts at St. Joseph
IT’S PLANNING ON LIMITING SERVICES AT HOSPITAL IN LOW-INCOME PART OF CITY
A growing chorus of public officials, community leaders and health systems is calling on Ascension Wisconsin to reconsider its plans to limit the services it provides at St. Joseph hospital in a largely lowincome part of Milwaukee.
“There is a reason we (the city) have the second-lowest health outcomes in the state,” said George Hinton, a former health care executive. “And it has a lot to do with how the systems are applying their resources to poor communities.”
If health systems continue to abandon poor neighborhoods, said Hinton, chief executive officer of the Community Relations Social Development Commission, then people will be disenfranchised from good health care.
“It’s just not right,” he said. “It’s just not what nonprofit organizations with a mission are supposed to do.”
Others in the community, including Milwaukee Mayor Tom Barrett and several members of the Common Council, also have criticized Ascension Wisconsin’s decision to no longer provide inpatient care and other services at the hospital in a largely low-income neighborhood.
“It’s just not right. It’s just not what nonprofit organizations with a mission are supposed to do.”
George Hinton, chief executive officer of the Community Relations Social Development Commission
“At the end of the day, the organization purportedly is a nonprofit organization, which as part of its mission includes special attention to those who are poor and vulnerable,” Barrett said.
Hospitals are not the center of health care that they were 50 or even 25 years ago, and many experts contend that access to primary care — as well as housing, education and jobs — can have a far greater influence on improving health in poor communities than the number of hospitals.
But Ascension Wisconsin’s planned move is certain to force patients to shift to Aurora Sinai Medical Center and Froedtert Hospital — and both of those hospitals are at or close to capacity.
Aurora Sinai Medical Center has 73 staffed medical or surgical beds and an average daily census of 68 patients, a 93 percent occupancy rate, during the week, according to Aurora Health Care, now part of Advocate Aurora Health.
Last year, Aurora Sinai had to “board” 335 patients in its emergency department because it did not have available inpatient beds.
“We simply cannot support additional volume,” Aurora said in a statement.
Froedtert Hospital said it often runs at 90 to 95 percent capacity for its medical and surgical inpatient care.
“We cannot make up for the loss of services at Ascension St. Joseph’s,” Froedtert Health said in a statement.
Aurora and Froedtert said they hoped the health systems and other health care providers in the community come together soon to assess the implications of Ascension Wisconsin’s plans.
St. Joseph hospital has 50 to 60 medical and surgical inpatients a day and is projected to have a total of 4,400 inpatients in the fiscal year ending June 30, Ascension Wisconsin said.
Under its pending plan, Ascension Wisconsin will continue to operate the hospital’s emergency department, which has about 75,000 patient visits a year, as well as continue to provide obstetric care, including operating its neonatal intensive care unit.
It also will continue to provide primary care on the campus at 5000 W. Chambers St.
Ascension Columbia St. Mary’s-Milwaukee hospital also will need to add surgical and medical beds to make up for those lost at St. Joseph hospital.
It plans to move the Ascension Sacred Heart Rehabilitation Hospital to the Ascension Elmbrook campus in Brookfield and add a new medical and surgical nursing unit at Ascension Columbia St. Mary’s-Milwaukee.
That, too, will mean the health system will be providing one less service in Milwaukee.
Mounting losses
Ascension Wisconsin’s decision came after years of losses at St. Joseph hospital.
The hospital lost $20.7 million in the fiscal year ended June 30, the health system said.
It lost roughly the same amount in the 2016 fiscal year.
In all, the hospital, formerly Wheaton Franciscan-St. Joseph, lost $81.9 million in the 2012 through 2016 fiscal years, based on the most recent information available from the Wisconsin Hospital Association.
Those figures include some other operations, such as an outpatient clinic in Wauwatosa and the former Wisconsin Heart Hospital, which was closed in 2016, also in Wauwatosa.
Wheaton Franciscan’s operations in southeastern Wisconsin, which included Wheaton Franciscan-St. Joseph, became part of Ascension in 2016.
From Ascension Wisconsin’s perspective, it is remaining committed to the community.
St. Joseph hospital and affiliated services still will have an operating budget of $150 million to $160 million a year after the pending changes, Bernie Sherry, the senior vice president of Ascension Health who oversees the Wisconsin market, said when the changes were announced.
Roughly 51 percent of the hospital’s patients are covered by BadgerCare Plus and other Medicaid programs, and an additional 5 percent are uninsured. And the percentage of patients covered by Medicaid programs often determines whether a hospital makes or losses money.
St. Joseph hospital, though, is not a stand-alone hospital, Hinton noted.
“It belongs to Ascension,” said Hinton, who was president of Aurora Sinai and also worked at Children’s Hospital of Wisconsin.
“It’s not a hospital by itself. It’s a system of hospitals, a system of physicians. And just like anything else, one thing pays for the other.”
Ascension Wisconsin is part of the largest nonprofit health system — and largest Catholic system — in the country.
Anthony Tersigni, its chief executive officer, received a $17.6 million package, including bonus, in 2014, according to a Wall Street Journal analysis of IRS data at the time.
More collaboration
Ascension Wisconsin’s long-term plan for the St. Joseph campus is to invite organizations and agencies to use the available space at the hospital as a base to help address the health and social needs of the surrounding community.
That could have a greater effect on the health of the neighborhoods surrounding the hospital.
“What we need is more focus on providing access to primary care and prevention,” said Leonard Egede, a physician and professor at the Medical College of Wisconsin who is an expert on health disparities.
Hospitals are important, he said, but they don’t drive the change needed in communities where people overall are in poorer health.
Health care has been estimated to account for only 20 percent of the factors that influence health. So-called socioeconomic determinants, such as housing, education, safety and jobs, are thought to have substantial influences on health.
“Those are the things in my mind should be the talk and center of the conversation about addressing disparities,” Egede said.
Hinton agreed on the need to improve access to primary care.
“But you still are going to need hospital services,” he said.
The poor overall health outcomes in Milwaukee, he contended, don’t stem solely from socio-economic determinants.
“Some of it is because we don’t have the resources in the right places,” Hinton said.
The problem is compounded by the hyper-segregation in Milwaukee.
“Would you be reducing these services in a more affluent community?” said Milwaukee County Supervisor Supreme Moore Omokunde.
Common Council members Tony Zielinski, Bob Donovan and Khalif J. Rainey also have challenged or questioned Ascension Wisconsin’s plans for St. Joseph hospital.
For his part, Barrett questioned the contention that fewer hospital services would not affect the community.
“I am seeing more beds in wealthy areas, so I am not buying the argument that fewer beds means better health care,” he said.
That, too, is part of the issue.
All the health systems in Milwaukee County, including Wheaton Franciscan before becoming part of Ascension, have expanded in the suburbs in recent years.
“In the suburbs, they will spend millions of dollars just to make the places look like palaces,” Hinton said.
Yet health care services in poor neighborhoods often have been reduced.
“It’s as simple as that,” he said. “It’s just not right.”