Larned residents trying to save hospital

The community hospital here and its long-term care unit are scheduled to close Sept. 30.

“This is devastating for this community,” said Mary Beth Herrmann, who runs that the Pawnee County Health Department. “We’re in a very grave situation.”

Herrmann is part of the Pawnee County Community Health Organization, a group that is trying to keep St. Joseph Memorial Hospital open. The organization was scheduled to host a town hall meeting at 7 p.m. Monday.

“The first thing we have to do is educate the public,” Herrmann said. “There’s a bigger picture here that people need to know about.”

The hospital’s directors announced June 10 that they planned to close the 25-bed facility.

The hospital is owned by Catholic Health Initiatives (CHI), a Denver-based nonprofit corporation with 78 hospitals and 40 nursing homes and assisted living facilities in 20 states. CHI is the nation’s second largest Catholic health care system.

CHI also owns the Central Kansas Medical Center in Great Bend, which is 21 miles northeast of Larned. It has 36 beds.

Administration of the Larned and Great Bend hospitals was merged in the late 1980s.

Great Bend, population 15,300, is the larger of the two cities. Larned has 4,300 residents.

On health-care issues, the two communities haven’t always been on the same page.

‘Neglected step child’

“We in the Larned and Pawnee County communities have felt for many years that we’ve not been treated fairly in the area of medical care,” said Robert Pivonka, now in his fifth year as mayor of Larned.

“At one time, they tried to close the emergency room and the delivery room, and there had to be a community effort to get that stopped,” Pivonka said. “Now, they’ve moved a lot of the lab work to Great Bend. They’ve made a shell out of the hospital here. They think the people here will take their business to Central Kansas, but that’s not happening. People here are saying, ‘To heck with that, we’re going to Hays or Hutchinson.’”

In an open letter printed in the Larned and Great Bend newspapers, Pivonka called the local hospital “a neglected step child.”

But Sharon Lind, president and CEO at Central Kansas Medical Center in Great Bend said the decision to close the hospital was based solely on economics.

The Larned hospital, she said, has lost money in each of the last 10 years or more.

“The operating losses date back a significant period of time,” Lind said, “and those losses have been significant.”

Lind noted that in the past 10 years, the Larned hospital’s market share had not risen above 20 percent.

“That means one of five people who could have been utilizing health care services there at the hospital were doing so elsewhere,” she said.

In recent years, the hospital’s average daily census has been between two and three patients; its emergency room sees between five and six patients a day.

One-third of the 30 beds in the hospital’s long-term care unit are vacant.

Losing population

The area’s demographics, too, have changed for the worse.

“It’s an aging population and a population that’s declining in numbers,” Lind said.

According to census data, Pawnee County had 7,525 residents in 1990; 7,217 in 2000; 6,415 in 2007.

Lind said she and CHI executives did everything they could to keep the Larned hospital open.

“It was a very difficult decision,” to close it, she said.

Lind said CHI was unwilling to sell or lease the three-story hospital back to the community.

“CHI officials notified Larned community leaders late Wednesday that they were not in a position to sell, transfer or gift the hospital to the community of Larned or to any other group,” Lind said. “We are moving forward with the closure plan.”

Try the Vatican

Pivonka participated in the conference call with CHI officials.

“We were told that it was their decision to make and that if we wanted to appeal their decision we would have go through the Vatican,” Pivonka said. “That sounds like I’m kidding, but I’m not. We were told we had no recourse.”

Now, he said, Pawnee County Community Health Organization wants CHI to at least let the group hold on to the hospital’s critical access designation.

“Basically, if you’re a small town, the only way you can have a hospital is if it’s critical access,” Pivonka said.

Critical access refers to a federal designation that allows a hospital to bill Medicare for 101 percent of its outpatient, inpatient, laboratory, physical therapy, and post-acute care costs.

The designation is meant to ensure the nation’s rural areas have access to emergency, primary and acute care.

A critical access hospital agrees to limit itself to no more than 25 beds. Its average inpatient length of stay may not exceed 96 hours annually and it’s required to provide emergency room care.

Generally, larger hospitals — Central Kansas Medical Center, for example — have not pursued critical access designation because they don’t want to limit themselves to 25 beds.

Designation will be moot

At first, a critical access hospital had to be at least a 35-mile drive from another hospital but in 1997, states were allowed to waive the distance requirement. Congress reinstated the distance requirement in 2005.

Today, Kansas has 83 critical access hospitals, the most of any state.

The Larned hospital’s critical access designation is controlled by CHI and Central Kansas Medical Center, which is not a critical access hospital.

Lind said that when the Larned hospital closes, its critical access designation will be moot.

Pivonka said he and other Pawnee County Community Health Organization members will ask the Kansas Department of Health and Environment to keep the designation active while the group figures out a way to reopen the hospital.

But KDHE is unlikely to agree to that.

“It would be real questionable,” said Charles Moore, director of medical facilities at KDHE.

Moore said when — or if — the hospital closes, the federal government will no longer recognize the designation.

“After that, they would have to either build a new building or somehow reopen the old building,” he said. “Then, they would have to get licensed and then get certified through one of the accreditation organizations, and then they could apply to the Centers for Medicare and Medicaid Services. The problem then is that we’ve already got 83 CAHs (critical access hospitals) in the state…it’s like every inch is covered.”

Moore noted that Larned is less than 35 miles from hospitals in Great Bend, Hoisington, Ellinwood, Kinsley, St. John, and La Crosse.

“It will be hard for them to make the access-to-care argument,” Moore said. “I’m not saying it can’t happen, but it would take an act of Congress, and I mean that literally.”

A second Great Bend hospital

Larned leaders’ criticism of CHI is compounded by that fact that a group of former Central Kansas Medical Center physicians opened a surgical center in Great Bend in 2001. The group is planning to open a 33-bed general hospital next month to compete with the city’s Catholic hospital.

“That’s the bigger picture,” Pivonka said. “Central Kansas knows it’s going to be scrambling for its life, so they’ve turned a blind eye to Larned. I understand that they have to do what they have to do, but they shouldn’t be saying Larned isn’t big enough to support a hospital because that’s not what’s going on. That’s what really irritates me.”

Pivonka’s analysis, Lind said, was off-target.

“Will the competing, physician-owned hospital have an impact on our operations here? Absolutely,” she said. “And from a business perspective, would it be wise for CHI to let another group operate the Larned hospital and, in turn, create more competition for Central Kansas Medical Center? No it would not.

“But that wasn’t what was behind the decision to close the hospital,” Lind said. “The decision was based on the fact that we could no longer subsidize the losses incurred at that institution.”

Rebound predicted

Dr. Mark Van Norden moved to Larned in August 2005.

“Fresh out of residency,” he said.

Van Norden worked for Central Kansas Medical Center’s clinic in Larned for two and a half years before opening his own practice.

“I just got fed up,” he said. “And I have to say that I’m not surprised by anything that CHI has done. I’ve seen it coming for about the past year and a half.”

Van Norden said he expects the Larned hospital to close and the community to lose its critical access designation.

“I know this is upsetting to a lot of people, but I think it needs to happen,” he said. “I say that because Larned needs to have local control and the only way that’s going to happen is for CHI to give it up, and the only way CHI is going to give it up is for the hospital to close. I don’t like it, but I don’t see a way around it.”

Larned, he predicted, will rebound.

“These are difficult times and adjustments will have to be made,” Van Norden said. “But if we stick together as a community we can make things work. We’ll get through this. I have faith.”

-Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at dranney@khi.org or at 785-233-5443, ext. 128.