Make Case Against Hospital, or Approve It

The average time a patient waits in the University of New Mexico Hospital emergency room for a hospital bed to open up is 11 hours. It is not unusual for a patient to wait 20 or 30 hours in the ER for someone to vacate a hospital bed.

UNMH says occupancy averages more than 91 percent and peaks at more than 95 percent. Hospitals like to operate at about 75 percent of capacity.

Some of its old hospital rooms resemble dungeons. Its operating rooms were built in the early years of the Vietnam War.

Even so, UNM is having trouble getting state Board of Finance blessing for a $146 million, 96-bed expansion of its main hospital on Lomas. The Journal reported the board’s biggest concern was that some of UNM’s data didn’t agree with Health Department numbers.

UNMH has been squirreling away the money it needs for the hospital for some time now, so it is not asking the taxpayers for more money to pay for the expansion.

Perhaps this is just the usual political morass UNM regularly finds itself in. This is a university, after all, whose presidents have routinely fielded phone calls from state legislators demanding that they personally admit unqualified sons and daughters of constituents. Given the money and jobs involved, it would be amazing if the institution were not highly political.

UNM leaders have a not-entirely-undeserved reputation for arrogance that probably costs them political capital from time to time.

And perhaps the rumors that a competing health care system has been working in secret to scuttle UNM’s plans are true.

Working against UNM’s proposal is the simple fact that there are no industry or governmental standards for deciding whether more hospital beds are needed. Hospital operators decide for their own reasons whether they want to add beds, a decision complicated by the fact that only doctors can put a customer in a hospital’s bed.

Albuquerque’s market is funny. UNM and Presbyterian Healthcare Services employ large numbers of doctors, so they can count on lots of practitioners to admit patients to their hospitals. Lovelace Health System employs few doctors, so it tries to create services, business relationships and practice environments that entice physicians to admit patients. It is a very competitive health care market where some competitors are more successful than others. Thus, it’s possible UNMH is bursting at the seams while another hospital in town could sit half-empty.

This offends some people’s common sense, and it can be wasteful. The alternative is to appoint someone, maybe the state Health Department, to decide how much of everything (MRIs, orthopedic surgeons, acute care beds) is needed and where it should be put. The VA health system and the British national health system work this way.

UNMH is a state agency, so it’s fair to ask why it is competing against private companies in this marketplace. There are a few reasons.

For one, it is trying to get paying customers with decent insurance into its system. UNMH gets very little money from state government, so it has to be able to pay its own way by providing services people want to buy.

The fiscal 2012 audit (available to all on the university website) shows UNMH received $5.1 million from the Legislature. Bernalillo County voters approved property taxes amounting to $77.5 million to support UNMH general operations. UNMH provided $98.1 million worth of care to people who never paid their bills. It provided another $129.5 million in what it calls charity care.

UNMH spent $693 million providing medical care last year and collected payments, grants and other operating revenue totaling $633.2 million, leaving it an operating deficit of almost $60 million. It also had nonoperating revenue and expenses (things like bequests, the county tax money, interest payments, etc.) that netted out to a positive $61.4 million in 2012.

UNMH operates a teaching hospital for the university’s medical, nursing and other schools, as the Legislature has directed it to do. To train medical personnel, the hospital has to offer the services the students will be called upon to deliver when their training ends, unless, of course, New Mexico wants to host the nation’s lamest medical school.

It turns out medical schools and health campuses are pretty good economic development engines. A study done for the Association of American Medical Colleges found that the nation’s medical schools and teaching hospitals supported 3.5 million jobs in 2011. The UNM Health Sciences Center brings in about $150 million a year in out-of-state money in the form of grants. A couple of startup companies have come out of UNM HSC.

The best case against hospital expansion comes from some community health care advocates who say $146 million is better spent on more community-based clinics and programs than hospitals. Indeed, much of health care reform is designed to reduce the need for hospital beds. Finding ways to reduce hospitalizations could be a better way to spend $146 million, provided someone can show how such programs will reduce 20- and 30-hour ER holds within a reasonable period of time.

UpFront is a daily front-page news and opinion column. Comment directly to Winthrop Quigley at 823-3896 or wquigley@abqjournal.com. Go to www.abqjournal.com/letters/new to submit a letter to the editor.
— This article appeared on page A1 of the Albuquerque Journal