In The Lead: Innovation / Decentralized medicine

Hospital care moves away from traditional hospital setting


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"Eds and Meds" may still be the twin engines driving the region's economy, but there are clear signs the "Meds" portion is steering away from the traditional hospital setting when it comes to job creation.

Some 3,900 jobs were cut at Pennsylvania hospitals last year, according to the Hospital and Healthsystem Association of Pennsylvania, and the state Department of Labor and Industry says 6,800 acute care hospital jobs have been lost across the commonwealth since 2008, a 2.52 percent decrease.

The story is the same closer to home.

A Hospital Council of Western Pennsylvania survey earlier this year found that the region's hospitals dropped 2,000 full-time equivalent jobs — across all job categories from escorts and housekeepers to administrators and physicians — in the last six months of 2013.

Distribution of health care services
(Click image for larger version)

For the year, employment in Western Pennsylvania hospitals dropped from 71,457 to 69,439 full-time equivalents, a 2.82 percent decrease.

While hospital employment has varied in the past, "This is significantly different," said Denis Lukes, vice president of financial services for Hospital Council, noting that 70 percent of the region's 57 hospitals reported reductions in full-time equivalents during the last half of 2013.

"We've seen little ups and downs before, but I don't think we've seen anything like this in recent times."

While hospitals are cutting back on personnel, though, other parts of the health care sector are seeing notable increases in new hires.

Ambulatory care centers, for example, have added 32,300 jobs statewide since 2008, while home health care and nursing care facilities each added another 8,800 jobs. In the past year alone, those two sectors added between 1,000 and 1,700 jobs, respectively.

The numbers — declining in hospitals and increasing in community settings — reflect a number of undercurrent changes that have been at work in health care for years, changes which have accelerated with passage of the 2010 Patient Protection and Affordable Care Act.

With less money and fewer patients coming in, hospitals are becoming less the solar center of health care while patient-centered medical homes, nursing facilities and community-based ambulatory surgical centers take a more prominent role.

Hospital closings, such as Braddock and Suburban General in Bellevue, as well as Jeannette in Westmoreland County, "are not isolated incidents," said Martin Ciccocioppo, vice president for research for the Hospital and Healthsystem Association of Pennsylvania.

"There will always be a need for emergency departments and acute care settings, but the hospital as we know it needs to have a broad focus because they are now being held accountable for keeping the patient healthy, which they weren't before."

What does that mean for someone interested in a health care career?

"The good news is that there will be work. The bad news is you will probably be overwhelmed with work," said Stephen Foreman, associate professor of health care administration at Robert Morris University. "I can't see the demand for medical care decreasing in the next 30 years. The demographics just drive it."

So while there should be ample job opportunities in health care, it's just not as likely that you will report for work at an acute care hospital.

Mr. Ciccocioppo said hospitals "were holding our own through the recession" of 2008. But continuing reimbursement cuts — particularly the 2 percent, across-the-board sequestration Medicare cuts mandated by Congress — plus reduced inpatient volumes has forced hospitals to look closely at their costs and personnel costs in particular.

"What we need to be able to work through this transition is stable state and federal funding." In other words, no more cuts and preferably some increases from hospitals' biggest payer, Medicare.

Meanwhile, the shift is underway, even at the hospital association itself.

"Our mission is no longer keeping hospitals financially solvent. The mission of [the Hospital and Healthsystem Association of Pennsylvania] is a healthy Pennsylvania," said Mr. Ciccocioppo.

To that end, the trade association is collaborating more with the other parts of the health care delivery system, centering its focus on patients.

"Inpatient hospital stays have been the bread-and-butter of the hospital industry," said Mr. Ciccocioppo. "Now we're recalibrating to be the integrated delivery system that is taking care of the patient, not just in the inpatient setting but taking care of the patient throughout the continuum of care."

— Steve Twedt: stwedt@post-gazette.com or 412-263-1963.


First Published May 13, 2014 11:26 AM

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