This week marks the end of Catholic healthcare in our region. With the purchase of St. Joseph’s Medical Center by a non-denominational hospital company, a 148 year legacy of service is finished. I spent three years in Catholic healthcare in Boston and that company, Caritas Christi, is also a thing of the past, having been purchased by venture capitalists.
The reality is that we have too much hospital capacity in Baltimore. The owners of St. Joseph’s, Catholic Health Initiatives (CHI) of Denver, Colorado, had only one hospital in the area and it was losing a lot of money. CHI is a very large company with $9.65 billion in annual operating revenues but after a number of years of losing money in Towson, they decided to divest themselves of St. Joseph’s. CHI is a mission-driven organization and they are also realists. It appears that the company could only rationalize losing millions if they could prove that there was an unmet need. With all of the excess hospital beds in Baltimore, they could not justify the need so they got out. Now, a smaller hospital company is the new owner.
What a long way from the reality found by the Sisters of St. Francis of Philadelphia in 1864 when Mrs. Catherine Eberhard donated three row houses on North Caroline Street to be used for the sick and infirm. In that era, there was not much available to cure disease. Hospitals were started as a place to care for the sick who were also poor. Those with means were cared for in their homes by their families. The Sisters of St. Francis and others who joined with them in this noble mission dedicated themselves to helping others in their time of need.
In 1870, the State approved the Act of Incorporation to create the Saint Joseph German Hospital and in 1872 a new facility with that name opened at Caroline and Oliver Streets in Baltimore City. During the 20th Century, with the advances of modern medicine, the hospital grew and changed and in 1965 (the year of the opening of GBMC), St. Joseph’s moved to Towson. In 1981, the hospital became a part of the Franciscan Health System and they began doing open heart surgery the next year. In 1996, St. Joseph’s became a part of CHI and continued their growth in heart and orthopedic procedures.
Everyone in Baltimore knows what happened next with the governmental investigation and the accusations of unnecessary procedures. What has not been discussed is how the hard-working nurses, doctors, and other clinicians kept serving patients. Unfortunately for them, the business model that St. Joseph’s had chosen is hard to make work with so many hospitals pursuing the same model, and the American people and American businesses are desperate for a new model. You see, building a lot of hospital beds and waiting for people to get sick to use them, or only providing a lot of elective procedures because that is where you make the money, has led us to our national predicament where we are bankrupting our federal government, our state government and making it difficult for businesses to provide health insurance to their people. The new model, a system of health care that works to keep people healthy and limits the need for patients with chronic disease to be admitted to the hospital, requires different capacities and capabilities.
The biggest capacity that is required of the new model is primary care. In the Greater Baltimore Health Alliance, (our system’s Accountable Care Organization) we now have close to 100 primary care providers, many of whom are working in Level 3 patient centered medical homes with care managers, extended office hours, and a fully functioning patient portal, among other things, to keep people healthy. None of these things are focused on by hospital companies using the old model, like St. Joseph’s.
It is sad to see the end of the legacy of the dedicated Sisters of St. Francis and all of the hard working physicians, nurses, and others who worked with them on a mission of service to others. We know however, that their spirit lives on in those who embrace the new model of service and who are willing to let go of the old model where filling hospital beds and focusing on services that make money were acceptable endpoints in and of themselves.