Wrong premise

Picton hospital may be more efficient health care provider than BGH

Is QHC making cuts to the wrong hospital? Was the determination process used to find $10 million stacked against the Picton and Trenton hospitals? Were the right questions asked?

Some health care insiders are beginning to ask some tough questions this week about the process and methods by which it was recommended that nine beds, maternity care and endoscopic procedures be cut from Prince Edward County Memorial Hospital to reduce costs at QHC.

The recommendations have aroused much furor in this community since they were announced just over a week ago—a community that has grown accustomed to seeing its much-loved hospital whittled away by successive QHC administrations in Belleville.

In response, QHC says folks in Prince Edward County need to understand that health care must change and they must overcome their attachment to this hospital and the past in order to improve overall care and lower costs.

But is this true? Does the data actually support the assertion that costs are higher in Picton than Belleville? The answer may in fact be no. QHC’s own statistics appear to show that the cost to treat virtually every commonly diagnosed condition is lower at PECMH than it is at BGH.

The length of time a patient spends in hospital is, in fact, a bit longer in Picton than in Belleville—but the overall cost of treating that patient is lower in Picton than at BGH. In an exercise in which the hospital corporation is working to find $10 million in annual operating savings, it would seem logical that lower costs, not length of stay, should be the measure. But that does not seem to have been the case.

QHC spokesperson Susan Rowe says, however, that these statistics are misleading. She says that BGH bears the cost of an array of services that are used by patients across the region.

“The costs of the full-service lab in Belleville, pharmacy costs, diagnostic imaging, etc., are all built into the BGH cost-per-weighted case even though these are services used by inpatients at all four hospitals,” explained Rowe. “Naturally this would make PECMH appear to be very efficient because the costs have excluded any pharmacy, DI, lab tests, etc. that are being used by the PECMH patients.”

But Rowe acknowledges that it is not yet clear which is the more efficient hospital.

“We are attempting to create a more accurate analysis of the cost per patient at each hospital, but this has not been finalized yet,” said Rowe.

So how could this be? How could the six teams assembled to make recommended cuts to QHC’s administration to save $10 million, fail to measure each hospital based upon cost efficiency?

Part of this answer may lie in the composition of the six evaluation committees assembled to find $10 million in savings in the hospital corporation. None of their members, it appears, included physicians or health care professionals from Prince Edward County. The health care professionals with the most at stake in the recommended cuts weren’t at the table.

Further it appears the calculation that led to bed cuts at Picton hospital and Trenton Memorial may have been measured differently than BGH. In Picton and Trenton the calculation was based, in part, upon the notion of “conservable days,” that is an accumulation of the extra days of stay required in Picton or Trenton, versus a Ministry of Health benchmark standard. Some are suggesting that same methodology wasn’t applied equally to BGH.

But QHC chief Mary Clare Egberts denies this assertion, saying “the same data was used for all hospitals including BGH.”

Dr. Elizabeth Christie, president of the Prince Edward Family Health Team, says more information and detail are required before any cuts are imposed.

“The assumptions underlying the proposal are fundamentally flawed and not evidencebased,” said Dr. Christie, speaking before a committee of council on Thursday.

Christie believes if QHC was solely motivated by lowering its costs it would add beds to Picton hospital rather than cut them, it would conduct more endoscopic procedures and deliver more babies in Picton, not fewer.

She says the achievements made in Prince Edward County should be emulated across QHC—not torn down.

“We have a great model of integrated care in Prince Edward County—this proposal risks crushing it.”