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Dear John,

We need to talk. It’s not you. It’s me.

I’ve been your publicly-owned, independent community hospital for 75 years.

You and other members of the county commission have done your level best to be good stewards of me over the decades, appointing thoughtful board members who helped us keep the lights on and the ER open year after year. You even raised the millage rate to help fund that wing we added in the 1980s. I’m so grateful to you.

I’ve been faithful in return. I’ve been an unfaltering pillar of our small community, supporting hundreds of steady, well-paying jobs, attracting other businesses to town, providing the warm security of neighbors caring for neighbors, offering good care, close to home. It was a great partnership. I’ll never forget those days.

But things have changed. You’ve changed. I’ve changed, too. Though it hurts me to say it, you may not be enough anymore to support the care I need to offer now.

I fear it may be time for us to go our separate ways. It may be time for you to let me go. How did we reach this point?

Our community has changed dramatically since I opened my doors in the 1940s. Back then, we were a long 60 miles from the city and had thriving local businesses and factories. We were the only healthcare game in town, we had all the care people needed and we were delivering scores of happy babies each week.

But you know what happened. Our younger generation migrated away for opportunities elsewhere. The number of local employers faded. Schools and roads and other county services became more expensive but there were fewer locals to pay the taxes to fund them.

And changes in healthcare?

The cost of providing care burst through the ceiling years ago and continues to climb like an untethered balloon. The cost of attracting and keeping good nurses, of medical technology, of buildings and operations keeps going up while my reimbursement keeps going down. It’s not a winning combination for either of us. How often will you raise taxes just for me?

Those happy days where I was the focal point of care are gone. People now travel the interstate to the big city for the big brand care, and the big brands themselves have invaded, building clinics and physician office outposts in those areas where our population is wealthier and growing. I’m lucky to deliver 20 babies a month now, which is barely enough to be sure we do every delivery well.

Let’s face it, we can’t continue this way. I not only need continued steady funding, but also access to resources it would be irresponsible to buy on my own, even if I could. I need to be part of something more to take care of the families in the community we both serve.

Yes, we could hang on as we are now for a bit longer. But neither of us would be happy. And it would end ugly as we watch our days cash on hand dwindle away and close one service after another. And bankruptcy? Who wants that?

Instead, it’s likely time for us to end our exclusive relationship and start seeing – ahem… “exploring partnerships” with others.

You may have seen this coming for a long time. Others, too, are consciously uncoupling.  Across the country, other county commissions, city councils and boards of community not-for-profit hospitals are pursuing alliances, partnerships and outright sales to larger healthcare organizations to ensure they’re prepared for the future. These new relationships can help them expand reach through improved access, more services and better clinician recruitment.

I know change is scary. Giving up local control and ceding aspects of our operations – including the control of so many local jobs – is a big shift from the relationship we’ve had for so long. But if we don’t make a change now, there may be no local jobs to control here anyway.

Still holding on? Need a Kleenex? I understand. I do. But ask yourself these questions:

  1. Do you really want to be in the business of healthcare? Healthcare is more complicated, more expensive, more competitive and more politically fraught than ever before. The position of traditional acute-care facilities is shifting dramatically as government and private payers move to value-based care. If providing care today is hard, it’s going to get harder. Is that a liability you want?
  1. What are you willing to give up? Sure, there’s power and pride in controlling the local hospital. Not only does it offer important access to medical care, it’s an economic engine that provides paychecks and taxes and makes it easier to recruit other businesses to town. That’s difficult to surrender. I get it. But for all of that, your tight grasp limits what we can do and what healthcare can be in our community. Can you make the sacrifice today for tomorrow’s gain? What’s the legacy story you want to tell?
  1. Are there worthy competitors in our community? If so, we may have potential partners at our door. If some of the big healthcare brands in the region are establishing beachheads close to our home, then it’s likely there will be organizations interested in allying with us. A partnership could advance their strategy while supporting our purpose – continued local access to high quality care.

I know what you may be thinking: Looking for a partner may feel as if you’re giving up on us, as if you’re abandoning the responsibility for the provision of local care you’ve been entrusted. Not so. You’re helping ensure it.

Here’s the good news: Many local community hospitals like ours have valuable attributes to offer these larger partners. An expanded service area, real estate, talent and the trust of the many “lives” that we cover, to name a few. We’re seeing that happen all over the country. It might be time for us, too: These days, more than six in 10 of the 5,157 hospitals across the U.S. are part of a larger system, with all the support those relationships provide. Government ownership, on the other hand. has dropped by nearly 30 percent since 1995.

Beyond all of that, though, your endorsement of the partnership – your blessing for it – is a political advantage every potential partner will crave.

You may be surprised to learn that we can act from a position of strength, which is what our community deserves.

Yes, it will be different. We won’t be like we were before. But, what is? The only constant is change. Time to let me go so we can build something new, something healthier, something sustainable.

I wish us both well.


Your Hopeful Community Hospital