Local officials expressed concern Tuesday over the challenges facing Columbus Regional Health and other hospitals across much of the state and country as the health care industry grapples with deepening uncertainty surrounding government funding, changes to reimbursement rates and other factors.

The comments come after CRH announced plans in recent days to lay off up to 50 workers, close two practices and end its sports medicine program, citing what hospital officials described as “unprecedented challenges and financial hardships.”

The practices include CRH’s Inpatient Rehabilitation Unit, which is described on its website as a specialized unit focusing on rehab services for strokes, amputations, brain and spinal cord injuries, orthopedic procedures and other debilitating conditions.

The layoffs also include staff at CRH’s Orthopedics and Sports Medicine practice. The county-owned hospital announced last week that it planned to close the practice and end its athletic trainer program with the Bartholomew Consolidated School Corp., Flat Rock-Hawcreek School Corp. and IU Columbus.

Columbus Mayor Mary Ferdon described CRH and the city as “critical partners in addressing health and wellness issues which affect our community.” The two entities have worked together to support a range of initiatives, including substance abuse disorders, mental health, wellness and related challenges, as well as NexusPark.

“I spoke with (CRH) CEO Steve Baker last week, and we talked through the changes CRH leadership believes need to be made to be sustainable and to continue to provide local care for their core businesses,” Ferdon said. “Change can be difficult, and I’m sorry for those employees who are affected.”

“Health care is undergoing many changes, and there is a tremendous amount of uncertainty from changes happening at the state and federal levels,” Ferdon added. “Currently, it’s hard to say how changes in the federal budget will affect our local hospital and healthcare providers — which then trickles down to our residents and employees. We deal with employee health care needs and costs every day at the city as we work to provide effective, accessible and affordable health care. We value having a county-owned hospital in Columbus and will do whatever we can to support this transition.”

Bartholomew County Commissioner Larry Kleinhenz said the CRH Board of Trustees met with the commissioners last week to notify them of the planned layoffs. CRH is a county-owned hospital.

During the meeting, the board members told the commissioners that they planned to lay off up to 50 workers, though the actual number of layoffs would most likely be somewhat less, potentially around 35 to 40, Kleinhenz said.

“While we hate to see jobs lost, it’s good to see the board making tough decisions in areas that become a financial burden to the whole system,” Kleinhenz said. “They have tried to give adequate notice to those employees. Some will be absorbed in other areas, while others will go elsewhere. We always hate to lose quality people, so efforts will be made to retain if possible.”

Fifty workers represents around 2% of the hospital system’s workforce. A notice that CRH filed with the Indiana Department of Workforce Development states that the layoffs were expected to start June 24.

CRH officials said a range of “outside pressures” influenced the decision, including reductions in government funding, changes to reimbursement rates, “a lot of uncertainty just with government legislation and administration in general,” among other factors have added further pressure to an already challenging landscape in the healthcare industry.

CRH officials emphasized that the decision was not made lightly and comes after a review of the potential impact in the community, whether there are alternate options for affected patients, among other factors.

“The changes associated with these closures will take place over the coming months, and these decisions have been communicated to the workforce members and providers directly affected,” CRH spokeswoman Kelsey DeClue said in a statement. “The organization is actively supporting those inpatient and practice workforce members affected in considering alternative employment options within CRH when and where possible. We are also committed to working with our partners in the school corporations with the goal of providing a smooth transition for the athletic trainer program.”

Last week, CRH officials told The Republic that the hospital system was facing “massive hurdles,” including rising costs for supplies, legislative scrutiny, as well as federal and state funding cuts.

“Columbus Regional Health, like many other hospitals and provider-based health care systems, is facing unprecedented challenges and financial hardships, currently, most of which are caused by outside factors,” DeClue said last week. “Rising costs in supplies, legislative scrutiny, along with federal and state funding cuts, pose massive hurdles, especially for non-profit county hospitals. Simply getting paid for the services Columbus Regional Hospital and Columbus Regional Health Physicians provides its patients is becoming more difficult as health insurance companies increasingly delay or deny reimbursement for hospitals and providers.”

Dr. Cary Guse, who was director of sports medicine at CRH and has been the team doctor for East and North for the past 20 years, said the loss of CRH’s sports medicine would be a “huge loss” for any school’s athletic program.

“Athletic trainers and athletic programs go hand in hand, from prevention to management of injuries to emergency action plans to just helping coaches keep athletes safe out there,” Guse said. “…As finances get crunched, more and more hospital programs, orthopedic programs are dropping it just because the return on investment is not what we would like it to be sometimes.”

Guse said one key issue is that reimbursement rates for providers has not been keeping pace with inflation.

“Inflation goes up but reimbursement for physician services … does not,” Guse said. “…It costs more money to do business. The government is not keeping up with reimbursement at the level that inflation is going up.”

Another issue is that trainers do not bill student athletes for the services they provide, Guse said. Instead, hospitals aim to recoup their investment when injured athletes seek follow-up services — such as physical therapy, imaging or surgery — at their facilities.

However, many local student athletes have ended up deciding to go to facilities that are not affiliated with CRH for those services.

“When the athletes go out of that system, then basically, the trainers are providing their free services, and there’s no reward at all for the people paying their salaries,” Guse said.

BCSC has said it “exploring options” to ensure that students continue receiving high-quality athletic training support but acknowledged that “creates a potential financial impact” on the school corporation.

“Our priority is maintaining the health and safety of our students, and we are committed to having a plan in place before the transition takes effect,” said BCSC Communications Coordinator Josh Burnett. “BCSC is actively exploring options to ensure that the current high-quality athletic training services continue without interruption for students. We’ll be happy to share more details as they become available.”

Guse, who is a board-certified orthopedic surgeon and fellowship-trained sports medicine surgeon at Southern Indiana Orthopedics in Columbus, said the loss of CRH’s Inpatient Rehabilitation Unit is also a “huge loss for the community.”

Guse said he has had patients who have been treated in the unit.

“They did a great job,” Guse said. “…Those patients were getting specialized rehab for five to six hours a day and getting back to life. …There are rehab hospitals in Indianapolis, but this was a great option. …And certainly from a family standpoint, not having to drive an hour every day to see your loved one was hugely advantageous.”
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