Sinking deeper into the red, Hutcheson Medical Center in Fort Oglethorpe is facing a critical shortage of admitted patients, according to physicians and hospital board members.
An eroded local referral base and the loss of employed specialists and attending physicians hit the community hospital at the same time the recession depleted patient volumes.
The 195-bed hospital's daily patient count, or census, has averaged just 42 so far this year, and Hutcheson is losing more money than it has in years, Chief Financial Officer Gerald Faircloth said.
Dr. Carlos Baleeiro of Battlefield Pulmonology, a practice employed by Hutcheson, described the hospital's challenges as "the proverbial perfect storm."
"It's an unfortunate financial situation and such a bad combination of everything that I don't have a good fix," he said.
Jim Emberson, a member of Hutcheson Medical Center's board, which governs the hospital's daily operations, said many community hospitals have similar problems.
"We're facing some hard times due to the economy, and as a result our census has been down for quite some time," said Emberson, a former Catoosa County commissioner.
But local doctors say that more than the economy has played a role in Hutcheson's recent struggles.
Over several years, the hospital has lost many of its referring and admitting physicians and specialty coverage.
"The doctors have left so they're not getting the admissions," said Don Oliver, a trustee of the Hospital Authority of Walker, Dade and Catoosa counties, which leases the hospital building to Hutcheson Medical Center Inc. "As a member of the board of trustees, I'm very, very concerned about what's happening right now."
Several doctors formerly associated with Hutcheson said privately they wished administrators had worked harder to cultivate relationships with local and employed physicians.
Martha Attaway, chairwoman of the hospital's board, did not return calls seeking comment.
Hutcheson President and CEO Charles Stewart declined to be interviewed for this story, and the hospital's communications staff did not respond to questions submitted by e-mail.
Hutcheson officials said this week they plan to hire Plano, Texas-based Community Hospital Corp. to help wade through the financial problems and consider whether Hutcheson should enter a relationship with a larger hospital.
Hutcheson faces the same challenges as community hospitals across the country in retaining market share and competing for patients with larger metropolitan hospitals, said Mike Williams, president and CEO of Community Hospital Corp.
"This is not just in Chattanooga; this is across the country," he said.
Diagnostic Cardiology Group split with Hutcheson in October, shortly after helping the hospital get state approval for an interventional cardiac lab. The $1.7 million catheterization lab would allow the hospital to perform interventional cardiac procedures such as balloon angioplasty.
The hospital said in December it hoped to have an interventional cardiologist on staff in three to six months, but none has been hired and the plan now is on hold. Hutcheson's sole on-call cardiologist does not perform interventional cardiology procedures.
Hutcheson has no neurology coverage and has 10 days a month of on-call orthopedic coverage from Dr. Peter Mulhern, an orthopedic surgeon.
Orthopedist Dr. Chad Smith, who used to provide an additional 10 days a month, recently stopped taking emergency calls at Hutcheson after a five-year contract ended.
There are two pulmonologists, Dr. Baleeiro and Dr. Nathan Mull with Battlefield Pulmonary.
Other primary care physicians who had been a major source of Hutcheson's patient referrals have become employed by larger hospitals.
Two years ago, Dr. David Bosshardt, a major source of patient admissions, went to HCA, which owns Parkridge Medical Center in Chattanooga.
This summer, Battlefield Internal Medicine physicians Tiku Bhutwala, William Horton and Terri Jones affiliated with HCA as Parkridge Medical Associates of North Georgia. The practice still treats patients at Hutcheson.
In 1994, TCFPA Family Medical Center, an eight-physician group in the Hutcheson on the Parkway physicians building, became a part of the Memorial Hospital physicians group, Memorial Health Partners.
Magdalena Kowalski, a TCFPA physician, emphasized that the group steadfastly has supported Hutcheson over the years and noted that patient preference often dictates admissions.
"Our practice has supported the community. This is our community," she said. "We go to both hospitals. We go to Memorial, we go to Hutcheson."
IN THE SHADOW OF LARGER HOSPITALS
The relationship between larger metro hospitals and county-owned suburban hospitals has shifted in recent years, said Williams of Community Hospital Corp.
Historically, suburban community hospitals such as Hutcheson found their niche in obstetrics and gynecology, primary care and general surgery cases, while larger metro hospitals handled highly specialized surgeries and trauma care, he said.
But a squeeze on insurance reimbursements and rising numbers of uninsured patients put added pressure on larger hospitals, Williams said.
"Safety net hospitals," which treat a large share of patients who can't pay for their care, were particularly strained, he said. That sent urban hospitals looking for paying patients in the territory of community hospitals, he said.
"They have needed to look to the suburbs to balance their payer mix," Williams said.
Hutcheson board member Emberson emphasized that Hutcheson and its officials are committed to maintaining local ownership and control.
"We have not discussed, and are not considering, a selling of the hospital," he said. "This is a community hospital. It serves the five-county area of North Georgia. We're dedicated to continuing that relationship with the people of North Georgia."
A relationship with another hospital does not have to mean a "merger" or a takeover, Williams said. But a collaboration of independents could save costs by cutting duplicate services and could benefit from referrals that go in both directions, he said.
And partnering with a larger facility could aid recruitment efforts, he said.
"I have absolutely no question about the viability and the need for a community hospital" in Fort Ogle-thorpe, Williams said.
"The question the board will have to address is, 'What is the model of delivery of care, organization structure, et cetera, which will allow them to optimize the situation they find themselves in?'"