Erlanger hospital’s board of trustees may be having trouble deciding what kind of severance package, if any, to give to outgoing CEO Jim Brexler, but their decision to find a new leader was necessary. All of the challenges confronting Erlanger may not be Brexler’s fault, but it is clear that the hospital needs stronger, more effective leadership.
Several major issues that are seriously undermining the hospital stand out. One is the exodus from Erlanger of many of its leading physicians’ groups over the past several years. A second is the gradual deterioration of the hospital’s retained earnings, a core measure of financial health. Another is the way Brexler has ballooned the executive staff and handled business operations.
The problem of the exodus of doctors’ groups that practice chiefly at Erlanger is best reflected in the adage that hospitals don’t have patients; doctors do. When doctors shift their practice to competitor hospitals, hospitals lose patients, and money.
Erlanger, of course, has plenty of walk-in patients, but a large percentage of them come through the emergency room because they are indigent, and Erlanger, as the region’s mainstay public hospital, is where they seek care. What Erlanger needs to help balance the cost of its indigent care load is more patients who have health care insurance.
Indigent patients deserve excellent care; that’s not disputed. But under this nation’s fractured and unbalanced health care system, and the ever-rising number of uninsured and under-insured citizens, public hospitals are struggling to keep a sufficient ratio of patients with private insurance, either their own individual plan or their employers’ health insurance plans. Without an adequate share of the latter to offset the more meager reimbursements provided by Medicaid or written off as a public service for indigent care, public hospitals do well to survive, much less thrive.