After Missouri's decision to not expand Medicaid and Medicare coverage under the Affordable Care Act of 2010, local hospitals are having to make tough decisions.
St. Francis Hospital & Health Services closed two satellite clinics earlier this year in Grant City and Burlington Junction, while opening a new clinic in Savannah.
The reason, according to hospital officials, is the volume of patients that the clinics saw. Many factors were also considered, including proximity to another healthcare destination.
But the difficult decision-making process is only beginning for area healthcare providers.
St. Francis Vice President of Operations and Planning Ty Griffith said that the hospital alone stands to lose roughly $7 million in funding between now and 2020.
Being part of the larger SSM Healthcare organization, St. Francis is in a better position than many area hospitals, but the cuts will still do some damage.
"We were really hoping that Missouri would expand Medicaid," Griffith said. "But when that didn't happen, we have to sit back and find ways to maintain quality and safety standards, all while doing it cheaper."
Within SSM and locally at St. Francis, there have been many efforts since the signing of the ACA to create that efficiency.
Sometimes that has meant closing facilities. Heartland Regional Medical Center in St. Joseph recently made the decision to no longer provide ambulance services, handing that burden to law enforcement.
"To combat this, we continue re-evaluating our resources that the volume doesn't support," Griffith said.
Even though St. Francis was forced to shut down the two facilities, no jobs have been lost — only transferred to the Maryville hospital and clinic.
Griffith said the volume of patients in Maryville can support those positions, and that the hospital has no plans to eliminate jobs in the near future.
But that could change as time goes on.
A report from the Missouri Hospital Association stated that in northwest Missouri, hospitals stand to lose close to $30 million in funding between now and 2019.
The same report estimated that if Missouri had accepted federal ACA funds, there would have been just over $80 million in revenue during that same time period.
It was also suggested that the total value added to the northwest Missouri economy would have been roughly $375 million over the next seven years.
Now, Griffith and other hospital officials are faced with the prospect of doing more with less.
St. Francis spokesperson Rita Miller said the hospital reviews operations daily and holds monthly meetings to monitor productivity.
"Throughout the industry, everyone is looking for ways to cut back," Miller said. "We're trying to move from volume to value. Part of that is effective planning. We are a smaller hospital; we don't have the cushion of high volume like some of the bigger city facilities."
Page 2 of 2 - To compensate for the loss of the clinics, Miller said that St. Francis is looking into the possibility of a mobile unit or a telemedicine system.