Detroit hospital closing part of pattern

DETROIT - Her legs crippled by diabetes, Mary Lewis is grateful it's a short distance between her doctor's office at Riverview Hospital and the adjacent apartment tower where she lives.

It will become a painful struggle next year when the hospital closes and physicians' offices are forced to move. The hospital last week said it was losing too much money and already stopped accepting inpatients, though the emergency room will remain open for now.

Because roughly 90 percent of its 11,000 annual inpatients are covered under the Medicare or Medicaid public assistance programs, Riverview has struggled economically, said Bob Hoban, a senior vice president for St. John Health, Riverview's parent company.

Experts say Riverview's decision to close fits a distressing, decades-long pattern of hospital closures in older cities across the nation. The trend has left large swaths of predominantly poor, black neighborhoods in cities such as St. Louis, Philadelphia and Cleveland underserved.

Many say the loss of medical facilities for low-income patients is increasingly leaving overcrowded emergency rooms to double as primary-care centers.

"This hasn't been happening in the suburbs and it isn't happening in Phoenix, Arizona, where they can't build hospitals fast enough," said Bruce Siegel, a research professor at the George Washington University Medical Center in Washington, D.C. "This is occurring in older, urban inner-city areas."

New York City, Philadelphia and parts of New Jersey have seen waves of hospital closings in inner-city neighborhoods, said Siegel, who directed a 2004 report examining the phenomenon for the Robert Wood Johnson Foundation.

The number of hospitals in the city has dwindled to seven or eight from 42 in 1960, said Alan Sager, director of the Health Reform Program at Boston University's School of Public Health. Hospitals that are larger, have major medical school-affiliated teaching programs and more money in the bank tend to survive.

Siegel's report warned that Detroit's safety net was already in a "fragile" state and could collapse entirely with further hospital closures. It said Detroit had lost more than 1,200 hospital beds with the closure of four hospitals since 1998.

"Some of it is population shifts and declines," Siegel said. "There's (also) more and more people without health insurance and Medicaid payments that don't keep up with the cost of providing care."

Riverview, a community hospital with 285 beds, specializes in general medical and surgical services, such as treatment of congestive heart failure, diabetes and obstetrics.

The hospital finished its last fiscal year with a nearly $9.5 million deficit and expects to end this fiscal year $23 million in the red.

Medicare payments to hospitals averaged 92 cents for every dollar spent providing care in 2005, the most recent figures available, according to the American Hospital Association. Medicaid's reimbursement rate was lower, at 87 cents per dollar.

Officials at other area hospitals have complained that Riverview's closing will burden them.

"We're 90 percent full on average and there are many days where we're 100 percent full," said Nancy Schlichting, president and chief executive of Henry Ford Health System, which has a trauma center hospital in Detroit.

Karmanos Cancer Institute plans to spend $20 million to renovate the 20-year-old Riverview and reopen it as a clinical center next year.

But Lewis is concerned her doctor's office will be forced to move too far from her home. "I'll have to find another doctor," the senior citizen said.

While waiting for a bus after a physical therapy appointment, Mary Sanders said Riverview is the closest hospital for residents of the east side, including many disabled senior citizens.

The 54-year resident of the neighborhood said she doesn't know where she'll go once the clinic closes.

The city of San Antonio is bigger than the city of Boston, sure, but that’s because San Antonio annexed everything in sight and has no suburbs. The Boston metro area, which includes everything people think of as Boston, dwarfs your hometown.

you know what.....nevermind...you're correct

San Antonio doesn't have any suburbs.

alamo heights, converse, kirby, leon valley, live oak, windcrest, schertz, universal city...don't exist in the Bostonian dimension.

Thanks for clearing that up for me. Next time you drive between San Antonio and Austin you might see a pretty vibrant economy, development and growth.

Since you know that there is no San Antonio metro area only a "Boston metro" area you're probably the same type of Yankee that made me decide that I'd rather live in Dallas and not live in Brighton and freeze my a## off.....

Yep, San Antonio has a metro area. It’s a little bit bigger than the city as a whole. Here are the numbers:

Boston-Cambridge-Quincy, MA-NH MSA is the 10th largest metro area in the country. Population: 4,455,217

San Antonio, TX MSA is the 29th largest metro area. Population: 1,942,217

Austinites are pretty proud of what they’ve accomplished and don’t think of themselves as part of San Antonio, but say they were feeling charitable and agreed with you that they were part of San Antonio, well, Austin-Round Rock, TX MSA is #37 at 1,513,565.

What does this mean? Throw in San Antonio and all its many, many suburbs with Austin and its suburbs, including Williamson County which is pretty damn far from San Antonio and I’ll wager has no one commuting down I-35 to your town, and guess what, you’re still 1 million people short of what Boston can boast.

This is why the city of Boston may have a smaller population than the sprawl of San Antonio but our downtown, transport links, economy, and skyscrapers are all bigger and more important.

Yes, our winters do tend to kick the asses of wimps, and yes, we’re not growing very much compared to less populous, less prosperous regions that are playing catch-up. We’ve got our problems, just as you do.

But if you want to simply talk about comparing cities, well, friend, you ain’t in the same league as us. Maybe in a few decades you’ll catch up. And if you’re happy there, more power to you.

you're right, that's what is so great about our country. We can move around and live where we want or have to live. I've done a lot of that and have always ended up right back in Texas.

I actually don't like San Antonio or Austin other than to visit, now that I'm married with the kids. That's just me.

I've seen the sights and lived in many areas of our country and the world. Prefer smaller cities.

As far as commuting, there are actually many who live in North San Antonio who work in Austin and vice versa. I'd kill myself if I had to live in my car.

Commuting well that depends on if you're single and what type of job you've got. Lots of IT folks like my sister actually split time between condos in Corpus Christi, main house in San Antonio and drive into Austin. Puts a lot of miles on her car, her hubby does the same from San Antonio to main job in Austin. They tell me the commute is what they got used to when they lived in Los Angeles...or actually Thousand Oaks area or Manhatten Beach area.

Boston has it all over Texas and San Antonio in particular. It's more important and with the great infrastructure, booming economy and friendly business/legal climate I'm sure that SA has nothing to offer anybody from Mass.

As far as being a wimp and hating the cold weather, you are correct sir. I've done training, hunting, skiing and had to live in Pennsylvania for a 1000 years in 1983-84. I HATE being cold. Put me in a desert, jungle, city street or beach with temp/humidity in the 90's I'm good.... in fact I'm great. If I were to have to fight or compete I used to be sure that the other feller would puke and die before I would.

Pennsylvania cured me of the north for good. Commonwealth tax, township tax, no beer in stores only "state stores", commuting tax for workers outside of a township that have to commute to another area for work.... and all the folks that wanted the government or the union to solve the problems. Stepped on my first homeless person in Philly, sleeping in his cardboard condo by a heating vent or something on the deck by a building. Met a lot of folks that were pretty cynical and mean, but they're everywhere. Just seems that there are less of them in Texas

The women I met on the Jersey shore were nice and my best friend had a nice situation in Barnegat Light, but moved to Florida.

You are also correct about us having problems down here. You've got Ted the swimmer and we've got Governor "Nice Hair".

We used to have a football team in Dallas, you've got a great football team in New England.

you've got Sam Adams

and we've got

I'm just a typical Texan. Love the state, love the people and just can't imagine anybody not thinking the same way...bwahahahaha

I think we might take ya on the cheerleader and hot women side of the ledger

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