Nursing shortages, physicians leaving for more money, aging facilities and a record number of emergency-room diversions have put Greater Cincinnati hospitals in a crisis, hospital leaders said Thursday.

        Chief executive officers of the region's three largest hospital companies put aside their usual competitiveness to bring together about 200 business, civic and government leaders for an extraordinary breakfast meeting at the Gregory Center downtown.

Rebecca Brown does a crossword puzzle Thursday afternoon while her husband, Clarence, waits at University Hospital for a doctor to review his ankle X-ray. They had been at the emergency room more than four hours. (Steven M. Herppich photos) | ZOOM |

        The issues raised by the executives are not new, but the coordinated, public presentation may represent a new, aggressive approach by the hospital industry.

        “The competitive atmosphere of the past can only create new problems now,” said Ken Hanover of the Health Alliance, which includes University and Christ hospitals. “It's time we work together to solve these problems.”

        The basic problem, the CEOs say, is that Cincinnati-area hospitals aren't being reimbursed adequately by insurance companies for the costs of providing health care.

        Despite the fact that insurance premiums paid by Cincinnati employers and employees have risen 15.8 percent this year, local hospitals have lost nearly $200 million over the years and are receiving lower payments from insurers than hospitals in comparable cities, the CEOs say.

        In Cleveland, the average net payment per hospital discharge is $7,332 and, in Indianapolis, $7,433, compared to $6,813 in Cincinnati.

        Part of the reason is that during the 1990s, Cincinnati hospitals cut costs to the point that now, health-care costs in Cincinnati are 91 percent of the national average.

        “We are now at a point where efficiency can't be achieved by more cost-cutting without lessening the quality of treatment,” said Tom Urban of Mercy Health Partners.

At University Hospital Thursday, emergency-room workers mobilize to treat an accident victim with head injuries who had to be was airlifted to the hospital ([name of photographer] photo) | ZOOM |

        Since 1984, nine area hospitals have been closed, reducing the number of available beds at a time when the population is growing and aging.

        Another reason, said Lynn Olman, president of the Greater Cincinnati Health Council, is that, in the 1990s, most major Cincinnati-area employers began steering their employees to health- care plans with the lowest possible costs.

        “We're paying the price for that today, with the lower payments to providers and physicians leaving for cities where they can make more money,” Ms. Olman said.

        “We're asking the business leaders to re-think those decisions.”

        Area hospitals, the CEOs said, are increasingly unable to staff emergency rooms with an adequate numbers of nurses and doctors.

        Ms. Olman said hospitals are on a pace to record about 1,000 instances this year where ambulances are diverted. . Four years ago, there were only 139 such diversions.

        Nearly 1,000 nursing positions in hospitals remain unfilled, Ms. Olman said.

        According to the Greater Cincinnati Health Council, physicians and specialists are leaving Cincinnati in record numbers, because ofdue to the disparity in pay with cities of comparable size.

CARE STATISTICS

Chief executive officers of Greater Cincinnati's three hospital companies — TriHealth, Health Alliance and Mercy Health Partners — argue that there are “cracks in the foundation” of Cincinnati's health care system for the following reasons:    Local hospitals have lost nearly $200 million in the past two years.    Cincinnati hospitals receive lower payments for service than those in similar-sized cities. The average net payments per discharge in Cleveland and Indianapolis are $7,332 and $7,433, respectively, compared to $6,813 in Cincinnati.    Insurance premiums paid by Cincinnati employers and employees have risen 15.8 percent this year.    Cincinnati hospital emergency rooms are on pace to divert ambulance nearly 1,000 times this year. Four years ago, there were only 139 diversions.    Cincinnati hospitals have a 15 percent nursing vacancy rate; there are more thanover 1,000 nursing positions open at area hospitals.    More pressure on the over-burdened health care system is expected from the continued aging of the baby boom generation. Over the last decade, the number of people in the Tri-State over age 65 rose by 8eight percent.    Since 1984, nine area hospitals have closed, reducing the number of available hospital beds in the future. The number of in-patient hospital beds per 1,000 residents has gone from 4.55 beds in 1984 to 2.29 beds in 2000.

        Thursday, the CEOs asked the business, civic and government representatives to help them find solutions to the problems.

        “We are not businesses,” said John Prout of TriHealth, which operates Bethesda North and Good Samaritan hHospitals.

        “We are social organizations that apply business techniques to providing health care. We need the help of all involved.”

        Russ Coile, a Texas-based health care “futurist” who writes and edits the Health Trends newsletter, said employers need to ask more questions of insurers when negotiating health care plans. .

        “Every employer ought to be asking how much of every dollar of those premiums is going to actual health care,” Mr. Coile said.

        “Instead of bickering over premiums, we have an opportunity to raise the bar and focus on quality.”

        Ms. Olman said that what the Greater Cincinnati Health Council wants of the business community here is its help in making Cincinnati's health- care system competitive with cities of similar size.

        “We're asking them to help us figure out how much quality we can afford, how much access we can afford,” Ms. Olman said.

        The Cincinnati Business Committee and the Health Council's Health Improvement Collaborative, Ms. Olman said, are in the beginning stages of a survey of the state of health care in Cincinnati.

        “We'll have everybody at the table — employers, providers, consumers — to see if we can find common ground on what the problems are,” Ms. Olman said. “Then, we can begin to fix them.”

        But one major player that which won't be at the table is the health- insurance industry.

        Kelly McGivern, president and chief executive of the Ohio Association of Health Plans, a health- insurance trade organization, said her group was ready to help fund the survey, but withdrew last mMonth when the Academy of Medicine of Cincinnati — representing 1,900 Cincinnatio doctors — filed a lawsuit against every major health- insurance company in the region.

        “We don't know if their claim that doctors are leaving because of a disparity in pay is true or not,” said Ms. McGivern. “There is no concrete material out there saying there is a shortage.”

        The health- insurance companies, Ms. McGivern said, were willing to help “take a look at the problem, until the doctors sued.”

        Sharron DiMario, executive director of the Employer Health Care Alliance in Cincinnati, said she believes area employers are already doing what the CEOs suggested they do Thursday — ask the right questions of health- insurance companies to see how the money is being spent.

        “Our people want to know what's going on,” Ms. DiMario said. “It only makes sense, since employers are bearing the burden of increased costs of health care.”

        Mr. Coile told the group that the baby boomers who are now aging are going to be “the fussiest bunch of consumers in the history of the world.

        “They are going to demand quality care, nothing but the best.”

        “You people here in this room are the rockers and shakers of Cincinnati.,” Mr. Coile said.

        “You know each other on a first-name basis. You ought to be able to get together with the insurers and the health- care providers and get it done.”

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