Fewer and fewer patients are filling beds in rural hospitals, but is occupancy the only measure of a hospital's value to a community?
Harold Brown says no. Brown, president of the National Rural Health Association and a hospital chief executive officer, is using that platform to show other rural executives how to show their facilities' value to their communities in larger terms.
Explaining a hospital's value to its constituents likely will become more important as tax-exempt hospitals are targeted for buyouts or as governments ask them to justify their tax exemptions.
Although tax exemption isn't the issue at Brown's facility, 44-bed Prairie du Chien (Wis.) Memorial Hospital, collecting data on its services outside the hospital's walls underscores its benefit to the community. Several states, including California and Texas, are requiring tax-exempt hospitals to report on their community benefits.
Since 1990, Prairie du Chien Memorial has been tabulating the amount of daily units of health services provided by the facility. The acronym is DUHS, which Brown pronounces as "do's" to show the community what the hospital can and will "do" for them.
Brown described the methodology earlier this month at the Southwest Conference of Rural and Community Hospitals in Dallas.
"It doesn't make any sense to use the standard performance data," Brown told the group, adding that "people in the community think bigger is better." The DUHS methodology demonstrates how big a rural hospital is to a community.
Looking at the larger picture is necessary because occupancy of rural hospitals is steadily declining.
In 1994, rural hospitals were less than one-third full-32.6%, according to HCIA, a Baltimore-based healthcare information company. That's down from 33.6% in 1993.
The HCIA data include only hospitals with 25 beds or more, but those with fewer beds probably wouldn't be much different, judging from anecdotal data.
From all indications, inpatient occupancy will continue to drop, and rural residents may start to question a hospital's reason for being, Brown said.
Measuring DUHS is "more important than saying we have 14 acute-care patients and it's going down," Brown said.
That's an accurate measure of Prairie du Chien Memorial's situation. Last month, the facility had 379 acute-care patient days, or about 12 patients a day. In January 1995 the hospital had 514 acute-care patient days, or about 16 patients a day.
However, its DUHS are up-11,701 vs. 10,204 in the same period. Because Prairie du Chien Memorial has spread its healthcare services into a variety of niches within the community, it's able to count on a healthy supply of DUHS.
Those DUHS include child care, meals on wheels, meals to the local prison, home healthcare visits, outpatient surgeries and independent-living residents. As Prairie du Chien Memorial increases its services, it increases its DUHS, as well as its measurable worth to the community, Brown said.
The hospital recently ran an advertisement in the local newspaper touting its DUHS in 1995. "Every day of the year, 381 people received one of our services," the ad explained.
Prairie du Chien Memorial's breadth of services also has helped it remain profitable. In 1995, the hospital posted net income of $1.6 million on revenues of $13.8 million. That's up from net income of $677,000 on revenues of $9.4 million in 1991.