This summer, Philadelphia became the epicenter of a looming crisis in the hospital industry in America. As detailed in the media, the owners of Hahnemann University Hospital declared bankruptcy in June. The summer saw the hospital's abrupt shutdown, the loss of 2,500 jobs, and the largest closure (571 residents) of a physician residency program in the U.S.
Built in 1928, Hahnemann provided emergency care to more than 50,000 patients a year, many among the city's most vulnerable.
The closure presented an unprecedented challenge. Only a few blocks away at Jefferson Health's hospitals, we absorbed 40 more emergencies a day and doubled our deliveries. In one weekend we accepted 150 new patient appointments for expectant mothers who were more than 36 weeks pregnant. Within 10 days we credentialed 12 Hahnemann obstetricians and eight midwives, while onboarding 78 Hahnemann residents. Outside my office, the sirens doubled.
I'm deeply proud of the clinicians and staff at Jefferson Health. Everyone, and I mean everyone, responded. From the ED to OB, from academics to administration. The intensity was acute. The commitment of my staff to serve vulnerable people was profound and inspiring.
But if Hahnemann's closure was a community crisis; it was also a national warning about the cost of caring for vulnerable populations, the aging of legacy hospitals, the speeding shift to outpatient care, the rise of virtual care, the competitiveness of nonhospital providers, and the gridlock in Washington.
Now is the time that we should be asking difficult questions. We should be ready to prevent similar pain for patients, students, staff and resident physicians—dislocated through no fault of their own.
For me, this closure was both professional and personal. In 2003, Tenet Healthcare Corp. announced its intent to close the Medical College of Pennsylvania Hospital—another historic hospital, while I was dean of its academic affiliate, Drexel University College of Medicine (Hahnemann was our other hospital!) As Jefferson and others did today, back in 2004 we worked hard to place those patients and to keep the resident trainees in Philadelphia.
In 2007, I published an article in Academic Medicine about the Medical College of Pennsylvania Hospital closure, chronicling the "once in a lifetime" disruption that occurred and laying out what I hoped could prevent that kind of chaotic dislocation. Sadly, I was wrong. That article could be republished today with Hahnemann instead of the Medical College of Pennsylvania Hospital.
So here's what happened this summer that does makes me optimistic about Philadelphia's healthcare future. In short order, we built a "crisis prevention and response" playbook by rethinking every process we use for acute and emergency care. Just as important, we teamed up with our colleague safety-net hospitals.
Almost every day during the crisis, a team of CEOs from nearby not-for-profits worked to mitigate long-term damage to the city. For example:
• A consortium of nearby hospitals filed a bid to take over Hahnemann's sister hospital, St. Christopher's Hospital for Children, and keep its ownership in the region. I'm deeply appreciative of the CEOs from the consortium that joined that bid, in addition to Jefferson: Christiana Care Health System, Cooper University Health Care, Einstein Healthcare Network, Main Line Health and Temple University Health System.
• A similarly mission-driven academic group bid for the permanent residency slots that were formerly Hahnemann's. This bid would keep those residencies in the tri-state area, depending on the bankruptcy court and the federal government determination: Einstein, Jefferson, Philadelphia College of Osteopathic Medicine and Temple.
• A number of Philadelphia universities worked closely with the Accreditation Council for Graduate Medical Education to make it easy for medical residents to apply to area programs.
In my 2007 warning, one lesson was: "In times of stress, read your mission statement, remember why you're in academic medicine and stay focused." It was only through staying focused on our mission that otherwise competitive hospitals collaborated to respond to the city's crisis.
While I am optimistic about Philadelphia's healthcare future, the closure of a storied institution like Hahnemann, like many other hospitals in the U.S., remains a dire warning and a time for action in our country.
We need a high-level national commission appointed by the president and endorsed by Congress to achieve nonpartisan stability in ensuring care for all, while resolving the fragmentation, fear, frustration and inequities in our current system.
Almost 250 years ago, Philadelphia was the epicenter of a revolution brought on by a lack of caring for the people most affected by the decisions of a few. The recent events in Philadelphia should stir national awareness and consensus that providing care for our people is going to require bold action. We need to stay focused on our mission—and it could not be a more urgent time to do so.
