Have Mercy

In a scene fit for the holiday season, Mercy Hospital was granted a stay of execution in December when a state board unanimously rejected Trinity Health’s bid to close the hospital.

But unlike a feel-good movie where the credits roll after the happy ending, Mercy’s fate remains up in the air, a symbol of much that is wrong with our nation’s healthcare system.

After 170 years serving the community, Mercy — Chicago’s oldest chartered hospital — was slated to close in early 2021. Trinity Health, the healthcare system that owns the hospital, said the reasons were primarily monetary. It reported that the hospital is operating at a loss of $4 million per month.

Caring for essential workers

Mercy’s payor mix reflects the populations of nearby Bronzeville, Bridgeport, Pilsen and Chinatown, all communities that provide many of the city’s essential workers. Mercy accepts approximately 30% Medicare patients and 40% Medicaid patients. By contrast, other nearby hospitals accept approximately 28 to 42% Medicare and 8 to 34% Medicaid patients.

Medicare, though, pays roughly only 50% of what private insurance pays. And Medicaid pays even less — roughly 70% of Medicare payments. So for every $1 that private insurance pays, Medicare pays just 50 cents and Medicaid pays 35 cents.

Closing Mercy will not solve the structural problem of an unsustainable Medicaid payment model. Health facilities that treat higher numbers of Medicaid and Medicare patients should qualify for additional funding rather than be allowed to go bankrupt and shuttered. The burden for caring for these patients falls disproportionately on larger hospital systems, because private providers cannot or will not take new Medicaid and Medicare patients.

Five percent of physicians in the United States, when surveyed in 2016, said they did not plan to take on new Medicaid patients. Two percent said they would actually stop caring for their current Medicaid patients.

Beware of healthcare deserts

Mercy’s value to the community cannot be measured in a balance sheet. The hospital employs 1,700 people and offers 289 beds, including 30 ICU beds. It trains internal medicine residents, nursing and pharmacy students. The emergency department records 43,000 visits per year. In 2019, the hospital’s cardiology department performed almost 600 cardiac catheterizations, including almost 50 emergency heart attack procedures, rivaling some of the largest health care centers in the city.

Chicago’s South Side has come out strongly in support of Mercy. The vote to hold off on the closing of Mercy Hospital, by the Illinois Hospital Facilities and Services Review Board, came after about four hours of testimony from dozens of community members, activists, doctors and nurses — all of whom called for the board to reject Trinity Health’s request.

They told the board what data repeatedly show: When we create healthcare deserts and make healthcare access more difficult, we marginalize and disenfranchise communities and, disproportionately, people of color. We create atmospheres of alienation.

And, they said, there are real healthcare consequences. As we saw during the initial stages of the pandemic, what starts in one community doesn’t stay there. We are all interconnected.

A question of values

How we spend our healthcare dollars says a lot about our values and priorities. For example, the $4 million a month that Mercy is losing seems like a lot of money until you look at McCormick Place, just two blocks away. During the first wave of the pandemic, McCormick Place was turned into an emergency facility, at a cost of $81.1 million, to accommodate a possible citywide overflow of COVID-19 patients. The facility opened in mid-April and shut down on May 8 after servicing a total of 38 patients.

More than $2.1 million, that is to say, was spent per patient.

Based on the McCormick Place experience, you might argue, Mercy’s monthly financial losses amount to the cost of caring for two patients.

Based on the McCormick Place model, Mercy’s losses reflect the cost of caring for just two patients a month. That may sound glib, and certainly COVID-19 has brought its own complexities, but the McCormick Place story shows that sometimes we are willing to spend money — lots of it. So why not at Mercy?

Mercy’s future remains unclear. Trinity can appeal the board’s decision. And the hospital is still losing money. It is inconceivable that we cannot find a way to fund this vital and important institution. Closing an established facility that has taken care of a community for over a century and a half — and doing now so during a pandemic — would be wasteful and short-sighted.

The saga of Mercy shows that we, as a nation, need to have a serious conversation about how to allocate healthcare resources. And we need to take a more holistic approach to treatment and care.

Otherwise, Mercy’s good deed of taking care of the poorly insured will not go unpunished.

And the ones to bear the cost will be those least able to do so.

Payman Sattar MD, MS is an associate professor of medicine at Rush University Medical Center, director of the cardiology catheterization lab at Mercy Hospital of Chicago, and a Public Voices Fellow with The OpEd Project.

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