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Posted on Thu, Jun 10, 2010 : 12:41 p.m.

Hospital quality may be declining with economy, University of Michigan and St. Joseph Mercy researchers say

By Tina Reed


Exterior construction at the new University of Michigan C.S. Mott Children's Hospital is shown in June 2009.

File photo

Turns out, health care isn't immune to the beating the current recession has been giving other sectors of the economy.

University of Michigan and Saint Joseph Mercy Health System research of hospitals across the country shows their finances have taken a hit, and health care quality may be declining as well.

Typically, economic downturns actually lead to growth or stability in the health care system, the analysis said.

The researchers wanted to see whether that rang true for hospitals during the recent economic recession, being called the worst since the Great Depression, said Matthew Davis, senior author of the analysis and U-M associate professor of pediatrics and communicable diseases and internal medicine.

Instead, they found drops in nearly every potential stream of income for hospitals, such as reimbursement rates for inpatients, number of admissions, charitable donations and ability to obtain bonds. More than 50 percent of U.S. hospitals had negative margins at the end of 2008, but have reported improvements since. 

"In the last 10 years, there has been more and better work on improving hospital quality than perhaps we've ever seen. This downturn threatens to perhaps undo some of those improvements," Davis said.

Even as health care legislation approved earlier this year promises millions of new patients, the decline has meant cuts in patient care staff like nurses and doctors across the U.S. and has halted new hospital projects. 

"Understaffed and under financed hospitals are rarely safe," reads the analysis. "Dissatisfaction and layoffs hurt the interactions between employees and patients. Robust nurse-to-patient ratios have proven vial to patients' hospitals outcomes could be at risk."


Check out how the University of Michigan and Saint Joseph Mercy Health System measure up on a government website called Hospital Compare at, which offers quality measures based on Medicare Data.

The analysis - conducted by lead author and U-M Internal Medicine Physician Jeremy Sussman and St. Joseph Mercy Health System Vice President for Quality and System Improvement Lakshmi Halasyamani — was published in the May/June issue of the Journal of Hospital Medicine.

Differences in the size of a hospital or the region it was located in didn't predict financial instability, but the health of its income could, according to the study. The researchers warn the financial instability of hospitals could lead to hospitals halting major construction projects or even lead to hospital closures, which can hurt a community's access to both health care and jobs.

Both U-M hospital and St. Joseph Mercy hospital have announced some layoffs in recent years due to revenue shortfalls. Recently, St. Joseph Mercy Health System announced it would consolidate some of its services into its Superior Township location.

However, both have also gone forward with major construction projects.

U-M is in the midst of constructing its replacement children and women's hospital with the building of the $754 million U-M C.S. Mott Children's and Von Voigtlander Women's Hospitals complex to open the fall of 2011. St. Joseph Mercy Health System built two patient care towers, just recently opened the second new tower on its Superior Township campus, and is continuing a build of its main entrance.

"The University of Michigan and Saint Joseph Mercy Health System have dealt with the recession in a variety of ways," Davis said. "I am confident both organizations have maintained an intense focus on quality. We will have to watch quality measures going forward."

The analysis suggests government incentives to encourage quality of hospital staff could be part of the solution to declining quality in cash-strapped hospitals. "State and federal leaders may need to watch these trends closely to design and to be ready to implement potentail government remedies for hospitals' fiscal woes," the paper said.

Davis pointed to research that shows patients who are being discharged from the hospital are more vulnerable than the average person of being admitted to the hospital soon after.

As hospital staffs get leaner, there are fewer resources to help patients transition out of the hospital. But having extra staff on hand to help those patients could actually save health care dollars while improving quality, Davis said.

Tina Reed covers health and the environment for You can reach her at, call her at 734-623-2535 or find her on Twitter @TreedinAA.



Tue, Jun 15, 2010 : 8:26 p.m.

Medicine was once a healing art and now it is a business. If Kennedy had never been shot would Johnson get credit for making the biggest burden on the American taxpayer


Fri, Jun 11, 2010 : 12:06 p.m.

Revenue losses? Hmmm. Sounds like some contracts are coming up for renegotiation and the groundwork is being laid.


Fri, Jun 11, 2010 : 7:42 a.m.

If you really want to review hospital quality, visit This is a federally funded program to deliver hospital quality information directly to the consumer.

Olan Owen Barnes

Fri, Jun 11, 2010 : 6:46 a.m.

You have to be your own patient advocate. For my return visit for transplant care I was put in to see a physician assistant and was told this was a routine practice. I had to call to have it changed to my regular doctor - a MD - a big difference. I car not who supervisors her she is still not a MD. This is a BAD practice and would not have been done at a place like the Mayo Clinic (at least not when I was there). If the U of M wants to be in the upper rung of hospitals it must keep the standards high IMHO.


Fri, Jun 11, 2010 : 5:43 a.m.

The Medical Staff, like the Doctors are the same at both Hospitals, the Nurses and other workers are different. Because M-Care was bought by Blue care network, I have to go to only U of M and I am not happy with the Medical Care with the plastic surgery, I had to go to Livonia surgery center and I am 5 min from U of M. I asked if I could go to St. Joes and I said because of the Insurance, I had to go to u of M and my surgery site is still open and bleeding and when I went back to see the Doctor that did the surgery, I could only see a nurse and the surgery will soon be a year and I can not change insurance company until October. Either place you will get a resident Doctor and when you are asleep you do not know who and what is being done to you. It is a chance you take when you go to the u of M usually a resident Doctor and you pay for a staff Doctor


Thu, Jun 10, 2010 : 10:05 p.m.

Medicine was once a healing art and now it is a business. If Kennedy had never been shot would Johnson get credit for making the biggest burden on the American taxpayer


Thu, Jun 10, 2010 : 8:41 p.m.

The medical business is hurting from the recession; customer counts are down; wait times for most procedures are significantly reduced. Be certain to obtain second opinions before buying significant procedures; many docs are subtly encouraging hasty decisions by potential customers in order to help keep income and proficiency stable.


Thu, Jun 10, 2010 : 8:30 p.m.

Of course the care quality is dropping. There are a hundred thousand of former auto workers (salaried and union) that are no longer contributing to the 'free' care coffers. GM was spending a billion every 3 months here alone on it's workforce's costs. Not any more. I expect dental and opthamologic services to be suffering as well, for the same reason. So, does buying autos from the foreign owned companies having young healthy employees not needing HC services, still make sense? That's been your choice, so sleep in the bed you've made. BTW: its Never coming back. No more 'free' babies, knees, hips, or heart treatments. What always cracked me up was the Dr.s and staff who drove foreign but took much of their budget from the domestics. Or worse, domestic employees who subscribed to Drs. buying foreign. One hand washes the other as they used to say.

dading dont delete me bro

Thu, Jun 10, 2010 : 8:06 p.m.

how can it be declining? one major contributor to this wonderful economy is the cost of health care (note, i did say "one") the cost of health care is ridiculous. in three years where i work, we've had three different plans. each cost a little more out of my pocket. we all still get sick. the economy doesn't seem to slow that down. both uofm and st.joe are building. i mean BUILDING. so i call bluff here.


Thu, Jun 10, 2010 : 6:33 p.m.

Compared to private hospitals, the University of Michigan Medical Center is not a paragon of efficient staffing. There are lots of reasons and you can't just cut staff withouth changing the management practices but I guarantee that better management would lead to lower staffing without loss of quality.


Thu, Jun 10, 2010 : 6:29 p.m.

When Obama care gets ramped up the quality will decline further. This fall seniors will get a notice informing them that their medicare private fee for service plan is being cancelled due to provisions of the health scam law. Millions of seniors nation wide will have their health care coverage reduced. That will reduce revenues of hospitals and other providers.


Thu, Jun 10, 2010 : 3:08 p.m.

Interesting article and a nice balance to this one:


Thu, Jun 10, 2010 : 1:08 p.m.

My wife had major surgery at St. Joe Ann Arbor a few weeks ago and stayed for two days. The overall lack of care and compassion was astounding! Actually, in a poor economy I would expect a "pick of the litter" for RN's and assistants...sure not the case here.


Thu, Jun 10, 2010 : 12:47 p.m.

From a personal experience, the best place to be admitted in the state is Henry Ford West Bloomfield. Comfort and the whole philosophy on how the facility is run is unbelievable. I was admitted to UM and the care was ok, but, inexperienced doctors and lack of privacy didn't make for a comfortable stay.