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Health care is forever changing, based on public health policy, technology, society and community needs.
Employees of Jamestown General Hospital stand outside the building in 1987. The hospital closed Aug. 8, 1988.
WCA Hospital officials recently announced an agreement with UPMC Hamot in Erie, Pa. The agreement between the two health systems will expand access to health care services and resources in the region.
"We have to reorganize and rethink how we are going to serve our community with the resources that we have," said Larry Senn, vice president of administration for WCA.
Twenty-four years ago, Jamestown and WCA Hospital went through a different change, with the closing of Jamestown General Hospital.
In the summer of 1988, WCA Hospital contracted to purchase the assets of the Jamestown General Hospital. WCA purchased the hospital site and land; landscaping, parking area and interior roads; the main hospital structure; the storage buildings; offices and rental units; an old paint shop; and the hospital equipment.
"The Jamestown General piece is like a spot in the history, based on public health policy, based on technology, based on community needs, based on reimbursement, insurance changes," Senn said.
THE HISTORY OF HEALTH CARE
To understand the changes in 1988 and now, though, is to understand the history of health care.
"If you go back to 1885, when this organization was established, there was no hospital. People were injured and treated in the street or in the hotel lobby or whatever," Senn said. "There were physicians who knew how to do certain things, but there really wasn't a whole lot of medical knowledge."
Around the time of the Civil War, New York state began passing corporate laws allowing the establishment of hospitals.
"I think there was a realization that something needed to be done. But, how to do it and get them organized was based on society, what was being done, that kind of stuff," Senn said.
Eventually, a maternity wing was established at WCA Hospital to help with the high mortality rates associated with birthing at the time.
Additionally, Senn said other issues were recognized at this time, such as how to handle people with mental illness.
By the 1930s, another policy was passed to make hospital structures more safe. The Depression also hit in the 1930s, which Senn said caused things to stop for an amount of time. Then, World War II began in the 1940s.
"We learned a lot about head trauma, a lot about labs. A lot about things like polio vaccines, helicopters, transporting people," Senn said. "In the '40s era, we picked up a lot of that kind of stuff."
Another government policy was set in the 1940s, which gave hospitals and other charitable missions tax-exempt status.
"That kind of set a whole different tone for how hospital organizations were organized. You did have a charitable mission. You did see people regardless of whether they were able to pay. That gave you the flexibility to not pay city taxes," Senn said.
In the 1950s, the emergency department got a makeover, to establish multiple rooms rather than one emergency room. New York state also established hospital regulations in the '50s.
By the 1970s, Senn said there was no personal responsibility for health, insurance covered everything. Medicaid and Medicare started becoming popular. However, in the 1980s, Medicare programs began to cost money as life expectancy increased. Technology began to boom as well, with the introduction of MRI machines and other helpful tools.
"Suddenly, there's this reality that this is costing us a lot of money in the '80s. We had to do something to contain cost," Senn said. "So, the government policy was to lump stuff together."
With this new policy, insurance grouped together health care into Diagnostic Related Groupings, or DRGs. The DRG system uses the diagnosis assigned by the physician to determine the amount of money the hospital will be paid for the entire hospitalization. The hospital is then paid a set amount determined by the diagnosis.
"What that meant was you had to be very efficient. You had to control your expenses, or else you would be losing money on every patient you admit," Senn said. "You also had to be a certain size to really stay in business. You couldn't employ a pharmacist for six patients. You can't employ all the things that you would need."
Between the 1980s and now, understanding of health care and technology have changed how patients are treated. Costs of health care are being recognized. And, there have also been major shortages across the country of health care professionals and staff.
TROUBLE FOR JAMESTOWN GENERAL
According to a 1988 article in The Post-Journal about how Jamestown General Hospital got to an emergency state, JGH was more than $3 million in debt. The amount of that debt was increasing each month. WCA, however, was growing, not in debt and in no threat of takeover.
The article read, "Each of three major studies has come to the same conclusion: Jamestown cannot support two separate acute care hospitals."
At the time, WCA had about 300 beds, while JGH had around 100. The two hospitals offered some duplicate services, and Jamestown General had higher rates for care than WCA.
"It's the mom-and-pop grocery store versus the Wal-Mart grocery store. You have to have a certain volume to stay in business," Senn said.
A May 16, 1988, memo from Mayor Steven B. Carlson to City Council said from the beginning of that year through May, Jamestown General had already lost $269,178.
"In my opinion, the situation at JGH can do nothing but get worse. As I have said for many months, the state and federal reimbursement formulas are stacked against small hospitals such as JGH, be they public or private," Carlson wrote in the memo.
At the time, Carlson looked to City Council to approve a resolution asking the governor and New York State Legislature to authorize Jamestown borrowing up to $5 million in serial bonds in order to support the deficits created by Jamestown General.
In a message to City Council from May 23, 1988, Carlson said that any borrowing to bail out the hospital would result in a real property tax increase, unless another health care provider could be found to assume the debts of Jamestown General Hospital.
"WCA purchased the buildings and the assets," Senn said. "And set forth a plan with the Department of Health, which had to approve everything, to add more services to the community that were currently being sent out of town."
A VARIETY OF CARE
In July 1988, WCA Hospital contracted to purchase the assets of Jamestown General Hospital. The name of the facility was changed from Jamestown General to the Jones Memorial Health Center.
By the end of 1988, a 20-bed inpatient adult mental health program was started. Through the years, the services offered grew to include a family health center; inpatient alcoholism program, 10-bed inpatient adolescent mental health program; inpatient medical rehabilitation program; inpatient PT, OT, recreational therapy, speech and hearing aid services; psychology services; outpatient alcoholism program; the WCA cancer treatment center: Chemotherapy program; radiation therapy treatment program at WCA cancer treatment center; a draw station; outpatient metal behavioral health program; sports medicine program; and a partial hospitalization program.
In 2010, a consolidation process began to move programs and services to WCA Hospital.
Today, hospital services offered at Jones Memorial Health Center include inpatient metal health for adults and adolescents; inpatient chemical dependency; outpatient chemical and mental health services; wellness services; public relations and marketing; occupational health services; cancer registry program; cancer treatment center; outpatient laboratory; and psychology services.
There is also space that is rented, leased or both at Jones Memorial Hospital to area health agencies that have a contractual relationship with WCA Hospital. This includes Chautauqua County Meals on Wheels meal preparation and the BOCES LPN program.
CONTINUALLY CHANGING HEALTH CARE SYSTEM
"As your government keeps defining what they are going to reimburse, you have to become even more efficient and more effective and more cost-contained," said Linda Johnson, WCA Hospital public relations officer. "You have to rethink how you're doing the care that you're doing."
As policies in health care continue to change, WCA Hospital continues with its mission to improve the health and well being of the people of Chautauqua County and the surrounding area.
Senn said affiliating with UPMC Hamot helps both hospitals align to provide the services necessary in each community. It essentially breaks down to providing the highest-quality care in the most cost-effective way in an industry constantly changing based on public health policy, technology, society and community needs.