Tonight We Closed Our Hospital

Written July 24, 2017, the closure date of Walla Walla General Hospital

This was the hospital where both of my parents were born, and the hospital where I was born. This was the hospital where my grandmother comfortably passed away. This was a place where I was mentored as a leader, encouraged as a female professional, and loved as a human. This was a place with 119 years of human stories in our little town.

I am of the stoic sort. My public face of strength at the hospital legacy celebration masked my tumultuous thoughts. My tears were shed later over Monday night chores, taking out the garbage, sweeping the garage, picking up the dog waste, harvesting the tomatoes. I cried for the leaders who have risen in grace to an unpleasant task, for the caregivers whose home of delivering loving care is closed, for the patients who placed their trust in this institution, and for the sense of letting the community down. I cried because I both strive and struggle to see the beauty and opportunity in change and in pain.

As I drive down Second Avenue in Walla Walla, I worry for the small businesses whose revenues will be affected by the closure: the small cafés and grocery who serve fresh and delicious food; the gas stations who keep our cars fueled; and the florist shop strategically built next to the hospital many years ago. Many of us with dental offices in the area will see a shift in our insurance reimbursements with an unwelcome increase in Delta Dental.

Rural hospitals provide essential care. They are a center point for local services, and a link to outside specialty services. They provide many jobs in the community and attract supporting businesses. Rural hospitals are uniquely able to provide patient-centered care.

According to the Washington State Hospital Association (WSHA), “Blanket policies in healthcare payment and regulation at the federal and state levels have put rural healthcare systems in a tenuous situation where adapting to the change may limit access to healthcare for their communities.”

As a member of the hospital governing board, whose primary responsibility was toward quality improvement and patient safety, I observed firsthand the challenges of legislation and regulation on our hospital’s ability to deliver patient centered care in a fiscally sustainable manner. WSHA goes on to say, “Current economic pressures, delivery, and payment-system reforms, and the shift from a volume-based business model to a value-based model, will necessitate that the hospital field consider redefining the ‘hospital’ of the future.”

Dentistry’s unique delivery and payment systems will inevitably shift in similar directions. Dental insurance will be increasingly integrated with medical insurance. And insurance companies combined with technology will be key drivers in the shift to value based models.

Prevention and wellness will form the foundation of the value-based model. The June 2017 issue of the Harvard Business Review says, “What makes prevention today different from past efforts is how it can be done. First, a wide range of new technologies and data analytics allows tracking of who and what is changing, making it possible to establish individualized targets, remedies, and incentives. Second, a systems approach helps companies go beyond single interventions to engage the entire insurance value chain — including local businesses, communities, and government — in the pursuit of these prevention gains. Third, with measurement linking risk-reduction milestones to improved business results, customers can be rewarded dynamically with behavior-based pricing that encourages positive behaviors and leads to a virtuous shared-value cycle between risk reduction and profit.”

Here is the opportunity I envision. Research has proven, and dentists well understand, the link between oral health and chronic diseases and systemic wellness. As dentists and dental hygienists, we often see our patients more frequently, and for a much longer period of time than primary care physicians. We must become a valuable member of the primary care team. We must leverage technology to develop individualized treatment and better outcomes. We must continue to develop effective and efficient systems of prevention and wellness in our dental practices, rather than only performing damage restoration. When gaps in care appear — the closing of a hospital, for example — we can step in and emerge as key leaders and innovators in the larger space of our healthcare system. Let us seize the opportunity.