Please write a 200 word response in AMA format with 2 references. Thanks you

St. Joseph’s Hospital is a nonprofit organization providing rural healthcare in Buckhannon, West Virginia. The Pallottine Missionary Society immigrated to the United States as early as 1912, passing the wreckage of the ill-fated Titanic on their voyage.1 The primary goal of this society was to provide necessary medical care to underserved regions. St. Joseph’s Hospital was founded on February 15, 1921, and operated by the Pallottine Sisters until its acquisition by United Hospital Center and West Virginia University Medicine in 2015.1 The hospital continues to serve the rural population of north-central WV. In 2019, St. Joseph’s was recognized as one of the top 100 critical access hospitals in the United States.2 This organization is the only hospital within 15 miles of Buckhannon, WV, which allows for their critical access status. Critical access allows for higher reimbursement from insurance payers. In recent years, the critical access status has been in jeopardy as Mon Health, Stonewall Jackson Memorial Hospital moves to build a new facility less than 12 miles from St. Joseph’s.3 If this critical access designation is lost, St. Joseph’s could suffer detrimental consequences. CEO Skip Gjolberg estimates these losses to be between $3-4 million annually, and litigation has begun to protect the facility’s critical access status.3 This facility was chosen due to this potential loss of revenue as this author’s employer. As this organization is a nonprofit, an IRS form 990 was utilized to complete this financial analysis.

         As a nonprofit, St Joseph’s Hospital reported total revenue of $91,224,270 in 2021, with $13,436,341 reported as profit minus expenses.4 This excess revenue includes all salaries, employee benefits, operational costs, contributions, and grants paid out during the fiscal year.  The overall assets at the end of the fiscal year were $76,723,048, with total liabilities of $32,567,019.4 Thus, St. Joseph’s Hospital had a total of $44,156,029 in net assets at the end of 2021. The highest-paid position within St. Joseph’s is one of the general surgeons. In 2021, Dr. Susan Long received a total of $786,761 in reportable compensation with an additional $42,055 in other compensation.4 Ranking in order of earnings, the CEO Ivar “Skip” Gjolberg was the 6th highest paid employee of the nonprofit. His gross earnings were reported as $349,644 in actual compensation, with 468,721 in other compensation from the organization.4 Employed physicians held the top 9 highest earning positions except number 6, which was the CEO.

         An evaluation of the past 3 years shows significant growth within St. Joseph’s Hospital regarding revenue. In 2019 a total revenue of $71,620,100 and $7,264,239 net revenue were reported.5 At the end of the 2020 fiscal year, total revenue was $77,330,909, with net revenue of $12,924,090.6. These figures show a significant upward trend in revenue for this organization.

         While the upward trend in revenue can be perceived as beneficial, should this facility lose its critical access status, a substantial decrease in revenue can be expected. Given that St. Joseph’s Hospital is a critical access rural hospital, should Mon Health, Stonewall Jackson Memorial Hospital obtain their certificate of need and build a facility within the 15-mile radius, St. Joseph’s will have to explore avenues to recoup the lost revenue.

References

1. St Joseph’s Hospital About US. WVU Medicine. Accessed May 29, 2023. https://wvumedicine.org/st-josephs-hospital/about-us/

2. Wharton, L. St. Joseph’s Hospital named one of the top 100 critical access hospitals in the nation. February 28, 2019. Accessed May 29, 2023. https://wvumedicine.org/news/article/st-joseph-s-hospital-named-one-of-top-100-critical-access-hospitals-innation/

3. St. Joseph’s Hospital files objection to Mon Health’s plan to build new Stonewall Jackson Memorial Hospital. WV News. May 29. 2021. Accessed May 29, 2023. https://www.wvnews.com/news/wvnews/st-josephs-hospital-files-objection-to-mon-healths-plan-to-build-new-stonewall-jackson-memorial/article_d67132cc-0ec6-5f3e-8f7c-24c09a2e457c.html

Please write a 200 word response in AMA format with 2 references. Thanks you

St. Joseph’s Hospital is a nonprofit organization providing rural healthcare in Buckhannon, West Virginia. The Pallottine Missionary Society immigrated to the United States as early as 1912, passing the wreckage of the ill-fated Titanic on their voyage.1 The primary goal of this society was to provide necessary medical care to underserved regions. St. Joseph’s Hospital was founded on February 15, 1921, and operated by the Pallottine Sisters until its acquisition by United Hospital Center and West Virginia University Medicine in 2015.1 The hospital continues to serve the rural population of north-central WV. In 2019, St. Joseph’s was recognized as one of the top 100 critical access hospitals in the United States.2 This organization is the only hospital within 15 miles of Buckhannon, WV, which allows for their critical access status. Critical access allows for higher reimbursement from insurance payers. In recent years, the critical access status has been in jeopardy as Mon Health, Stonewall Jackson Memorial Hospital moves to build a new facility less than 12 miles from St. Joseph’s.3 If this critical access designation is lost, St. Joseph’s could suffer detrimental consequences. CEO Skip Gjolberg estimates these losses to be between $3-4 million annually, and litigation has begun to protect the facility’s critical access status.3 This facility was chosen due to this potential loss of revenue as this author’s employer. As this organization is a nonprofit, an IRS form 990 was utilized to complete this financial analysis.

         As a nonprofit, St Joseph’s Hospital reported total revenue of $91,224,270 in 2021, with $13,436,341 reported as profit minus expenses.4 This excess revenue includes all salaries, employee benefits, operational costs, contributions, and grants paid out during the fiscal year.  The overall assets at the end of the fiscal year were $76,723,048, with total liabilities of $32,567,019.4 Thus, St. Joseph’s Hospital had a total of $44,156,029 in net assets at the end of 2021. The highest-paid position within St. Joseph’s is one of the general surgeons. In 2021, Dr. Susan Long received a total of $786,761 in reportable compensation with an additional $42,055 in other compensation.4 Ranking in order of earnings, the CEO Ivar “Skip” Gjolberg was the 6th highest paid employee of the nonprofit. His gross earnings were reported as $349,644 in actual compensation, with 468,721 in other compensation from the organization.4 Employed physicians held the top 9 highest earning positions except number 6, which was the CEO.

         An evaluation of the past 3 years shows significant growth within St. Joseph’s Hospital regarding revenue. In 2019 a total revenue of $71,620,100 and $7,264,239 net revenue were reported.5 At the end of the 2020 fiscal year, total revenue was $77,330,909, with net revenue of $12,924,090.6. These figures show a significant upward trend in revenue for this organization.

         While the upward trend in revenue can be perceived as beneficial, should this facility lose its critical access status, a substantial decrease in revenue can be expected. Given that St. Joseph’s Hospital is a critical access rural hospital, should Mon Health, Stonewall Jackson Memorial Hospital obtain their certificate of need and build a facility within the 15-mile radius, St. Joseph’s will have to explore avenues to recoup the lost revenue.

References

1. St Joseph’s Hospital About US. WVU Medicine. Accessed May 29, 2023. https://wvumedicine.org/st-josephs-hospital/about-us/

2. Wharton, L. St. Joseph’s Hospital named one of the top 100 critical access hospitals in the nation. February 28, 2019. Accessed May 29, 2023. https://wvumedicine.org/news/article/st-joseph-s-hospital-named-one-of-top-100-critical-access-hospitals-innation/

3. St. Joseph’s Hospital files objection to Mon Health’s plan to build new Stonewall Jackson Memorial Hospital. WV News. May 29. 2021. Accessed May 29, 2023. https://www.wvnews.com/news/wvnews/st-josephs-hospital-files-objection-to-mon-healths-plan-to-build-new-stonewall-jackson-memorial/article_d67132cc-0ec6-5f3e-8f7c-24c09a2e457c.html

Please do a 200-word rebuttal.

AMA format

2 references (in order please 1,2)

Thanks!

Approaching the discussion of healthcare systems in America and globally is quite a complex process. I do not feel any particular system is the best. Rather merging systems or taking parts of whole systems to create a new system that works for Americans would be my opinion. Granted any new system will take significant change and likely opposition, but changes are needed. 

Some years ago, I was lucky enough to be part of a Youth Leadership Forum as a “pre-med” college student which traveled to Australia to study their healthcare system. One of the key points I remember in my experience with discussing their system with healthcare providers was the decreasing interest in young intellectuals wanting to continue into medicine. They described the education process as long and robust and the salaries were being increasingly decreased leading to a weakened workforce. They also complained that the national healthcare system wanted more general practitioners, but this led to an increased work burden. They were being asked to expand their scope of practice as specialists dwindled with the decreased reimbursement. Anecdotally, the providers I spoke with agreed that healthcare should be universal, but were left feeling exhausted and frustrated. Some shared that wealthy citizens would pay some physicians “under the table” cash to have earlier and better access to healthcare. So while they did not have private insurance options, wealthier people still found a way to get to the head of the line leaving poor patients still waiting longer times. 

A narrative review by Debie et al1 describes one of the key challenges in implementing a one-size-fits-all approach to universal healthcare is an inadequate workforce. While it may be moral and noble to admit that all citizens deserve healthcare, if we cannot motivate people to commit to that service, supplying everyone with this right is moot. We should allow for some competition between private and public payers to keep healthcare providers with motivating salaries and incentives. Chris Pope of E21 for the Manhattan Institute pointed out that in a 2018 review study of annual physician salaries, American physicians made an estimated $218,000 compared to physicians in countries in the Organisation for Economic Co-operation and Development (OECD) which was roughly $138,000, largely due to discrepancies in educational training.2 

We should all be taxed to allow for a universal healthcare option, such as the Medicare or Medicaid system now. If we do not have to pay monthly premiums, we can allocate some of that costs to healthcare tax. However, we should also have the option to purchase additional private insurance coverage. That additional coverage should be competitive across state lines and affordable, much like car insurance. Also, private insurance companies should have their profits taxed at a higher “corporate” rate to then help fund public healthcare. If people want to pay more for their healthcare, then we should allow that option. We must allow some free market competition to promote innovation and healthcare discoveries.