I grew up in and around the hospitals in Boone County. I still remember my physician Mom running the Emergency Room at what was then called the “Medical Center,” her first gig here in Columbia, and my Dad as the Chair of the Urology Department at that hospital, where he remained until his death in the mid-1970’s. But despite my parents’ professional ties to University Hospital, I had a proverbial foot in Boone Hospital as well. Boone was my Dad’s hospital of choice for several cardiac episodes, and I came to know it well, in addition to Regional Hospital (as it was then known), before his death.
I knew early on how fortunate I was to live in a community that had such assets—on one side of town, a teaching and research hospital, and on the other side of town, decades before Regional/”Women’s and Childrens’” was built, another hospital that served as the backbone for the region, a hospital with the core purpose of serving EVERYONE in the community. Not only did I learn about these assets firsthand, I was taught that these assets, their core values, and purposes must be maintained.
Over the last few years, I’ve gained another perspective that further adds to my understanding of how precious these assets are to our community.
My brother Ian currently serves as the hospital administrator for a large hospital in San Antonio, Texas. As some of you will know, Ian comes to this position after a first career as a urologist in the Army Medical Corps, then as Chief of Urology at the University of Texas, San Antonio, and decades as an internationally-known oncologist, When he began his newest “career,” he brought with him those decades of practice, but he also brought the understanding, as did I, of growing up in a time and in a community largely defined by its medical care.
A Brief History of Boone Hospital
A “Cliff Notes” version of the history of the Boone Hospital might be helpful in better understanding its current situation. In 1917, the state legislature first authorized counties to issue bonds to fund the building of health facilities. Dr. Frank Nifong, a strong proponent of this statutory change, would later be named the first medical chief of the subsequently named Boone Hospital. With the new statute in place, Boone County was among the first in Missouri to pursue this opportunity, and, on April 29, 1919, Boone County voters approved bonding for $100,000 to build the new hospital.
Five appointed trustees selected a site—four acres along East Broadway—and, after discovering that additional funds would be needed to build the hospital, asked voters to approve another $75,000 in bonds to build a 40-bed hospital. With voter approval, construction began May 30, 1920 and the hospital opened in December 1921, where on Christmas Eve, David Etheridge became the first “Boone Baby.”
Although expanded over time, the original hospital building still stands on the Boone Hospital site. Five trustees, now elected by Boone County voters, are responsible for the management of the hospital. In recent history, however, the trustees entered into a negotiated, leased-management agreement with St. Louis-based BJC Healthcare, one of the nation’s largest nonprofit healthcare organizations. As part of the agreement, the County of Boone receives an annual payment in recognition of its ownership of and the initial investment in Boone Hospital made by the people of Boone County. Of that annual payment, a portion goes into the general revenue fund and a portion is designated specifically for healthcare-related issues in the county.
As the leadership of BJC Healthcare indicated their desire to end the lease agreement, the trustees began to seriously explore options and opportunities—another lease with a different company? A stand-alone hospital? Far from being a simple decision, the timing of the decision, even pre-COVID-19, added layers of complexity to the process.
The Intervening Factors That Brought Us to This Point
Until the passage of Amendment 2 on August 4, Missouri had not expanded Medicaid even though 38 states, including all surrounding states, had already done so. Failure to expand Medicaid created several problems for hospitals:
First, it led to the demise of many smaller hospitals around the state since those hospitals were still providing care to individuals who arrived in their emergency rooms but were unable to pay. This uncompensated care cost was a liability that few hospitals could absorb. Even a hospital as well-resourced as Boone Hospital has felt this impact.
Second, since BJC is headquartered in St. Louis and, because Illinois had expanded Medicaid, it undoubtedly made financial sense for BJC to focus its attention on metro-St. Louis and Illinois rather than on mid-Missouri and Boone Hospital.
Another factor that the trustees have had to consider as they navigate toward a new reality for Boone Hospital is that, through the years, the delivery of medical services has changed drastically. No longer is the hospital the only place in which medical care is dispensed. Even surgeries that traditionally were performed in hospital operating rooms have often been moved to operating suites within private physician offices.
With the advent of COVID-19, we have seen a further erosion of the reliance on hospitals as a bastion of medical care, as telemedicine has taken hold on a scale heretofore uncontemplated by even the most forward-thinking service providers.
A Pathway to the Future
As has been reported often and thoroughly, the trustees have explored and rejected the path for Boone Hospital that would have placed leadership in the hands of an outside corporation through another lease agreement. Instead, the trustees have started down the path toward a stand-alone hospital, one that would give Boone Countians—and indeed, people from around the region—an alternative to University Hospital for the delivery of high-quality medical care and first-rate surgical experiences. While neither writing in stone nor signing on the proverbial dotted line, the trustees have promised to continue the commitment to the community, in the form of the annual payment to the County that had occurred under the BJC lease.
For this new form of management to succeed, several things must occur: First, as my brother Ian discovered as he took over the hospital in San Antonio, the trustees must reach out to the physicians in Boone County and bring them back into the fold. Even as the practice of medicine has changed, everyone understands the need for the hospital, and both sides of the equation—both the hospital administrators and the physicians—must come together to find that economic and medical balancing point where private practice and the hospital can be sustained and can thrive. Having trustees who have been part of the medical community here in Boone County and are well-respected by their peers is an asset that cannot be under-valued. They can and must reach out to their colleagues to bridge the divide that has grown in recent years under BJC’s leadership.
Second, as the trustees have already indicated, their skillset must be amplified by community members with expertise in finance, information technology, and similar fields in order to position Boone Hospital for growth and success.
Third, the trustees must work with University Hospital to find a way to ensure that both hospital systems can thrive. The patient base for these hospitals is not just local, it is regional.
Finally, it is incumbent upon us, the people of Boone County, to support this hospital as it embarks on a new pathway forward.
Boone Hospital has been and remains a crown jewel in our community. It has faithfully served generations of Boone Countians and we remain its stalwart champions. Its dedicated staff continue to provide excellent care for all who enter its doors. I know that is why my Dad chose Boone for his care. That is why my brother and I chose Boone for our Mom’s care in her final days. So many Boone County and mid-Missouri families feel as we do. Boone Hospital’s future depends on our widespread support as we undertake a new management model in a new healthcare era. The future of Boone Hospital is up to all of us.
Supporting Boone seems only right.