Headlines say small hospitals are in trouble. But how much, and for how much longer? We wanted to look.

Readers may have seen the news that the state of Illinois bailed out failing Roseland Community Hospital on Chicago’s Far South Side, a small safety-net hospital that’s on the brink of closure. But there are more.

To offer readers a fuller picture of the stresses some of these hospitals are facing, we spent some time in three of Chicago’s safety nets: Norwegian American Hospital in Humboldt Park, St. Bernard Hospital in Englewood and St. Anthony Hospital in Lawndale.

The nation’s hospitals are under unprecedented pressure to lower costs and build new streams of revenue amid massive changes to the health care system. Nowhere are those pressures more apparent than at the region’s safety-net hospitals, which serve some of Chicago’s poorest and sickest patients.

Tribune photographer Anthony Souffle and I spent a few hours tagging along with Dr. Kaleem Malik in St. Anthony’s busy emergency department on a warm day last week. While we didn’t see any victims of violence, we saw plenty who were uninsured and at least a couple who were undocumented.

The doctors and nurses in St. Anthony’s ER treated all of them, without question, even though they knew there was the distinct chance some of them may never pay for those services.

In what other industry does a business rush to serve customers who they know many never pay? For safety-net hospitals like St. Anthony, St. Bernard, Mount Sinai and Norwegian, that’s all part of their mission.

It also speaks to how important some of these hospitals are to their communities, where they’re often the largest employers and the hub of economic development.

The Affordable Care Act, which aims to extend health insurance coverage to as many as 27 million Americans, offers a glimmer of hope for some of these hospitals. Many patients who previously had no insurance are expected to become paying customers.

But in exchange for newly insured patients, hospitals will be forced to absorb substantial cuts in payment and must meet new federal guidelines governing quality.

The new paradigm for hospitals – particularly the most vulnerable -- is evolve or die.

-- Peter Frost

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