OP-ED

Hold the Mayo and Save Our Hospital

There is a grassroots movement, 4300 strong, known as “Save Our Hospital” gaining notoriety in Albert Lea, Minnesota.  This story is symptomatic of the fact that hospital consolidation has slowly become a national pastime.  With declining revenue under the Affordable Care Act, mergers increased by 70%, leaving small communities scrambling for healthcare access.  The latest casualty in the ‘hospital-consolidation-for-sport’ trend is Albert Lea, a small city located in Freeborn County, Minnesota.

Known affectionately as the ‘Land between the Lakes,’ it has a population of 18,000 spread over 14 square miles.  Not surprisingly, Mayo is their largest employer; the 70-bed hospital serves almost 60,000 in a region including patients who live in Iowa.  In Rochester, MN, the Mayo Clinic is regarded by many as one of the premier medical facilities in the country.  Originally of humble origins, founder William Mayo opened a practice during the Civil War and later, passed it down to his sons; today, the Mayo Clinic flagship is located in Rochester, Minnesota and plans to become a renowned premier medical destination for the world. 

Corporations with such lofty ambitions tend to make “small” sacrifices along the way; often, on the back of a beloved rural town.  On June 12, Mayo clinic administrators announced they would transition all inpatient services to Austin, more than 20 miles away.  Mayo cited ongoing staff shortages, reduced inpatient censuses, and ongoing financial difficulties as their reasons for hospital closure.  Rural care was mentioned to be at a crisis point, which is an altogether callous assessment of the troubling situation facing communities across this country. 

The Albert Lea City and County Hospital Association formed in 1905 when concerned citizens raised funds to build a community hospital.  Renamed Naeve Hospital, after a prominent donor, it became the lifeblood of this rural community.  Physician groups collaborated to start the Albert Lea Clinic and Albert Lea Medical and Surgical Centers.  For financial reasons, on Jan. 1, 1997, Albert Lea’s Clinics and Naeve Hospital merged with the Mayo Medical Center in Rochester.  At that time, a now-retired local physician expressed concern about the challenges of recruiting physicians to the rural locale.  Mayo, however, scoffed at his assertion.  Recently, Dr. Bobbie Gostout, Vice President of Mayo Health Clinics, confirmed it was indeed difficult to recruit newly trained physicians to small areas with a heavy night call burden.

It is estimated the facility in Albert Lea sees 500 patients per day including office visits, dialysis, cancer care, and other outpatient services.  Approximately 7 patients per day will be affected by this move.   Freeborn County Attorney David Walker is evaluating if Mayo violated their bylaws by not holding a vote for the consolidation decision.  Mayo is denying a vote was necessary.  Walker has asked the state Attorney General to weigh in on the debate. 

Hospitals across the nation are focusing on efficiency while trying to improve care quality and maximize revenue.  Consolidation can help lower overhead expenses; however, over time, the heartland and the people being served suffer for a variety of reasons.  Mayo administrators blame $13 million in losses over the last two years at the Austin and Albert Lea campuses as the cause for hospital closure.   Prior to making this pivotal move, Mayo conducted an 18-month internal review; unfortunately, neither the City Council nor County Commissioners were consulted.  In July, Albert Lea City Council unanimously approved a resolution requesting Mayo halt the process until 2018, in order to solicit feedback from the community impacted by this decision.  The Freeborn County Board also called for a six-month moratorium from Mayo.  Both requests were denied by the behemoth that is Mayo. 

Not every community member in Albert Lea is opposed to hospital closure.  Some physicians working at Mayo feel they are stretched too thin and cannot survive with two rural facilities to staff.  Recruiting nurses and physicians has been extremely challenging, according to them.  The hospital in Austin is 20 minutes away, which they feel is adequate, alternatively, Owatonna is 25 minutes north, and Mankato is 35 minutes away and has a Mayo helicopter stationed there for medical evacuation needs.

Mariah Lynne, co-founder of Save Our Hospital, said “Our mission for Save Our Hospital is to maintain a full service, acute hospital in Albert Lea, Minn., for the benefit of our citizens and our surrounding citizens.”  This grassroots organization is asking Mayo to return the hospital facility to Albert Lea so they can find another company interested in providing hospital services for their residents.  The Service Employees International Union (SEIU), which covers healthcare workers, is also supporting this community effort. 

Mayo plans to move intensive care, labor and delivery, and surgery services to the Austin facility, which is more than 20 minutes away.  Reduced access to timely medical care can actually translate into higher mortality in rural areas overall.  Since 1990, maternal mortality in the United States has been increasing steadily.  Today, more American women are dying of pregnancy-related complications than in any other developed country throughout the world. Rural hospitals, which are financially struggling, are less prepared for maternal emergencies today than they were two decades ago.  Potentially fatal complications which are initially treatable may become lethal in the setting of fewer resources and longer travel distance when seeking care.     

Mayo appears to be sacrificing a rural hospital in Albert Lea to pursue ‘champagne wishes and caviar dreams.’  Mayo plans to invest in the Destination Medical Center Project, focused on drawing foreign visitors who will bring with them not only champagne and caviar, but also open wallets.  Two major projects in Rochester are currently under way – the expansion of the Mayo Civic Center to the tune of $84 million and $93 million in upgrades at Mayo’s St. Mary’s Hospital.   When asked about complaints regarding the loss of services in Albert Lea while making elaborate plans in Rochester, Dr. Gastout said investments are helping to shore up Mayo’s long term survival.   She denies allegations the exorbitant Destination project is related to the Albert Lea Hospital closure, stating “Growth should not be misinterpreted as easy sailing in one place, and difficulties in another.”   

Reflecting on the loss of rural hospitals across the nation, my thoughts circle back to residents in Lee County, Georgia and my hometown in Kitsap County, Washington.  All three groups are engaged in clashes of David and Goliath-esque proportion against conglomerate hospital corporations threatening to destroy their respective healthcare landscapes.   While they might make strange bedfellows, City and County leaders are finding common interests aligning with local unions supporting healthcare workers, such as the SEIU (Minnesota) and UFCW-21 (Washington State.)  Together, these innovative alliances are making significant progress which may turn the tide.   For some of the large hospital systems, “easy sailing” may soon look like nautical navigation during a tropical storm.  While corporate headquarters is distracted with their dwindling bottom lines, betting on the underdogs seems prudent; after all, they are the ones gambling with their lives.   

Niran Al-Agba, MD is a pediatrician based in Washington state.

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kmbernsPaul @ Pivot ConsultingLLCoskie94Steve2Niran Al-Agba Recent comment authors
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kmberns
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kmberns

For what it’s worth, here are some of my immediate thoughts upon reading this article. The decision to close this rural clinic was very obviously influenced by the (financial) bottom line and when the numbers don’t make sense, that decision becomes clearer. The effects that decisions in healthcare have on a clinic’s or medical group’s constituents certainly deserve airtime during those decision making processes, but a lot of times, it really comes down to keeping the budget in check. Unfortunately, sometimes this results in consequences for the underdogs. Many hospitals have negative operating margins and in an attempt to make… Read more »

oskie
Member
oskie

Minnesota is not alone. Consolidation is not improving access or lowering costs. Oregon is dealing with similar problems from monopolies:

https://www.thelundreport.org/content/healthcare-reform-creates-provider-monopolies

Paul @ Pivot ConsultingLLC
Member

Thanks for the link to the lund report piece….excellent analysis!

Steve2
Member
Steve2

1) They are correct that it is difficult to recruit staff for small rural hospitals. It is part of what I do and it takes a lot of time and creativity, but mostly I have been lucky. At one of our smaller hospitals we have been unable to obtain 7 day a week general surgery coverage. Most weekends have no ortho coverage. 2) At least in our area, there is a general shortage of OB docs. We are having trouble recruiting staff for a large hospital in a medium sized town an hour away from two major cities. I cannot… Read more »

Niran Al-Agba
Member

Steve, I can’t really disagree with most of what you said. Yes, Albert Lea hospital was in financial trouble from the research I have done prior to being sold to Mayo. It is difficult to recruit staff and basically #6 sums it up nicely. Small hospitals must be realistic about what they can offer. Sometimes, if we could take a step back and start over in healthcare, ie build it from the ground up, it could organically add service lines as needed over time. We have a new family med residency program starting and there is no reason that a… Read more »

Peter
Member
Peter

“For financial reasons, on Jan. 1, 1997, Albert Lea’s Clinics and Naeve Hospital merged with the Mayo Medical Center in Rochester.”

How would you have kept the hospital a community hospital?

Niran Al-Agba
Member

Peter, your question is a good one. There are many different ways to keep a community hospital. 1) Become a Hospital district, pass a levy, and raise money from a tax base to support repairs or staffing etc… after soliciting community vote, IF the community would like to do that. 2) recruit another organization, such as Swedish, Virginia Mason, Providence, Kaiser, well you get the idea. 3) My personal favorite is conversion to a micro-hospital. Micro-hospitals are the lean, mean, fighting machines of hospital based care. They are smaller scale, built to serve a specific population, and focus on short-stay… Read more »

Peter
Member
Peter

“There are many different ways to keep a community hospital.”

First you have to own it. I think all hospitals should be community owned and tax subsidized when operated efficiently. They then make decisions based on community need not distant corporate finances.

Why did not your community step forward to purchase this hospital?

Niran Al-Agba
Member

Most are community owned to begin with… then the Board of Directors agrees to sell it. First to a local corporation, then that corporation merges with another, then another, and soon to be another requiring approval from the Vatican. Communities are complicit initially, because they believe the corporation is genuinely interested in their well being, but many find out this is not true. I believe these communities should revoke the tax-exempt status if the hospital is not holding up its charity care mandate. Or maybe take the closed facility back by eminent domain. We are at the beginning of a… Read more »

Steve2
Member
Steve2

We should get someone to write about the micro-hospitals. It was my understanding that these are basically money making places being built in generally affluent areas that don’t have quick access to larger hospitals. Vegas has some I believe (according to friends) as does Phoenix and some other southern cities with large suburban areas. If this is working for rural areas that are low on financial resources I am unaware of it. Would love to hear what they are doing since it is basically what our network is doing, but it only works when you have a strong association with… Read more »

Niran Al-Agba
Member

I have written a piece on microhospitals and they are pretty interesting. You are correct. They need a larger hospital to be associated with. We basically have that already in my hometown. Only one of the hospitals has OB and many of us left the county to receive OB care. Right now, ortho surgery is done at one place and general surgery at the other until they transition. Micro is exactly the right term… think small but bed space for basic general short stay admits…

pjnelson
Member
pjnelson

Fundamentally, academic healthcare centers are financially precarious. They have, nation wide, hedged their stability on a wider base of community healthcare. This is a tumultuous deviation for Universities, since their heritage has been to be isolated from the day to day affairs of their social context as a means to more independently pursue the preservation and advancement of fundamental systems of knowledge. No other portion of a University has an involvement in the fabric of our nation’s civil life to the financial extent that its medical school has. Its no wonder that a very influential presence in Washington D.C. is… Read more »

Niran Al-Agba
Member

Thanks Dr. Nelson. Our increased costs are due in large part to this hospital consolidation game. The more hospitals own private clinics, radiology suites, or surgicenters… the higher the overall costs. That extra $ goes to the CEO at the top. I know Barry will say that individual sets the tone for the organization etc. and he is partially right. My counterpoint to that statement is a physician does not need a businessperson to “set the tone” of anything while in their private office. If we cut out facility fees, spread reimbursement in a fair way comparing apple services to… Read more »

Barry Carol
Member
Barry Carol

The hospitals are always telling us “No margin, no mission.” There is a long term secular trend driving down the need for inpatient hospital beds as more and more care can safely be delivered on an outpatient basis and inpatient stays are getting shorter due to a combination of less invasive surgical procedures and better drugs. I don’t think it’s reasonable to expect Mayo or any other hospital system to subsidize individual hospitals that chronically lose money. At the same time, if state and / or county politicians think it’s necessary and desirable to keep such hospitals in business, they… Read more »

Niran Al-Agba
Member

Barry, the point of this post is not necessarily expecting Mayo to subsidize the community hospital, rather the community is asking for the facility to be returned. This is not about the fact that rural areas have cheap homes, this is a community of people who want and need basic health care. Mayo gets a substantive tax break in that community. They should not still be receiving the exemption is they are closing the facility. So either settle out the difference and pay the community for the property taxes or allow them to exchange it and find another provider to… Read more »