Holyoke hospital unit closures part of larger trend, experts say

  • Alex Wright, the union nurse coordinator at Mercy Medical Center, with other nurses and supporters protesting the closing of inpatient psychiatric services at Providence Behavioral Health Hospital, and general lack of support for health care workers, in front of Mercy in Springfield on Thursday, May 7, 2020. GAZETTE FILE PHOTO

  • Holyoke Medical Center. GAZETTE FILE PHOTO

  • Providence Behavioral Health Hospital in Holyoke. SCREENSHOT/GOOGLE MAPS

Staff Writer
Published: 6/22/2020 11:22:40 AM

HOLYOKE — When Cambridge Health Alliance decided to shut down Cambridge Hospital’s pediatric unit in 2009, longtime pediatric nurse Donna Kelly-Williams said she was alarmed at how easy it was for the hospital system to close her unit.

In the following decade, Kelly-Williams — now the president of the state’s nurses union — says she has witnessed the same pattern repeat itself. Hospitals decide which services are no longer profitable, she explained, then begin to limit resources to those units: not hiring nurses or limiting the number beds, for example. She said the hospitals then tell the Department of Public Health that they intend to close a unit; the DPH declares those units “necessary” to the region, yet the hospitals close the unit anyway.

“There is almost a blueprint of how this is done,” Kelly-Williams said in a phone interview Wednesday. “It just saddens me that we continue to see this over and over and over again.”

The trend of hospital unit closures has recently reached Holyoke, where two facilities are planning to shutter services that critics say are vital to local residents. In early March, Providence Behavioral Health Hospital announced that it intended to close 74 inpatient psychiatry beds. And early this month, Holyoke Medical Center said it was shutting down its Birthing Center, which it had already “temporarily” shuttered to house residents from the Holyoke Soldiers’ Home.

In interviews this week, several local health care economists and public health researchers told the Gazette that the two closures are different, but that they represent a growing trend that they fear will be further exacerbated by financial losses hospitals have suffered amid the COVID-19 pandemic.

“There’s been a tremendous consolidation in the hospital markets across the country,” said Peter Arno, a health economist who works with the University of Massachusetts Amherst’s Political Economy Research Institute. “This is part of a long-term trend that has been accelerated by the pandemic.”

Similar service closures across the state in recent years are leading some state lawmakers, as well as the Massachusetts Nurses Association, or MNA, to call for DPH’s “essential service closure process” to be strengthened.

“I would like to see a framework set up where, if hospitals are going to make these announcements — and quite frankly leave patients out to dry — there’s got to be something that they give us in return,” said state Sen. John Velis, D-Westfield, whose district includes Holyoke. 

Velis and several other local lawmakers are cosponsors of a bill put forward by the MNA that would require hospitals to notify DPH of a closure earlier in the process and to show proof that they collected community feedback before issuing that notice. It would also instruct the attorney general to seek an injunction to maintain essential services during that expanded notice period — which currently doesn’t happen in many cases — and make hospitals ineligible to apply for licensure or expansion for three years after discontinuing a service, unless they restored that service or DPH approved a modified plan.

Different challenges

While the two closures appear to be part of a larger trend, some local experts say they also represent separate challenges that hospitals face.

“I think that they’re pretty different from one another,” said Kimberley Geissler, a University of Massachusetts Amherst assistant professor of health policy and management. “Except for the fact that they’re both in Holyoke, which is substantially underserved and has a large minority population.”

Geissler, who studies health economics, said she views the closure of the inpatient psychiatry beds at Providence — which is run by the Michigan-based chain Trinity Health — as “much more devastating to the region.” She said there really isn’t any backup for that facility, particularly given the trend of closures and the reduction in the number of beds in behavioral health services nationwide.

Geissler pointed to several challenges leading to behavioral health closures. One is that there has been a psychiatrist shortage, with many providers getting older and not enough being trained to replace them. That problem will get worse before it gets better, she said.

Another problem Geissler identified is an exclusion that prevents states from using federal Medicaid funds to pay for behavioral health care in institutions with more than 16 beds. Though some states have been granted waivers for substance abuse disorder treatment, Geissler said funding continues to be a challenge.

“I’m not exactly sure we’ve arrived at a policy solution yet,” she said.

As for maternity service closures, Geissler said those have tended to be a bigger problem in rural areas, where there has been a push to regionalize services and provide more care through telemedicine.

Overall, Geissler said that as hospital systems get bigger and bigger, it becomes easier for those systems to identify and cut units that aren’t profitable. She said that even if the United States had a single-payer, universal health care system, some of those problems might persist if the government is not involved in the delivery of health care.

“Whereas, if hospitals were owned by the government, this profit piece wouldn’t necessarily be a problem,” she said.

Hospitals do receive much of their funding from the public. Arno, the health economist, noted that one-third of all government health care dollars go to hospitals. And yet, despite that public funding and the essential local services those hospitals provide, government officials often have little to no power to stop a closure, he said.

“It sounds ridiculous and outrageous that the government has no authority to do anything about providing essential services to their community,” Arno said. “This is one of the failings of our current system. Because the system is so based on profit … the people, the communities and their representatives have less and less influence on the services that are available to them.”

And now, amid a pandemic that has cut deep into hospital revenues, some expect that services will continue to consolidate, particularly at smaller community hospitals such as Holyoke Medical Center. Arno noted that large health care chains, including Trinity Health, have managed to eat up pandemic stimulus packages while smaller facilities get left behind.

Earlier this month, Holyoke Medical Center CEO and President Spiros Hatiras told The Republican that the federal aid the hospital had received fell very short of what it needed. “The lion’s share went to big hospitals with deep pockets and lots of cash reserves, and the smaller places like ours are struggling to stay afloat,” Hatiras told the Springfield-based newspaper.

Hatiras and a Holyoke Medical Center spokesperson have not responded to repeated interview requests in recent weeks about the closure of the Birthing Center.

According to a “COVID Stimulus Watch” database compiled by the research organization Good Jobs First, Holyoke Medical Center has received an approximately $2.95 million grant from the federal government and a $5.1 million loan.

Amid the pandemic, Valley Health Systems — which includes Holyoke Medical Center, Holyoke Medical Group, Holyoke Visiting Nurse Association, and River Valley Counseling Center — furloughed some 225 employees, or 11% of the workforce, according to Rebecca MacGregor, a Holyoke Medical Center spokesperson. 

In an email to staff explaining the Birthing Center’s closure, Hatiras said that the maternity services lost between $3-$4 million annually for the hospital. He said those were growing losses Holyoke Medical Center couldn’t “sustain any longer without risking the entire organization.” In its most recent, readily accessible federal tax filing covering the fiscal year ending in September 2018, Holyoke Medical Center made nearly $171 million in revenue and had $165 million in expenses.

Trinity Health, meanwhile, has so far received more than $625 million in federal stimulus grants and over $1 billion in loans. The organization has annual operating revenues of $19.3 billion and assets of $27 billion, according to its website.

Mercy Medical Center, the Trinity-owned hospital in Springfield that also runs Providence, received a $12.7 million stimulus grant. Maternity patients of Holyoke Medical Center are now delivering at Mercy Medical Center after the announced closure of the Birthing Center.

According to an unaudited quarterly report, Trinity had approximately $80 million less in revenue in the first nine months of the current fiscal year compared to the same period last year, resulting in a $103.5 million operating loss. The health system attributed the decrease to the pandemic and to the transfer, or divestiture, of a health system. 

“Now is a good time to consolidate and get rid of something,” said Gerald Friedman, an economics professor at the UMass Amherst.

Friedman said that hospitals may see the current pandemic as an excuse to cut services that are no longer profitable, especially given the large impact coronavirus lockdowns have had on their revenues. And under the current health care system, the bottom line is all that matters, he said.

“It’s business, it’s not health care,” said Friedman, a vocal critic of private health care. “And they’re saying we’re not able to make as much money on it.”

Dusty Christensen can be reached at dchristensen@gazettenet.com.

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