What hospital consolidation means in Ohio

Some rural areas fight to keep their health services.

CLEVELAND— This past summer, the Cleveland Clinic pulled the plug on the maternity unit at Medina Hospital.

The closing, part of the Clinic’s larger consolidation of labor and delivery services, was a contentious one.

Local residents banded together in a Save Medina Birthing Center campaign. They made shirts. They attended city council meetings. They wrote letters. But still, on June 30 the birthing center closed its doors permanently, forcing women who live in Medina County to travel 35 minutes to the nearest Clinic maternity unit or to switch systems.

Nationally, fewer than 50 percent of women in rural areas live within a 30-minute drive of a hospital with maternity services, according to the American College of Obstetricians and Gynecologists.

“There is no place in Medina County for a woman to give birth to a baby. It puts the mother at risk since she has to travel outside of the county now,” said Dolly Yowler, who launched the Save Medina Birthing Center campaign. “There is great concern for mothers not making it to the hospital on time when they go into labor.”

The loss of the maternity ward in Medina is fallout from a national consolidation of the healthcare market. Across the state and country, hospitals and health systems are merging, changing the healthcare landscape and what it means to access local care.

In the past few years, a number of local independent hospitals have been absorbed by larger systems such as the Clinic and University Hospitals. In addition to Medina Hospital, the Clinic has taken on Akron General Hospital and Union Hospital in Dover, and UH has acquired Parma Community General Hospital and Elyria’s EMH Healthcare, among others.

“Some of the other hospitals wouldn’t be in existence if we hadn’t come along,” Dr. Toby Cosgrove, outgoing president and CEO of the Clinic, said in a recent interview. “Medina Hospital, when we came there, they didn’t have any computers. The scheduling for the operating room was in a leather-bound book.”

Medina Hospital still will deliver babies in emergency situations but, for the most part, the Clinic is centralizing labor and delivery services at three of its hospitals - Akron General, Fairview Hospital in Cleveland and Hillcrest Hospital in Mayfield Heights.

Pregnant wo m en in Medina County also can travel to Southwest General Medical Center, which is affiliated with University Hospitals, in Middleburg Heights or to the independent Wooster Community Hospital, both of which are up to 30 to 40 minutes away.

Cosgrove attributed the decision to shutter the birthing center to a declining delivery rate.

Roughly 75 percent of the deliveries of Medina County residents already were being performed outside of the county when the Clinic closed the unit, Cosgrove said. Births had been steadily falling, dropping from about 1,100 in 2002 to about 880 in 2016. The Clinic acquired Medina Hospital in 2009.

“We put more and more resources into that hospital, and the number of deliveries kept going down,” Cosgrove said. The likelihood for error also becomes higher when physicians aren’t practicing regularly, he said.

The Clinic CEO expects to see more hospitals and health systems merge as providers try to deal with rising healthcare costs.

“A lot of it is being driven by economics,” said John Palmer, director of media and public relations for the Ohio Hospital Association. “In some cases, you’re fighting against the storm.”

In Ohio, 50 of the state’s 220 hospitals are in what OHA characterizes as a “precarious economic situation.” Of those, 14 have margins less than 2 percent. Fifty-five are independent hospitals.

“In order for hospitals to maintain services, they’re looking at partnerships, cost reductions and consolidations,” Palmer said.

The mergers enable struggling hospitals to stay afloat and continue to serve their communities, Palmer said.

“You need to have consolidation of hospitals so you don’t have repetition, and you have more efficiency,” the Clinic’s Cosgrove said.

‘In order for hospitals to maintain services, they’re looking at partnerships, cost reductions and consolidations.’ John Palmer Director of media and public relations for the Ohio Hospital Association