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Rural areas increasingly lose inpatient hospitals like UPMC Lock Haven

LOCK HAVEN -- Many rural hospitals can no longer afford to offer inpatient care, and UPMC has decided that its Lock Haven Hospital has become one of them.

The American Hospital Association (AHA) said the increasing closures of inpatient services at rural hospitals across the country are typically preceded by low patient volumes, low reimbursement rates, staffing shortages and regulatory barriers.

"Empty beds can drain a hospital's ability to provide outpatient services that the community needs," the AHA said in a recent report.

So it goes with UPMC Lock Haven, which is slated to lose its inpatient services completely by April 1 and become an outpatient emergency center.

UPMC announced the local hospital lost roughly $4.4 million last year, "including physician investment."

This after spending $5.2 million to buy the hospital in 2017, investing another $4 million in capital improvements and yet another $4.7 million in support of community-based health programs, physician practice support and inkind services in 2021.

A recent Pennsylvania Health Care Cost Containment Council report showed UPMC Lock Haven having net patient revenue of $30 million in 2020, but total operating expenses came in at $33 million. Further, the report showed a huge drop in patient revenue in 2018, caused by the hospital's temporary closure following a fire. The local hospital showed a -2.26 percent operating margin loss in 2020, creating a three-year average loss of about -6 percent. The local hospital also has a high rate of patients on Medicare (58%) and Medicaid (18%).

Comparatively, UPMC Wellsboro showed a profit margin of +11.23% in 2020, while UPMC Muncy was at +11.83%.

UPMC Williamsport came in at +15.4% profit margin in 2020.

Surgeries moving

Meanwhile, some surgeries scheduled at the local hospital reportedly will end in just a few weeks, shifting to UPMC's Williamsport, Divine Providence and Muncy Valley campuses in Lycoming County.

UPMC said all employees impacted by the move will be given jobs at those other campuses.

With the outpatient emergency center, UPMC will preserve imaging services -- CAT scans, X-rays and the like -- here.

Also staying will be Haven Place, where long-term patients, as well as those needing memory care, reside.

UPMC is switching to what is said is a new "Outpatient Emergency Department" model only recently sanctioned by the Pennsylvania Department of Health.

"We want to be the best outpatient emergency department and have Clinton County be that model for the rest of the state," said Patti Jackson-Gehris, president of UPMC North Central Pa., during a recent interview with The Express.

While UPMC said the new outpatient ER center will be the first of its kind in Pennsylvania, free-standing emergency departments are common in other states.

AHA said rural hospitals across the country are converting to outpatient emergency departments to stay in the communities they serve.

Board member

frustrated

Mike Flanagan is CEO of the Clinton County Economic Partnership.

He also is a UPMC Lock Haven Hospital Advisory Board member, but said he was not notified in advance by UPMC of the pending decision.

That has him frustrated as to the long-term impact the move will have here.

"Obviously there is going to be an impact on our greater community. It stands to reason that if a local hospital goes from an acute care center to basically an emergency room, that is not good news regarding the local economy and perhaps the attractiveness of someone or businesses coming to the area. And, if existing employees eventually move out of the area, that's an impact on local governments. It also raises questions about an impact on Lock Haven University's nursing program, as well as the health occupations field offered by the Keystone Central career and vocational program," Flanagan said.

"With that said, there really was no other option offered by UPMC. At one point on Saturday, Jan. 14, our State Sen. Cris Dush was informed that the hospital was going to close completely because of a dispute regarding language that UPMC was seeking with state officials. With Saturday afternoon work conducted by Sen. Dush, State Rep. Stephanie Borowicz and our county commissioners Miles Kessinger, Angela Harding and Jeff Snyder, the language was worked out and the emergency room will continue on, and emergency rooms do save lives."

Flanagan said any talk that local officials knew of the hospital closure of inpatient services weeks ago is just not true.

"The narrative floating around that local officials knew about this matter weeks ago is simply not true. As a hospital board member and Chamber of Commerce official, I essentially found out the seriousness of this when Commissioner Kessinger called me on Jan. 16. It would have been nice to see if the local officials could have had a say or impact weeks ago, but that didn't happen," he said.

Hospital closures

A report released last fall by AHA highlights the variety of causes that resulted in 136 rural hospital closures from 2010 to 2021, and a record 19 closures in 2020 alone.

"These include many longstanding pressures, such as low reimbursement, staffing shortages, low patient volume and regulatory barriers, as well as the continued financial challenges associated with the COVID-19 pandemic. Recently, expenses for labor, drugs, supplies and equipment have also increased dramatically, ultimately causing difficulties in maintaining access to care for people in rural communities," the report states.

"While many hospitals and health systems are facing unprecedented challenges, those faced in rural America are unique," said AHA President and CEO Rick Pollack. "We must ensure that hospitals have the support and flexibility they need to continue to be providers of critical services and access points for patients and communities."

According to the Pennsylvania Department of Health, "in many instances, hospitals have to choose to close a campus or hospital entirely because there are not meaningful or sustainable alternatives. The purpose of the OED model is to provide an alternative to closure to hospitals that are facing those operational challenges and are unable to sustain inpatient services."

It is just that OED model that Jackson-Gehris spent time talking about.

'High quality care'

"It's important to understand that this is high quality emergency care. These are physician providers -- an experienced and skilled clinical workforce that's going to be there. The same quality emergency care that (you're) getting today stays in place with this model," Jackson-Gehris said.

Jackson-Gehris was quick to explain that the physicians that work in the hospital today "will also be the ones to take care of the community tomorrow -- with some shifts throughout UPMC to best fit the needs of the community and the employees."

"We are committed to being part of this community for the future. We're committed to innovating and changing healthcare to meet the needs of the community. We believe that this is a step in that direction," she said.

Jackson-Gehris was asked about the following scenario: A local resident starts to feel ill and believes they're having a heart attack or stroke. They dial 9-1-1 and the EMTs-paramedics make the decision to take them to the new Lock Haven Outpatient Emergency Department.

Her response: "The same level of care that they'd provide today (as inpatient) is still there. (The job of) the Emergency Department is to stabilize the patient in the immediate emergency situation and then figure out what is the next level of care that they need. If they can be stabilized, treated and discharged from the ED, that's what happens to the majority of patients. If they need to be transported to any level of care, they can arrange the transportation for them."

"The biggest change," she said, "is that it will now be part of the Williamsport Hospital Emergency Operation. That connection is really important."

She emphasized that the "most important piece of the puzzle is UPMC's commitment to the community and that isn't going to change.

"UPMC still plans to partner with local businesses to provide on-site wellness programs for staff and provide them access to the healthcare they need to run their business operations," she said. "Right now what we're really focused on is making sure that, as the first outpatient emergency department in Pennsylvania, we have the absolute best model, so we're very focused on making this a successful addition."

Jackson-Gehris pledged to continue to provide updates as UPMC moves toward implementing the OED model.