Why Urban Hospitals Are Leaving Cities for Fancy Suburbs

Source: Phil Galewitz, Kaiser Health News, April 14, 2015

….Currently, hospital relocations are planned or underway in South and Central Florida, eastern Tennessee, central Georgia, Birmingham, Ala., and northeast Ohio. Some have stirred controversy, as in Belleville:

— Just west of Fort Lauderdale, HCA Inc., a for-profit hospital chain, plans to close Plantation General Hospital and open a new hospital seven miles away in more affluent Davie, near a medical school. “It’s all about greed,” said Plantation Mayor Diane Bendekovic. When HCA offered to keep some outpatient services in town, she told them: “Don’t throw Plantation any crumbs.”

— Tennova Healthcare is moving its flagship Physicians Regional Medical Center near downtown Knoxville, Tenn. closer to higher-income suburbs eight miles west. “Clearly …they want to be near the better zip codes” said Tony Spezia, CEO of Covenant Health, owner of Fort Sanders Regional Medical Center, which will become the last general hospital downtown. Tennova is owned by Community Health Systems, a large for-profit hospital system.

— Just outside Cleveland, Lakewood Hospital in Lakewood, Ohio, which is managed by the Cleveland Clinic, is slated to close in 2016, and patients will be directed to the Clinic’s newer Fairview Hospital three miles away or to another facility being built in Avon, 13 miles away. Both Fairview and Avon are higher-income towns. Lakewood officials say losing the hospital and its 1,000 employees could have a prolonged impact…..

….Hospital officials point to their aging, landlocked facilities and argue it is cheaper to build, rather than renovate. What they don’t say publicly is how geography is often economic destiny for a hospital, especially at a time of increasing financial pressure as a result of Medicare funding cuts, including penalties that may result from new pay-for-performance measures in the Affordable Care Act. By moving to wealthier areas, hospitals can reduce the percent of uninsured and lower-paying Medicaid patients, while increasing the proportion of privately insured patients – what hospitals refer to as attracting better “payer mix.” That’s also why they locate outpatient centers and medical offices in affluent suburbs. But relocations often spark anger from those left behind, who worry about loss of jobs and of access to care, particularly for the poor. When the hospitals are nonprofits, like St. Elizabeth’s, questions loom larger because they are exempted from taxes in exchange for providing benefits to the community. “Hospitals were established in inner cities where the greatest needs were and now, essentially, that charity obligation has gone by the wayside as they are looking at their bottom line,” said Gerard Anderson, director of the Center for Hospital Finance and Management at the Johns Hopkins Bloomberg School of Public Health. Even nonprofit hospitals want to be near wealthier residents. “You move to where the money is,” he said….