Mayo’s Austin-Albert Lea Consolidation Reflects Rural Health Trends

Recent U of M study shows 7.2 percent of rural hospitals have closed OB units.

Much of the controversy surrounding the Mayo Clinic’s move to shift and consolidate inpatient functions between its hospitals in Albert Lea and Austin revolves around the availability of childbirth services – a key concern of those in Albert Lea who oppose the decision to move them 22 miles away to Austin.
The debate is coming after a University of Minnesota study of 306 rural hospitals in nine states found that 7.2 percent of them had closed their obstetrics units between 2010 and 2014, most frequently at smaller, privately owned facilities in communities with lower family incomes, fewer obstetricians and fewer family physicians.
The researchers also determined that among the 19 rural hospitals closing their obstetric units during that four-year period, the most commonly cited reason for the move was difficulty in staffing the unit, including retention, recruitment and liability issues surrounding obstetricians – one of Mayo’s publicly stated reasons for making the switch. 
However, the study, conducted by the U of M’s Rural Health Research Center, also validated a key objection of Albert Lea residents, concluding that the closure of OB units at rural hospitals raises concerns “about continuity of rural maternity care arising for women with local prenatal care but distant intrapartum care (during labor).”
Mayo’s decision to consolidate its OB units in Austin came after posting what it says is a combined $13 million in operating losses for two facilities over a two-year span — thus, it has defended the move, saying it is necessary for the economic survival of the two facilities.
 And, reflecting the U of M study results, the Mayo asserts that recruiting obstetricians to work in Albert Lea is a challenge. Mayo Vice President Dr. Bobbie Gostout told the Star Tribune its small staff size means OBs practicing there face “a lifestyle choice of being on call every third or fourth night or every third or fourth weekend.
Albert Lea residents are also protesting Mayo’s plan to refocus their facility on inpatient chemical dependency and mental health care, which they contend will leave their area with less economically lucrative health care specialties.
They also assert the decisions came without sufficient community consultation and in essence are handing their city of 17,000 the short end of the stick. The complaints have brought expressions of concern from Gov. Mark Dayton and U.S. Rep. Tim Walz, a Democratic candidate to replace the retiring Dayton in 2018.
In response to the outcry, Mayo moved to sweeten the deal for Albert Lea, pledging last week to beef up the local hospital’s cancer care center with a $720,000 investment, as well as $2.75 million for a new campus cooling plant and $600,000 for a new CT scanner.
But inpatient obstetrics care is still slated for a move to Austin.
The U of M study on the topic of rural hospital OB unit closures, released last year, reflects many of the elements in of the Albert Lea controversy, including a finding that while prenatal care was still available in 17 of 19 communities with closed units, women in those towns needed to travel an average of 29 additional miles to access care during intrapartum – the period from the onset of labor to the end of the third stage of labor.
“Rural obstetric unit closures are more common in smaller hospitals and communities with a limited obstetric workforce,” the authors concluded, meanwhile adding that the results raise “concerns about continuity of rural maternity care arise for women with local prenatal care but distant intrapartum care.”
The research conducted by doctoral student Peiyin Hung of the U of M’s School of Public Health and three co-authors included a phone survey of 306 rural hospitals providing obstetric services in nine states: Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington and Wisconsin, from September 2013 to March 2014.
The results showed that discontinuation of obstetric services was more likely to occur in critical access hospitals than other rural hospitals (83 percent vs. 51 percent), and less likely to happen in accredited hospitals (33 percent vs. 62 percent).
The study also found that on average, those rural OB units which remained open had a significantly higher volume of births than those shuttered (328 vs. 87 births in 2010), illustrating a trend toward eliminating units which don’t attract as many patients.
Other frequently cited reasons for closure included low birth volume, low reimbursement and other financial issues, such as surgical and anesthesia coverage, the cost of operating the units and budget cuts.