Pa. lawmakers say communities need more notice to prepare for hospital closings

By Peter Hall – Capital-Star

HARRISBURG, PA – When Crozer Health slashed services at two of its hospitals last year, it left Delaware County residents with longer drives and longer waits for emergency care and made crucial maternal care harder to access, state Rep. Jennifer O’Mara, D-Delaware, said.

That’s a scenario that has played out more than a dozen times across Pennsylvania in the last five years.

“When someone needs emergency care, every second counts, even a one minute increase in travel time during the life or death situation can increase mortality rates,” O’Mara said during a Capitol news conference on Wednesday. She also noted that when maternity wards close, emergency and preterm births increase.

The shutdowns closely correlate with mergers and acquisitions of hospitals by for-profit health care networks, according to the Pennsylvania Health Access Network’s director of consumer protection and policy, Patrick Keenan.

While lawmakers say they cannot change those companies’ business decisions, a pair of bills in the General Assembly would give the affected communities more time and information to help them prepare for the loss of medical services.

Under Pennsylvania’s existing law, hospital companies are required to provide only 90 days’ notice of plans to reduce services or close hospitals.

Legislation introduced in the state House by O’Mara and and Rep. Eddie Day Pashinski, D-Luzerne, and in the state Senate by Sen. Carolyn Comitta, D-Chester, would double the required notice to six months.

It would also require hospital owners to hold public hearings, perform health equity impact assessments, and provide data on alternative providers. Owners would be required to submit a closure plan to the state attorney general’s office or local health authority.

“We’re not trying to prevent them from making a change. What we’re trying to do is say let’s give that community, let’s give those people, those patients an opportunity to make the adjustment necessary to … provide some kind of quality health care,” Pashinski said.

The Hospital and Healthsystem Association of Pennsylvania said it is pushing for state and federal policies that would strengthen hospitals’ financial positions and prevent closures.

The association said hospitals face financial pressure as the cost of providing care, driven by record inflation and a national health care workforce shortage, has increased. Meanwhile, payments from government and private payors have not.

The decision to close a hospital is often a last resort and the organization’s focus must be on continuing to deliver care to patients safely in the interim. Extending the time required to close a hospital would make it difficult to maintain the staff needed to ensure patients’ safety, the association said.

A hospital closure has a destabilizing impact across an entire region, said Comitta, whose district saw two Tower Health hospitals in the rural southern part of Chester County and in Coatesville close in the last 18 months.

“This sudden closure of two hospitals last year led to longer wait times, a lack of beds, staffing shortages, gaps in the EMS service, a strain on behavioral health services and additional challenges at neighboring hospitals and health care providers,” Comitta said.

After Crozer Health announced the closure of its emergency room at Springfield Hospital and the elimination of all but in-patient behavioral health services at Delaware County Memorial Hospital, Delaware County faced a health care void in its most populous region, County Council Chairperson Marion Taylor said.

In response, Delaware County Council passed an emergency ordinance requiring 180 days’ notice before a closure.

“This extension of time and data will allow time and planning for the transition for thousands of patients who are directly and negatively affected by an abrupt termination of crucial services,” Taylor said. “It will allow the stakeholders within a community time to prepare and find alternatives for vital services such as maternal care, drug and alcohol services, and advanced life support coverage.”

The pace at which hospitals are closing across Pennsylvania appears to be increasing compared to past decades, Keenan of the Health Access Network said.

The organization identified 33 Pennsylvania hospitals that have closed in the last 20 years. Among those, 15 closed in the last five years. And 90% of the closures followed mergers, Keenan said.

“This pace is alarming and the reality is that it’s only coming quicker,” Keenan said.

Over the span of 20 years, the time between a merger and a closure averaged 7.6 years, but among the closures in the last five years, the average was 4.1 years, he said.

“This indicates to us that a merger, acquisition or change in ownership is one of the best predictors that a community will experience a full or partial closure and we need to begin with empowering state officials and regulators to examine that impact,” Keenan said.